CTS CPG - 4.13.2017

MANAGEMENT OF CARPAL TUNNEL SYNDROME
EVIDENCE-BASED CLINICAL PRACTICE GUIDELINE
Adopted by the American Academy of Orthopaedic Surgeons

Board of Directors
February 29, 2016
Please cite this guideline as:

American Academy of Orthopaedic Surgeons. Management of Carpal Tunnel Syndrome
Evidence-Based Clinical Practice Guideline. www.aaos.org/ctsguideline. Published February
29, 2016.
This Guideline has been endorsed by the following organizations:
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Disclaimer
This Clinical Practice Guideline was developed by an AAOS physician volunteer Guideline
development group based on a systematic review of the current scientific and clinical
information and accepted approaches to treatment and/or diagnosis. This Clinical Practice
Guideline is not intended to be a fixed protocol, as some patients may require more or less
treatment or different means of diagnosis. Clinical patients may not necessarily be the same as
those found in a clinical trial. Patient care and treatment should always be based on a clinicians
independent medical judgment, given the individual patients clinical circumstances.
Disclosure Requirement
In accordance with AAOS policy, all individuals whose names appear as authors or contributors
to Clinical Practice Guideline filed a disclosure statement as part of the submission process. All
panel members provided full disclosure of potential conflicts of interest prior to voting on the
recommendations contained within this Clinical Practice Guidelines.
Funding Source
This Clinical Practice Guideline was funded exclusively by the American Academy of
Orthopaedic Surgeons who received no funding from outside commercial sources to support the
development of this document.
FDA Clearance
Some drugs or medical devices referenced or described in this Clinical Practice Guideline may
not have been cleared by the Food and Drug Administration (FDA) or may have been cleared for
a specific use only. The FDA has stated that it is the responsibility of the physician to determine
the FDA clearance status of each drug or device he or she wishes to use in clinical practice.
Copyright
All rights reserved. No part of this Clinical Practice Guideline may be reproduced, stored in a
retrieval system, or transmitted, in any form, or by any means, electronic, mechanical,
photocopying, recording, or otherwise, without prior written permission from the AAOS. If you
wish to request permission please contact the AAOS Evidence-Based Medicine Unit at
ebm@aaos.org.
Published 2/29/16 by the American Academy of Orthopaedic Surgeons

9400 W Higgins Road
Rosemont, IL 60018
First Edition
Copyright 2/29/16 by the American Academy of Orthopaedic Surgeons
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User-Friendly Format, Please Visit the OrthoGuidelines Web-Based App at
www.orthoguidelines.org or by clicking the icon above!
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I. SUMMARY OF RECOMMENDATIONS
The following is a summary of the recommendations of the AAOS Clinical Practice Guideline
on the Management of Carpal Tunnel Syndrome. All readers of this summary are strongly urged
to consult the full guideline and evidence report for this information. We are confident that those
who read the full guideline and evidence report will see that the recommendations were
developed using systematic evidence-based processes designed to combat bias, enhance
transparency, and promote reproducibility.
This summary of recommendations is not intended to stand alone. Treatment decisions should be
made in light of all circumstances presented by the patient. Treatments and procedures
applicable to the individual patient rely on mutual communication between patient, physician,
and other healthcare practitioners.
Strength of Recommendation Descriptions

Overall
Strength
of
Strength Evidence Description of Evidence Quality Strength Visual
Evidence from two or more High quality
Strong Strong studies with consistent findings for
recommending for or against the intervention.
Evidence from two or more Moderate quality
studies with consistent findings, or evidence from
Moderate Moderate
a single High quality study for recommending
for or against the intervention.
Evidence from two or more Low quality
Low
studies with consistent findings or evidence from
Strength
a single Moderate quality study recommending
Evidence
Limited for against the intervention or diagnostic or the
or
evidence is insufficient or conflicting and does
Conflicting
not allow a recommendation for or against the
Evidence
intervention.
There is no supporting evidence. In the absence
of reliable evidence, the guideline development
No group is making a recommendation based on their
Consensus
Evidence clinical opinion. Consensus statements are
published in a separate, complimentary
document.
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OBSERVATION
Strong evidence supports Thenar atrophy is strongly associated with ruling-in carpal tunnel
syndrome, but poorly associated with ruling-out carpal tunnel syndrome.
Strength of Recommendation: Strong Evidence

Description: Evidence from two or more High strength studies with consistent findings for recommending for or
against the intervention.
PHYSICAL SIGNS
Strong evidence supports not using the Phalen Test, Tinel Sign, Flick Sign, or Upper limb
neurodynamic/nerve tension test (ULNT) criterion A/B as independent physical examination
maneuvers to diagnose carpal tunnel syndrome, because alone, each has a poor or weak
association with ruling-in or ruling-out carpal tunnel syndrome.

MANEUVERS
Moderate evidence supports not using the following as independent physical examination
maneuvers to diagnose carpal tunnel syndrome, because alone, each has a poor or weak
association with ruling-in or ruling-out carpal tunnel syndrome:
Carpal Compression test
Reverse Phalen Test
Thenar Weakness or Thumb Abduction Weakness or Abductor Pollicis Brevis
Manual Muscle Testing
2-point discrimination
Semmes-Weinstein Monofilament Test
CTS-Relief Maneuver (CTS-RM)
Pin Prick Sensory Deficit; thumb or index or middle finger
ULNT Criterion C
Tethered median nerve stress test
Vibration perception tuning fork
Scratch collapse test
Luthy sign
Pinwheel
Strength of Recommendation: Moderate Evidence

Description: Evidence from two or more Moderate strength studies with consistent findings, or evidence from a
single High quality study for recommending for or against the intervention.
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HISTORY INTERVIEW TOPICS
Moderate evidence supports not using the following as independent history interview topics to
diagnose carpal tunnel syndrome, because alone, each has a poor or weak association with
ruling-in or ruling-out carpal tunnel syndrome:
Sex/gender
Ethnicity
Bilateral symptoms
Diabetes mellitus
Worsening symptoms at night
Duration of symptoms
Patient localization of symptoms
Hand dominance
Symptomatic limb
Age
BMI

PATIENT REPORTED NUMBNESS OR PAIN

Limited evidence supports that patients who do not report frequent numbness or pain might not
have carpal tunnel syndrome.
Strength of Recommendation: Limited Evidence
Description: Evidence from two or more Low strength studies with consistent findings or evidence from a single
study for recommending for or against the intervention or diagnostic test or the evidence is insufficient or
conflicting and does not allow a recommendation for or against the intervention.
HAND-HELD NERVE CONDUCTION STUDY (NCS)

Limited evidence supports that a hand-held nerve conduction study (NCS) device might be used
for the diagnosis of carpal tunnel syndrome.
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MRI
Moderate evidence supports not routinely using MRI for the diagnosis of carpal tunnel
syndrome.

DIAGNOSTIC ULTRASOUND
Limited evidence supports not routinely using ultrasound for the diagnosis of carpal tunnel
syndrome.
DIAGNOSTIC SCALES
Moderate evidence supports that diagnostic questionnaires and/or electrodiagnostic studies could
be used to aid the diagnosis of carpal tunnel syndrome.

INCREASED RISK OF CTS

A. Strong evidence supports that BMI and high hand/wrist repetition rate are associated with the
increased risk of developing carpal tunnel syndrome (CTS).

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B. Moderate evidence supports that the following factors are associated with the increased risk
of developing carpal tunnel syndrome (CTS)
a. Peri-menopausal
b. Wrist Ratio/Index
c. Rheumatoid Arthritis
d. Psychosocial factors
e. Distal upper extremity tendinopathies
f. Gardening
g. ACGIH Hand Activity Level at or above threshold
h. Assembly line work
i. Computer work
j. Vibration
k. Tendonitis
l. Workplace forceful grip/exertion

C. Limited evidence supports that the following factors are associated with the increased risk of
developing carpal tunnel syndrome (CTS):
a. Dialysis
b. Fibromyalgia
c. Varicosis
d. Distal radius fracture
DECREASED RISK OF CTS

Moderate evidence supports that physical activity/exercise is associated with the decreased risk
of developing carpal tunnel syndrome (CTS).

8
FACTORS SHOWING NO ASSOCIATED RISK OF CTS
A. Moderate evidence supports that the use of oral contraception and female hormone
replacement therapy (HRT) are not associated with increased or decreased risk of
developing carpal tunnel syndrome (CTS).

B. Limited evidence supports that race/ethnicity and female education level are not
associated with increased or decreased risk of developing carpal tunnel syndrome (CTS).

FACTORS SHOWING CONFLICTING RISK OF CTS

Limited evidence supports that the following factors have conflicting results regarding the
development of carpal tunnel syndrome (CTS):
Diabetes
Age
Gender/Sex
Genetics
Comorbid drug use
Smoking
Wrist bending
Workplace
IMMOBILIZATION
Strong evidence supports that the use of immobilization (brace/splint/orthosis) should improve
patient reported outcomes.

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STEROID INJECTIONS
Strong evidence supports that the use of steroid (methylprednisolone) injection should improve
patient reported outcomes.

MAGNET THERAPY
Strong evidence supports not using magnet therapy for the treatment of carpal tunnel syndrome.

ORAL TREATMENTS
Moderate evidence supports no benefit of oral treatments (diuretic, gabapentin, astaxanthin
capsules, NSAIDs, or pyridoxine) compared to placebo.

ORAL STEROIDS
Moderate evidence supports that oral steroids could improve patient reported outcomes as
compared to placebo.

KETOPROFEN PHONOPHORESIS
Moderate evidence supports that ketoprofen phonophoresis could provide reduction in pain
compared to placebo.

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THERAPEUTIC ULTRASOUND
Limited evidence supports that therapeutic ultrasound might be effective compared to placebo.
LASER THERAPY
Limited evidence supports that laser therapy might be effective compared to placebo.
SURGICAL RELEASE LOCATION

Strong evidence supports that surgical release of the transverse carpal ligament should relieve
symptoms and improve function.

SURGICAL RELEASE PROCEDURE

Limited evidence supports that if surgery is chosen, a practitioner might consider using
endoscopic carpal tunnel release based on possible short term benefits. Strength of Strength of
Recommendation: Limited Evidence
SURGICAL VERSUS NONOPERATIVE

Strong evidence supports that surgical treatment of carpal tunnel syndrome should have a greater
treatment benefit at 6 and 12 months as compared to splinting, NSAIDs/therapy, and a single
steroid injection.
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ADJUNCTIVE TECHNIQUES
Moderate evidence supports that there is no benefit to routine inclusion of the following
adjunctive techniques: epineurotomy, neurolysis, flexor tenosynovectomy, and
lengthening/reconstruction of the flexor retinaculum (transverse carpal ligament).
BILATERAL VERSUS STAGED CARPAL TUNNEL RELEASE

Limited evidence supports that simultaneous bilateral or staged endoscopic carpal tunnel release
might be performed based on patient and surgeon preference. No evidence meeting the inclusion
criteria was found addressing bilateral simultaneous open carpal tunnel release.
LOCAL VERSUS IV REGIONAL ANESTHESIA

Limited evidence supports the use of local anesthesia rather than intravenous regional anesthesia
(bier block) because it might offer longer pain relief after carpal tunnel release; no evidence
meeting our inclusion criteria was found comparing general anesthesia to either regional or local
anesthesia for carpal tunnel surgery.
BUFFERED VERSUS PLAIN LIDOCAINE

Moderate evidence supports the use of buffered lidocaine rather than plain lidocaine for local
anesthesia because it could result in less injection pain.

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ASPIRIN USE
Limited evidence supports that the patient might continue the use of aspirin perioperatively; no
evidence meeting our inclusion criteria addressed other anticoagulants.
PREOPERATIVE ANTIBIOTICS
Limited evidence supports that there is no benefit for routine use of prophylactic antibiotics prior
to carpal tunnel release because there is no demonstrated reduction in postoperative surgical site
infection.
SUPERVISED VERSUS HOME THERAPY

Moderate evidence supports no additional benefit to routine supervised therapy over home
programs in the immediate postoperative period. No evidence meeting the inclusion criteria was
found comparing the potential benefit of exercise versus no exercise after surgery.
POSTOPERATIVE IMMOBILIZATION
Strong evidence supports no benefit to routine postoperative immobilization after carpal tunnel
release.
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II. TABLE OF CONTENTS
I. Summary of Recommendations ..........................................................................................................4
Observation ............................................................................................................................................................. 5
Physical Signs ......................................................................................................................................................... 5
Maneuvers ............................................................................................................................................................... 5
History Interview Topics ........................................................................................................................................ 6
Patient Reported Numbness or Pain ....................................................................................................................... 6
Hand-Held Nerve Conduction Study (NCS)........................................................................................................... 6
MRI ......................................................................................................................................................................... 7
Diagnostic Ultrasound ............................................................................................................................................ 7
Diagnostic Scales .................................................................................................................................................... 7
Increased Risk of CTS ............................................................................................................................................ 7
Decreased Risk of CTS ........................................................................................................................................... 8
Factors Showing No Associated Risk of CTS ........................................................................................................ 9
Factors Showing Conflicting Risk of CTS ............................................................................................................. 9
Immobilization ........................................................................................................................................................ 9
Steroid Injections .................................................................................................................................................. 10
Magnet Therapy .................................................................................................................................................... 10
Oral Treatments .................................................................................................................................................... 10
Oral Steroids ......................................................................................................................................................... 10
Ketoprofen Phonophoresis .................................................................................................................................... 10
Therapeutic Ultrasound ......................................................................................................................................... 11
Laser Therapy ....................................................................................................................................................... 11
Surgical Release Location..................................................................................................................................... 11
Surgical Release Procedure................................................................................................................................... 11
Surgical versus Nonoperative ............................................................................................................................... 11
Adjunctive Techniques ......................................................................................................................................... 12
Bilateral versus Staged Carpal Tunnel Release .................................................................................................... 12
Local versus IV Regional Anesthesia ................................................................................................................... 12
Buffered versus Plain Lidocaine ........................................................................................................................... 12
Aspirin Use ........................................................................................................................................................... 13
Preoperative Antibiotics........................................................................................................................................ 13
Supervised versus Home Therapy ........................................................................................................................ 13
Postoperative Immobilization ............................................................................................................................... 13
II. Table of Contents ..............................................................................................................................14
List of Tables ........................................................................................................................................................ 18
Table of Figures .................................................................................................................................................... 23
III. Introduction .......................................................................................................................................24
Overview ............................................................................................................................................................... 24
Goals and Rationale .............................................................................................................................................. 24
Intended Users ...................................................................................................................................................... 24
Patient Population ................................................................................................................................................. 25
Burden of Disease ................................................................................................................................................. 25
Etiology ................................................................................................................................................................. 25
Risk Factors .......................................................................................................................................................... 25
Emotional and Physical Impact ............................................................................................................................ 26
Potential Benefits, Harms, and Contraindications ................................................................................................ 26
Future Research .................................................................................................................................................... 26
IV. Methods.............................................................................................................................................27
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Formulating PICO Questions................................................................................................................................ 28
Study Selection Criteria ........................................................................................................................................ 28
Best Evidence Synthesis ....................................................................................................................................... 29
Minimally Clinically Important Improvement...................................................................................................... 29
Literature Searches................................................................................................................................................ 30
Methods for Evaluating Evidence ......................................................................................................................... 30
Defining the Strength of the Recommendations ................................................................................................... 32
Wording of the Final Recommendations .............................................................................................................. 33
Applying the Recommendations to Clinical Practice ........................................................................................... 34
Voting on the Recommendations .......................................................................................................................... 34
Statistical Methods ................................................................................................................................................ 35
Peer Review .......................................................................................................................................................... 36
Public Commentary .............................................................................................................................................. 37
The AAOS Guideline Approval Process .............................................................................................................. 37
Revision Plans....................................................................................................................................................... 37
Guideline Dissemination Plans ............................................................................................................................. 37
V. Overview of Articles by Recommendation*.....................................................................................39
VI. Full Guideline Recommendations.....................................................................................................40
Physical Exam Guideline Recommendations ....................................................................................................... 40
A. Observation ................................................................................................................................................... 40
B. Physical Signs ............................................................................................................................................... 40
C. Maneuvers ..................................................................................................................................................... 41
Study Quality Table of Physical Exam and History Interview Recommendations ...................................... 43
Results ........................................................................................................................................................... 45
Meta-Analyses .............................................................................................................................................. 83
History Interview Guideline Recommendations ................................................................................................... 89
A. History Interview Topics .............................................................................................................................. 89
B. Patient Reported Numbness and Pain ........................................................................................................... 90
Study Quality Table of History Interview Guideline Recommendations ..................................................... 91
Results ........................................................................................................................................................... 93
Meta-Analyses ............................................................................................................................................ 144
Imaging Guideline Recommendations ................................................................................................................ 146
A. Hand-Held Nerve Conduction Study (NCS)............................................................................................... 146
B. MRI ............................................................................................................................................................. 146
C. Diagnostic Ultrasound ................................................................................................................................ 147
Study Quality Table of Imaging modalities ................................................................................................ 148
Results ......................................................................................................................................................... 151
Diagnostic Scales ................................................................................................................................................ 187
Results ......................................................................................................................................................... 190
Risk Factor Guideline Recommendations .......................................................................................................... 220
Increased Risk of CTS ........................................................................................................................................ 220
Decreased Risk of CTS ....................................................................................................................................... 222
Factors Showing No Associated Risk of CTS .................................................................................................... 223
Factors Showing Conflicting Risk of CTS ......................................................................................................... 225
Results ......................................................................................................................................................... 231
NonOperative Treatments for Carpal Tunnel Syndrome .................................................................................... 407
A. Immobilization ............................................................................................................................................ 407
B. Steroid Injections ........................................................................................................................................ 407
C. Magnet Therapy .......................................................................................................................................... 408
D. Oral Treatments .......................................................................................................................................... 409
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E. Oral Steroids ............................................................................................................................................... 409
F. Ketoprofen Phonophoresis .......................................................................................................................... 410
G. Therapeutic Ultrasound ............................................................................................................................... 410
H. Laser Therapy ............................................................................................................................................. 411
Results ......................................................................................................................................................... 414
Surgical Release for Carpal Tunnel Syndrome (CTS) Guideline Recommendations ........................................ 515
A. Surgical Release Location........................................................................................................................... 515
B. Surgical Release Procedure......................................................................................................................... 515
C. Surgical Procedures versus Nonoperative Treatments ............................................................................... 516
Results ......................................................................................................................................................... 520
Adjunctive Techniques ....................................................................................................................................... 635
Results ......................................................................................................................................................... 638
Bilateral versus Staged Carpal Tunnel Release .................................................................................................. 649
Results ......................................................................................................................................................... 651
Anesthesia Guideline Recommendations ........................................................................................................... 660
A. Local versus Intravenous (IV) Regional Anesthesia .................................................................................. 660
Rationale ............................................................................................................................................................. 660
Future Research Statement ................................................................................................................................. 660
B. Buffered versus Plain Lidocaine ................................................................................................................. 660
Rationale ............................................................................................................................................................. 661
Future Research Statement ................................................................................................................................. 661
Results ......................................................................................................................................................... 663
Aspirin Use ......................................................................................................................................................... 675
Results ......................................................................................................................................................... 677
Preoperative Antibiotics...................................................................................................................................... 680
Results ......................................................................................................................................................... 682
Supervised versus Home Therapy ...................................................................................................................... 684
Results ......................................................................................................................................................... 686
Postoperative Immobilization ............................................................................................................................. 736
Results ......................................................................................................................................................... 738
VII. Appendixes .....................................................................................................................................758
Appendix I .......................................................................................................................................................... 759
Work Group Roster ..................................................................................................................................... 759
Appendix II ......................................................................................................................................................... 763
AAOS Bodies That Approved This Clinical Practice Guideline ................................................................ 763
Appendix III ........................................................................................................................................................ 764
A Priori Pico Questions and Additional Details Regarding Pico Questions ...................................................... 764
Appendix IV........................................................................................................................................................ 766
Study Attrition Flowchart ........................................................................................................................... 766
Appendix V ......................................................................................................................................................... 767
Literature Search Strategies ........................................................................................................................ 767
Appendix VI........................................................................................................................................................ 770
Companion Consensus Statements ............................................................................................................. 770
Companion Consensus Statement Protocol ................................................................................................ 770
Appendix VII ...................................................................................................................................................... 771
Participating Peer Review Organizations ................................................................................................... 771
Structured Peer Review Form ..................................................................................................................... 772
Appendix VIII ..................................................................................................................................................... 774
Interpreting the Forest Plots ........................................................................................................................ 774
Appendix IX........................................................................................................................................................ 775
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Conflict of Interest ...................................................................................................................................... 775
Appendix X ......................................................................................................................................................... 778
Bibliographies ............................................................................................................................................. 778
Included Studies .......................................................................................................................................... 778
Excluded Studies......................................................................................................................................... 793
Appendix XIII ..................................................................................................................................................... 982
Letters of Endorsement from External Organizations ................................................................................ 982
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LIST OF TABLES
Table 1. Strength of Recommendation Descriptions ............................................................................................ 33
Table 2. AAOS Guideline Language Stems ......................................................................................................... 34
Table 3. Clinical Applicability: Interpreting the Strength of a Recommendation ................................................ 34
Table 4. Interpreting Likelihood Ratios ................................................................................................................ 35
Table 5. Diagnostic Quality Evaluations .............................................................................................................. 43
Table 6: Summary of Findings- Index Test Versus AANEM Referenced EDS................................................... 45
Table 7: Summary of Findings- Index Test Versus General EDS Methods ......................................................... 46
Table 8: High Quality Studies- PICO 1 (Physical Tests Versus Reference Standard) ......................................... 47
Table 9: Moderate Quality Studies- PICO 1 (Physical Tests Versus Reference Standard).................................. 58
Table 10: Low Quality Studies- PICO 1 (Physical Tests Versus Reference Standard)........................................ 82
Table 11. Diagnostic Quality Evaluations ............................................................................................................ 91
Table 12: Summary of Findings- Index Test Versus AANEM Referenced EDS................................................. 93
Table 13: Summary of Findings- Index Test Versus General EDS Methods ....................................................... 94
Table 14: High Quality Studies- PICO 2 (History Interview Topics Versus Reference Standard) ...................... 95
Table 15: Moderate Quality Studies- PICO 2 (History Interview Topics Versus Reference Standard) ............ 104
Table 16: Low Quality Studies- PICO 2 (History Interview Topics Versus Reference Standard) .................... 143
Table 17. Diagnostic Quality Evaluations .......................................................................................................... 148
Table 18: Summary of Findings- Index Test Versus AANEM Referenced EDS............................................... 151
Table 19: Summary of Findings- Index Test Versus General EDS Methods ..................................................... 152
Table 20: High Quality Studies- PICO 3 (Imaging Modalities Versus Reference Standard) ............................ 153
Table 21: Moderate Quality Studies- PICO 3 (Imaging Modalities Versus Reference Standard) ..................... 173
Table 22: Low Quality Studies- PICO 3 (Imaging Modalities Versus Reference Standard) ............................. 184
Table 23. Diagnostic Quality Evaluations .......................................................................................................... 189
Table 24: Summary of Findings- Index Test Versus AANEM Referenced EDS............................................... 190
Table 25: Summary of Findings- Index Test Versus General EDS Methods ..................................................... 191
Table 26: High Quality Studies: PICO 4 (Diagnostic Scales Versus Reference Standard)................................ 192
Table 27: Moderate Quality Studies: PICO 4 (Diagnostic Scales Versus Reference Standard) ........................ 198
Table 28: Low Quality Studies- PICO 4 (Diagnostic Scales Versus Reference Standard) ................................ 217
Table 29. Prognostic Quality Evaluations .......................................................................................................... 227
Table 30: Summary of Findings- Female Gender/Sex Related Risk Factors ..................................................... 231
Table 31: Summary of Findings- Job Related Factors........................................................................................ 232
Table 32: Summary of Findings- Job Related Factors Contd ........................................................................... 233
Table 33: Summary of Findings- Comorbid Disease Risk Factors .................................................................... 234
Table 34: Summary of Findings- Demographic Risk Factors ............................................................................ 235
Table 35: Summary of Findings- Anthropometric Measure Risk Factors .......................................................... 236
Table 36 Risk Factor: ACGIH Hand Activity .................................................................................................... 237
Table 37 Risk Factor: Age .................................................................................................................................. 243
Table 38 Risk Factor: Anthropometric Measures ............................................................................................... 253
Table 39 Risk Factor: Any Facilitating Comorbidities ....................................................................................... 262
Table 40 Risk Factor: Arthritis ........................................................................................................................... 264
Table 41 Risk Factor: Assembly Line ................................................................................................................ 267
Table 42 Risk Factor: Automatic Work Pace ..................................................................................................... 269
Table 43 Risk Factor: BMI ................................................................................................................................. 270
Table 44 Risk Factor: Bending ........................................................................................................................... 282
Table 45 Risk Factor: Chemicals ........................................................................................................................ 286
Table 46 Risk Factor: Clerical ............................................................................................................................ 287
Table 47 Risk Factor: Cold Exposure ................................................................................................................. 288
Table 48 Risk Factor: Comorbidity Drug Use .................................................................................................... 289
Table 49 Risk Factor: Computer Work ............................................................................................................... 291
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Table 50 Risk Factor: Construction Work .......................................................................................................... 293
Table 51 Risk Factor: Dexterity.......................................................................................................................... 294
Table 52 Risk Factor: Diabetes ........................................................................................................................... 295
Table 53 Risk Factor: Dialysis ............................................................................................................................ 298
Table 54 Risk Factor: Dynamic Strength............................................................................................................ 299
Table 55 Risk Factor: Education......................................................................................................................... 300
Table 56 Risk Factor: Endocrine ........................................................................................................................ 302
Table 57 Risk Factor: Exertion ........................................................................................................................... 303
Table 58 Risk Factor: Farming ........................................................................................................................... 306
Table 59 Risk Factor: Female Risk Factors ........................................................................................................ 307
Table 60 Risk Factor: Fibromyalgia ................................................................................................................... 314
Table 61 Risk Factor: Force ................................................................................................................................ 315
Table 62 Risk Factor: Fracture ........................................................................................................................... 319
Table 63 Risk Factor: Gender/Sex (F) ................................................................................................................ 321
Table 64 Risk Factor: General Comorbidities .................................................................................................... 324
Table 65 Risk Factor: Genetics/Family History ................................................................................................. 329
Table 66 Risk Factor: Grip ................................................................................................................................. 331
Table 67 Risk Factor: Height .............................................................................................................................. 333
Table 68 Risk Factor: Hobbies ........................................................................................................................... 334
Table 69 Risk Factor: Hospital Work ................................................................................................................. 338
Table 70 Risk Factor: Housework ...................................................................................................................... 339
Table 71 Risk Factor: Industrial ......................................................................................................................... 342
Table 72 Risk Factor: Job Control ...................................................................................................................... 344
Table 73 Risk Factor: Lack of Coworker Support .............................................................................................. 346
Table 74 Risk Factor: Length of Employment ................................................................................................... 347
Table 75 Risk Factor: Level of Satisfaction ....................................................................................................... 349
Table 76 Risk Factor: Lifting.............................................................................................................................. 350
Table 77 Risk Factor: Managerial Jobs .............................................................................................................. 352
Table 78 Risk Factor: Marital Status .................................................................................................................. 353
Table 79 Risk Factor: Mental ............................................................................................................................. 354
Table 80 Risk Factor: Moderate Alcohol Use .................................................................................................... 357
Table 81 Risk Factor: Musculoskeletal............................................................................................................... 358
Table 82 Risk Factor: Office Work .................................................................................................................... 361
Table 83 Risk Factor: Other ................................................................................................................................ 362
Table 84 Risk Factor: Paraplegic ........................................................................................................................ 364
Table 85 Risk Factor: Piecework Payment ......................................................................................................... 365
Table 86 Risk Factor: Pressing ........................................................................................................................... 366
Table 87 Risk Factor: Professional Jobs ............................................................................................................. 368
Table 88 Risk Factor: Race/Ethnicity (white vs non-white) ............................................................................... 370
Table 89 Risk Factor: Raynauds ........................................................................................................................ 371
Table 90 Risk Factor: Repetition ........................................................................................................................ 372
Table 91 Risk Factor: Rotation ........................................................................................................................... 378
Table 92 Risk Factor: SF-36 Physical Component ............................................................................................. 380
Table 93 Risk Factor: Sales ................................................................................................................................ 381
Table 94 Risk Factor: Service Occupations ........................................................................................................ 382
Table 95 Risk Factor: Skilled Trades.................................................................................................................. 386
Table 96 Risk Factor: Smoking .......................................................................................................................... 387
Table 97 Risk Factor: Static Strength ................................................................................................................. 391
Table 98 Risk Factor: Strain ............................................................................................................................... 392
Table 99 Risk Factor: Symptoms........................................................................................................................ 393
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Table 100 Risk Factor: Technical Jobs ............................................................................................................... 396
Table 101 Risk Factor: Tendonitis ...................................................................................................................... 397
Table 102 Risk Factor: Varicosis ........................................................................................................................ 398
Table 103 Risk Factor: Vibration ....................................................................................................................... 399
Table 104 Risk Factor: Work Length ................................................................................................................. 402
Table 105 Risk Factor: Finger Pinch .................................................................................................................. 406
Table 106. Intervention Quality Evaluations ...................................................................................................... 412
Table 107: Summary of Findings PICO 6 Part 1 Immobilization (Early Follow-up (<90days)) ....................... 414
Table 108: Summary of Findings PICO 6 Part 2 Steroid Injection (Early Follow-up (<90days)) ..................... 414
Table 109: Summary of Findings PICO 6 Part 2 Steroid Injection (Late Follow-up (>90days)) ...................... 416
Table 110: Summary of Findings PICO 6 Part 4 Oral Treatment (Early Follow-up (<90days)) ....................... 417
Table 111: Summary of Findings PICO 6 Part 5 Topical Treatment (Early Follow-up (<90days)) .................. 418
Table 112: Summary of Findings PICO 6 Part 6 Other Treatments (Early Follow-up (<90days)).................... 419
Table 113: Summary of Findings PICO 6 Part 6 Other Treatments (Late Follow-up (>90days)) ..................... 421
Table 114: Pico 6 Part 1- Immobilization: Function .......................................................................................... 422
Table 115: Pico 6 Part 1- Immobilization: Other................................................................................................ 433
Table 116: Pico 6 Part 1- Immobilization: Pain.................................................................................................. 434
Table 117: Pico 6 Part 1- Immobilization: Symptoms ....................................................................................... 435
Table 118: Pico 6 Part 2- Injection (steroid): Complications ............................................................................. 437
Table 119: Pico 6 Part 2- Injection (steroid): Function ...................................................................................... 440
Table 120: Pico 6 Part 2- Injection (steroid): Other ........................................................................................... 446
Table 121: Pico 6 Part 2- Injection (steroid): Pain ............................................................................................. 449
Table 122: Pico 6 Part 2- Injection (steroid): Symptoms ................................................................................... 452
Table 123: Pico 6 Part 4- Oral Treatments: Symptoms ...................................................................................... 460
Table 124: Pico 6 Part 5- Topical Treatments: Function .................................................................................... 462
Table 125: Pico 6 Part 5- Topical Treatments: Pain ........................................................................................... 468
Table 126: Pico 6 Part 5- Topical Treatments: Symptoms ................................................................................. 470
Table 127: Pico 6 Part 6- Other Treatments: Complications .............................................................................. 471
Table 128: Pico 6 Part 6- Other Treatments: Function ....................................................................................... 475
Table 129: Pico 6 Part 6- Other Treatments: Pain .............................................................................................. 500
Table 130: Pico 6 Part 6- Other Treatments: Quality Of Life ............................................................................ 503
Table 131: Pico 6 Part 6- Other Treatments: Symptoms .................................................................................... 504
Table 132: Intervention Quality Evaluations ...................................................................................................... 517
Table 133: Summary of Findings PICO 7 Part 1 Endoscopic (Early Follow-up (3 months up to 1 year)) ........ 520
Table 134: Summary of Findings PICO 7 Part 1 Endoscopic (Late Follow-up (> 1 year)) ............................... 522
Table 135: Summary of Findings PICO 7 Part 2 Mini (Early Follow-up (3 months up to 1 year)) ................... 523
Table 136: Summary of Findings PICO 7 Part 2 Mini (Late Follow-up (> 1 year)) .......................................... 524
Table 137: Summary of Findings PICO 7 Part 3 Open (Early Follow-up (3 months up to 1 year)) .................. 525
Table 138: Summary of Findings PICO 7 Part 4 Surgical vs. Conservative (Early Follow-up (3 months up to 1
year)) ................................................................................................................................................................... 526
Table 139: Summary of Findings PICO 7 Part 4 Surgical vs. Conservative (Late Follow-up (> 1 year)) ......... 527
Table 140: Pico 7 Part 1- Endoscopic: Complications ....................................................................................... 528
Table 141: Pico 7 Part 1- Endoscopic: Other Questionnaire .............................................................................. 536
Table 142: Pico 7 Part 1- Endoscopic: Function ................................................................................................ 537
Table 143: Pico 7 Part 1- Endoscopic: Other...................................................................................................... 557
Table 144: Pico 7 Part 1- Endoscopic: Pain........................................................................................................ 559
Table 145: Pico 7 Part 1- Endoscopic: Postoperative Pain Control.................................................................... 565
Table 146: Pico 7 Part 1- Endoscopic: Quality Of Life ...................................................................................... 566
Table 147: Pico 7 Part 1- Endoscopic: Symptoms.............................................................................................. 568
Table 148: Pico 7 Part 2- Mini: Complications .................................................................................................. 578
20
Table 149: Pico 7 Part 2- Mini: Function ........................................................................................................... 582
Table 150: Pico 7 Part 2- Mini: Other ................................................................................................................ 597
Table 151: Pico 7 Part 2- Mini: Pain .................................................................................................................. 599
Table 152: Pico 7 Part 2- Mini: Quality Of Life ................................................................................................. 602
Table 153: Pico 7 Part 2- Mini: Symptoms ........................................................................................................ 603
Table 154: Pico 7 Part 3- Open: Complications ................................................................................................. 610
Table 155: Pico 7 Part 3- Open: Other Questionnaire ........................................................................................ 612
Table 156: Pico 7 Part 3- Open: Function .......................................................................................................... 613
Table 157: Pico 7 Part 3- Open: Symptoms........................................................................................................ 615
Table 158: Pico 7 Part 4- Surgical Versus Conservative: Complications .......................................................... 616
Table 159: Pico 7 Part 4- Surgical Versus Conservative: Other Questionnaire ................................................. 620
Table 160: Pico 7 Part 4- Surgical Versus Conservative: Function.................................................................... 622
Table 161: Pico 7 Part 4- Surgical Versus Conservative: Pain ........................................................................... 626
Table 162: Pico 7 Part 4- Surgical Versus Conservative: Quality Of Life ......................................................... 629
Table 163: Pico 7 Part 4- Surgical Versus Conservative: Symptoms ................................................................. 630
Table 164: Observational Study Quality............................................................................................................. 637
Table 165: Randomized Trial Quality ................................................................................................................ 637
Table 166: Summary of Findings PICO 8 Adjunctive/Alternative Surgical Techniques (Early Follow-up (3
months up to 6 months)) ..................................................................................................................................... 638
Table 167: Summary of Findings PICO 8 Adjunctive/Alternative Surgical Techniques (LateFollow-up (> 6
months)) .............................................................................................................................................................. 639
Table 168: Pico 8 Part 1- Adjunctive/Alternative Surgical Techniques: Complications ................................... 640
Table 169: Pico 8 Part 1- Adjunctive/Alternative Surgical Techniques: Function ............................................ 641
Table 170: Pico 8 Part 1- Adjunctive/Alternative Surgical Techniques: Pain.................................................... 645
Table 171: Pico 8 Part 1- Adjunctive/Alternative Surgical Techniques: Quality Of Life .................................. 646
Table 172: Pico 8 Part 1- Adjunctive/Alternative Surgical Techniques: Symptoms.......................................... 647
Table 174: Summary of Findings PICO 9 Simultaneous Bi-lateral Release (Early Follow-up (3 months up to 6
months)) .............................................................................................................................................................. 651
Table 175: Summary of Findings PICO 9 Simultaneous Bi-lateral Release Techniques (LateFollow-up (> 6
months)) .............................................................................................................................................................. 652
Table 176: Pico 9- CT release (simultaneous Versus staged): Function ............................................................ 653
Table 177: Pico 9- CT release (simultaneous Versus staged): Quality Of Life.................................................. 657
Table 178: Pico 9- CT release (simultaneous Versus staged): Symptoms ......................................................... 659
Table 179: Observational Study Quality............................................................................................................. 662
Table 180: Randomized Trial Quality ................................................................................................................ 662
Table 181: Summary of Findings PICO 11 part 1 Modes of Analgesia: Local Vs Local (Early Follow-up (Pre-
Op/Intra-Op)) ...................................................................................................................................................... 663
Table 182: Summary of Findings PICO 11 part 2 Modes of Analgesia: Local Vs Regional (Early Follow-up
(Pre-Op/Intra-Op)) .............................................................................................................................................. 664
Table 183: Summary of Findings PICO 11 part 2 Modes of Analgesia: Local Vs Regional (Late Follow-up
(Post-op)) ............................................................................................................................................................ 665
Table 184: Pico 11 Part 1- Local Versus Local: Pain ......................................................................................... 666
Table 185: Pico 11 Part 2- Local Versus Regional: Function ............................................................................ 668
Table 186: Pico 11 Part 2- Local Versus Regional: Other.................................................................................. 669
Table 187: Pico 11 Part 2- Local Versus Regional: Pain.................................................................................... 670
Table 188: Pico 11 Part 2- Local Versus Regional: Quality Of Life .................................................................. 672
Table 190: Summary of Findings PICO 12 Peri-Operative Anticoagulation Cessation .................................... 677
Table 191: Pico 12- Anticoagulation: Complications ......................................................................................... 678
21
Table 193: Summary of Findings PICO 13 Prophylactic Antibiotics ................................................................ 682
Table 194: Pico 13- Prophylactic Antibiotics: Complications ........................................................................... 683
Table 196: Summary of Findings PICO 14 Post-Op Therapy (Early Follow-up (< 1 Month)) ......................... 686
Table 197: Summary of Findings PICO 14 Post-Op Therapy (Late Follow-up (> 1 Month)) ........................... 687
Table 198: Pico 14- Post-op Therapy: Complications ........................................................................................ 688
Table 199: Pico 14- Post-op Therapy: Function ................................................................................................. 696
Table 200: Pico 14- Post-op Therapy: Other ...................................................................................................... 706
Table 201: Pico 14- Post-op Therapy: Pain ........................................................................................................ 709
Table 202: Pico 14- Post-op Therapy: Quality Of Life ...................................................................................... 720
Table 203: Pico 14- Post-op Therapy: Symptoms .............................................................................................. 722
Table 205: Summary of Findings PICO 15 Post-Op Immobilization (Early Follow-up (< 1 Month)) .............. 738
Table 206: Summary of Findings PICO 15 Post-Op Immobilization (Late Follow-up (> 1 Month)) ............... 739
Table 207: Pico 15 Part 1- Post-op Immobilization: Complications .................................................................. 740
Table 208: Pico 15 Part 1- Post-op Immobilization: Function ........................................................................... 742
Table 209: Pico 15 Part 1- Post-op Immobilization: Other ................................................................................ 750
Table 210: Pico 15 Part 1- Post-op Immobilization: Pain .................................................................................. 752
Table 211: Pico 15 Part 1- Post-op Immobilization: Quality Of Life................................................................. 755
Table 212: Pico 15 Part 1- Post-op Immobilization: Symptoms ........................................................................ 756
22
TABLE OF FIGURES
Figure 1: General EDS Versus Phalen Test and Tinel Sign ......................................................... 83
Figure 2: General EDS Versus Phalen Test .................................................................................. 84
Figure 3: General EDS Versus Tinel Sign .................................................................................... 85
Figure 4: EDS AANEM Versus Phalen Test ................................................................................ 86
Figure 5: EDS AANEM Versus Tinel Sign .................................................................................. 87
Figure 6: EDS AANEM Versus Thenar Atrophy ......................................................................... 88
Figure 7: EDS AANEM Versus Female Gender/Sex ................................................................. 144
Figure 8: EDS AANEM Versus Male Gender/Sex..................................................................... 145
Figure 9: General EDS Versus Katz Hand Diagram (Classic or Probable) ................................ 218
Figure 10: EDS AANEM Versus Katz Hand Diagram (Classic or Probable) ............................ 219
Figure 11: Pico 6 Part 1 Immobilization Versus No Immobilization: NCS DML-Function ...... 513
Figure 12: Pico 6 Part 1 Immobilization Versus No Immobilization: NCS SNCV.................... 514
Figure 13: Pico 7 part 1 Endoscopic Versus Open: Symptom Recurrence: Pain ....................... 634
23
III.INTRODUCTION
Overview
This clinical practice guideline is based on a systematic review of published studies with regard
to the diagnosis and treatment of carpal tunnel syndrome (CTS). In addition to providing practice
recommendations, this guideline also highlights limitations in the literature and areas that require
future research.
This guideline is intended to be used by all qualified and appropriately trained physicians and
surgeons involved in the diagnosis and treatment of CTS. It is also intended to serve as an
information resource for decision makers and developers of practice guidelines and
recommendations.
The following definition of carpal tunnel syndrome has been added to the introduction section:
For the purpose of this guideline, Carpal Tunnel Syndrome (CTS) is defined as follows: Carpal
Tunnel Syndrome is a symptomatic compression neuropathy of the median nerve at the level of
the wrist, characterized physiologically by evidence of increased pressure within the carpal
tunnel and decreased function of the nerve at that level. Carpal Tunnel Syndrome can be caused
by many different diseases, conditions and events. It is characterized by patients as producing
numbness, tingling, hand and arm pain and muscle dysfunction. The disorder is not restricted by
age, gender, ethnicity, or occupation and is associated with or caused by systemic disease and
local mechanical and disease factors.
Goals and Rationale

The purpose of this clinical practice guideline is to help improve treatment based on the current
best evidence. Current evidence-based medicine (EBM) standards demand that physicians use
the best available evidence in their clinical decision making. To assist them, this clinical practice
guideline consists of a systematic review of the available literature regarding the diagnosis and
treatment of CTS. The systematic review detailed herein was conducted between February 2013
and February 2015 and demonstrates where there is good evidence, where evidence is lacking,
and what topics future research must target in order to improve the diagnosis and treatment of
CTS. AAOS staff and the physician work group systematically reviewed the available literature
and subsequently wrote the following recommendations based on a rigorous, standardized
process.
Musculoskeletal care is provided in many different settings by many different providers. We

created this guideline as an educational tool to guide qualified physicians through a series of
treatment decisions in an effort to improve the quality and efficiency of care. This guideline
should not be construed as including all proper methods of care or excluding methods of care
reasonably directed to obtaining the same results. The ultimate judgment regarding any specific
procedure or treatment must be made in light of all circumstances presented by the patient and
the needs and resources particular to the locality or institution.
Intended Users
This guideline is intended to be used by orthopaedic surgeons and physicians managing carpal
tunnel syndrome. Typically, orthopaedic surgeons will have completed medical training, a
qualified residency in orthopaedic surgery, and some may have completed additional sub-
24
specialty training. General surgeons, plastic surgeons, neurosurgeons, primary care physicians,
hospital-based and outpatient adult internal medicine specialists, including neurologists,
physiatrists and occupational health medicine specialists, physical therapists, occupational
therapists, nurse practitioners, physician assistants, and other healthcare professionals who
routinely see this type of patient in various practice settings may also benefit from this guideline.
Insurance payers, governmental bodies, and health-policy decision-makers may also find this
guideline useful as a summary of the current research regarding carpal tunnel syndrome. This
guideline and its individual recommendations are not intended for use as a stand-alone benefits
determination document. Making these determinations involves many factors not considered in
the present document, including available resources, business and ethical considerations,
cost/benefit analysis, risk/harms analysis and need.
The care of CTS is based on the assumption that decisions are predicated on the patient and / or
the patients qualified heath care advocate having physician communication with discussion of
available treatments and procedures applicable to the individual patient. Once the patient and or
their advocate have been informed of available therapies and have discussed these options with
his/her physician, an informed decision can be made. Clinician input based on experience with
conservative management and the clinicians surgical experience and skills increases the
probability of identifying patients who will benefit from specific treatment options.
Patient Population
This document addresses the diagnosis and treatment of adult patients presenting with
complaints which may be attributable to CTS.
Burden of Disease
CTS is the most common compressive neuropathy affecting the upper extremity and is an
important cause of lost workplace productivity. The prevalence of CTS is estimated to be
0.7/10,000 workers. Between 1997 and 2010 CTS was the second most common cause of days
lost from the workplace. Throughout this period the median time lost per case of CTS varied
between 21 and 32 days.
Etiology
CTS is caused by compression of the median nerve under the transverse carpal ligament.
Although pressure on the median nerve is clearly the pathophysiologic basis for the symptoms
observed clinically, the etiology of elevated pressure within the carpal canal is unknown.
Risk Factors
Conditions which occupy volume within the carpal canal may increase the risk of symptomatic
compression of the median nerve. Diseases affecting the synovium of the flexor tendons, such as
rheumatoid arthritis, or rare tumors or anomalous muscles in the carpal canal are example of
uncommonly encountered medical conditions associated with an increased risk of CTS. Given
that the cause of increased pressure within the carpal canal is unknown in the majority of cases,
there is little known about risk factors for developing CTS, although a number of associations
both with medical conditions and workplace exposures have been described. For more
information regarding risk factors, please see the recommendations concerning risk factors for
CTS.
25
Emotional and Physical Impact
The principal impact of CTS on patients relates to the sensory disturbance which may disrupt
sleep and, during non-sleeping hours, impair strength and the ability to carry out fine
manipulation. CTS may also be associated with pain in the wrist and digits. These symptoms
may have a substantial effect on an individuals ability to accomplish activities of daily living
and to perform work-related duties.
Potential Benefits, Harms, and Contraindications

The main benefit of a guideline focused on diagnosis is the emphasis on standardized diagnostic
criteria which reduce variability in the case definition for CTS. This could have an important
impact on the care of CTS, by minimizing the risk of incorrect diagnosis, and also help in the
design of studies seeking to identify associations with specific workplace exposures, an area of
interest for workers.
Future Research
A significant obstacle to evaluating pathways to the treatment of CTS is the absence of a widely
accepted reference standard for the diagnosis. An effort to achieve consensus among the many
clinical disciplines which evaluate and treat CTS is an important goal of future research in this
area. If consensus of this nature can be established, then a clear and consistent case definition
should allow a comparison of treatment options as well as an evaluation of the impact of
workplace exposures on the development of CTS symptoms.
26
IV.METHODS
The methods used to perform this systematic review were employed to minimize bias and
enhance transparency in the selection, appraisal, and analysis of the available evidence. These
processes are vital to the development of reliable, transparent, and accurate clinical
recommendations for treating carpal tunnel syndrome.
This clinical practice guideline and the systematic review upon which it is based evaluate the
effectiveness of treatments for carpal tunnel syndrome. This section describes the methods used
to prepare this guideline and systematic review, including search strategies used to identify
literature, criteria for selecting eligible articles, determining the strength of the evidence, data
extraction, methods of statistical analysis, and the review and approval of the guideline. The
AAOS approach incorporates practicing physicians (clinical experts) and methodologists who
are free of potential conflicts of interest as recommended by guideline development experts.M10
The AAOS understands that only high-quality guidelines are credible, and we go to great lengths
to ensure the integrity of our evidence analyses. The AAOS addresses bias beginning with the
selection of guideline development group members. Applicants with financial conflicts of
interest (COI) related to the guideline topic cannot participate if the conflict occurred within one
year of the start date of the guidelines development or if an immediate family member has, or
has had, a relevant financial conflict. Additionally, all guideline development group members
sign an attestation form agreeing to remain free of relevant financial conflicts for two years
following the publication of the guideline.
This guideline and systematic review were prepared by the AAOS Management of Carpal
Tunnel Syndrome Guideline physician guideline development group (clinical experts) with the
assistance of the AAOS Evidence-Based Medicine (EBM) Unit in the Department of Research
and Scientific Affairs (methodologists) at the AAOS. To develop this guideline, the guideline
development group held an introductory meeting on February 1, 2013 to establish the scope of
the guideline and the systematic reviews. As the physician experts, the guideline development
group defined the scope of the guideline by creating PICO Questions (i.e. population,
intervention, comparison, and outcome) that directed the literature search. When necessary, these
clinical experts also provided content help, search terms and additional clarification for the
AAOS Medical Librarian. The Medical Librarian created and executed the search(s). The
supporting group of methodologists (AAOS EBM Unit) reviewed all abstracts, recalled pertinent
full-text articles for review and evaluated the quality of studies meeting the inclusion criteria.
They also abstracted, analyzed, interpreted, and/or summarized the relevant evidence for each
recommendation and prepared the initial draft for the final meeting. Upon completion of the
systematic reviews, the physician guideline development group participated in a three-day
recommendation meeting on May 15-17, 2015. At this meeting, the physician experts and
methodologists evaluated and integrated all material to develop the final recommendations. The
final recommendations and rationales were edited, written and voted on at the final meeting. The
draft guideline recommendations and rationales received final review by the methodologists to
ensure that these recommendations and rationales were consistent with the data. The draft was
then completed and submitted for peer review on September 8th, 2015.
27
The resulting draft guidelines were then peer-reviewed, edited in response to that review and
subsequently sent for public commentary, where after additional edits were made. Thereafter, the
draft guideline was sequentially approved by the AAOS Committee on Evidence-Based Quality
and Value, AAOS Council on Research and Quality, and the AAOS Board of Directors (see
Appendix II for a description of the AAOS bodies involved in the approval process). All AAOS
guidelines are reviewed and updated or retired every five years in accordance with the criteria of
the National Guideline Clearinghouse.
Thus the process of AAOS guideline development incorporates the benefits from clinical
physician expertise as well as the statistical knowledge and interpretation of non-conflicted
methodologists. The process also includes an extensive review process offering the opportunity
for over 200 clinical physician experts to provide input into the draft prior to publication. This
process provides a sound basis for minimizing bias, enhancing transparency and ensuring the
highest level of accuracy for interpretation of the evidence.
FORMULATING PICO QUESTIONS

The guideline development group began work on this guideline by constructing a set of PICO
questions. These questions specify the patient population of interest (P), the intervention of
interest (I), the comparisons of interest (C), and the patient-oriented outcomes of interest (O).
They function as questions for the systematic review, not as final recommendations or
conclusions. Once established, these a priori PICO questions cannot be modified until the final
guideline development group meeting.
STUDY SELECTION CRITERIA

We developed a priori article inclusion criteria for our review. These criteria are our rules of
evidence and articles that did not meet them are, for the purposes of this guideline, not
evidence.
To be included in our systematic reviews (and hence, in this guideline) an article had to meet the
following criteria:
Study must be of an CTS injury or prevention thereof

Study must be published in or after 1966 for surgical treatment, rehabilitation, bracing,
prevention and MRI
Study must be published in or after 1966 for x rays and non-operative treatment
Study must be published in or after 1966 for all others non specified
Study should have 10 or more patients per group
For surgical treatment a minimum of 3 months follow up duration.
Antibiotic prophylaxis, anticoagulations, mode of anesthesia: all follow-ups
For non-operative treatment a minimum of 1 month.
Standard Criteria for all CPGs

Article must be a full article report of a clinical study.
Retrospective non-comparative case series, medical records review, meeting abstracts, historical
articles, editorials, letters, and commentaries are excluded.
Confounded studies (i.e. studies that give patients the treatment of interest AND another treatment)
are excluded.
28
Case series studies that have non-consecutive enrollment of patients are excluded.
Controlled trials in which patients were not stochastically assigned to groups AND in which there
was either a difference in patient characteristics or outcomes at baseline AND where the authors did
not statistically adjust for these differences when analyzing the results are excluded.
All studies of Very Weak strength of evidence are excluded.
All studies evaluated as Level V will be excluded.
Composite measures or outcomes are excluded even if they are patient-oriented.
Study must appear in a peer-reviewed publication
For any included study that uses paper-and-pencil outcome measures (e.g., SF-36), only those
outcome measures that have been validated will be included
For any given follow-up time point in any included study, there must be 50% patient follow-up (if
the follow-up is >50% but <80%, the study quality will be downgraded by one Level)
Study must be of humans
Study must be published in English
Study results must be quantitatively presented
Study must not be an in vitro study
Study must not be a biomechanical study
Study must not have been performed on cadavers
We will only evaluate surrogate outcomes when no patient oriented outcomes are available.
BEST EVIDENCE SYNTHESIS

We included only the best available evidence for any given outcome addressing a
recommendation. Accordingly, we first included the highest quality evidence for any given
outcome if it was available. In the absence of two or more occurrences of an outcome at this
quality, we considered outcomes of the next lowest quality until at least two or more occurrences
of an outcome had been acquired. For example, if there were two moderate quality occurrences
of an outcome that addressed a recommendation, we did not include low quality occurrences of
this outcome. A summary of the evidence that met the inclusion criteria, but was not best
available evidence was created and can be viewed by recommendation in Appendix XII.
MINIMALLY CLINICALLY IMPORTANT IMPROVEMENT

Wherever possible, we consider the effects of treatments in terms of the minimally clinically
important difference (MCID) in addition to whether their effects are statistically significant. The
MCID is the smallest clinical change that is important to patients, and recognizes the fact that
there are some treatment-induced statistically significant improvements that are too small to
matter to patients. However, there were no occurrences of validated MCID outcomes in the
studies included in this clinical practice guideline.
When MCID values from the specific guideline patient population are not available, we use the
following measures listed in order of priority:
1) MCID/MID
2) PASS or Impact
3) Another validated measure
4) Statistical Significance
29
LITERATURE SEARCHES
We begin the systematic review with a comprehensive search of the literature. Articles we consider
were published prior to February 27, 2015 in four electronic databases; PubMed, EMBASE,
CINAHL, and The Cochrane Central Register of Controlled Trials. The medical librarian conducts
the search using key terms determined from the guideline development groups preliminary
recommendations.
We supplement the electronic search with a manual search of the bibliographies of all retrieved
publications, recent systematic reviews, and other review articles for potentially relevant citations.
Recalled articles are evaluated for possible inclusion based on the study selection criteria and are
summarized for the guideline development group who assist with reconciling possible errors and
omissions.
The study attrition diagram in Appendix IV provides a detailed description of the numbers of
identified abstracts and recalled and selected studies that were evaluated in the systematic review of
this guideline. The search strategies used to identify the abstracts are contained in Appendix V.
METHODS FOR EVALUATING EVIDENCE

As noted earlier, we judge quality based on a priori PICO questions and use an automated numerical
scoring process to arrive at final ratings. Extensive measures are taken to determine quality ratings so
that they are free of bias.
We evaluate the quality of evidence separately for each study using modified versions of the GRADE
and QUADAS instruments. Depending on the type of study (i.e. diagnostic, prognostic, randomized
control trial, or observational) the study design is evaluated using a list of standardized questions (see
below for the domains evaluated for each type of study design).
DIAGNOSTIC STUDY QUALITY APPRAISAL QUESTIONS

The following questions are used to evaluate the study quality of diagnostic study designs.
1. Was the patient spectrum representative of the patients who will receive the test in
practice?
2. Were the selection criteria clearly described?
3. Was the execution of the index and reference tests described in sufficient detail to permit
its replication?
4. Is the reference standard likely to correctly classify the target condition?
5. Are the index test(s) results interpreted by an examiner without the knowledge of the
reference tests results (or vice versa)?
6. Other Bias?
Diagnostic Study Design Quality Key
High Quality Study <1 Flaw

Moderate Quality Study 1 and <2 Flaws
Low Quality Study 2 and <3 Flaws
Very Low Quality Study 3 Flaws
30
PROGNOSTIC STUDY QUALITY APPRAISAL QUESTIONS
The following questions are used to evaluate the study quality of prognostic study designs.
1. Was the spectrum of patients studied for this prognostic variable representative of the
patient spectrum seen in actual clinical practice?
2. Was loss to follow up unrelated to key characteristics?
3. Was the prognostic factor of interest adequately measured in the study to limit potential
bias?
4. Was the outcome of interest adequately measured in study participants to sufficiently
limit bias?
5. Were all important confounders adequately measured in study participants to sufficiently
limit potential bias?
6. Was the statistical analysis appropriate for the design of the study, limiting potential for
presentation of invalid results?
Prognostic Study Design Quality Key

RANDOMIZED STUDY QUALITY APPRAISAL QUESTIONS

The following domains are evaluated to determine the study quality of randomized study
designs.
1. Random Sequence Generation

2. Allocation Concealment
3. Blinding of Participants and Personnel
4. Incomplete Outcome Data
5. Selective Reporting
6. Other Bias
Upgrading Randomized Study Quality Questions
1. Is there a large magnitude of effect?

2. Influence of All Plausible Residual Confounding
3. Dose-Response Gradient
31
Randomized Study Design Quality Key

OBSERVATIONAL STUDY DESIGN QUALITY APPRAISAL QUESTIONS

The following questions are used to evaluate the study quality of observational study designs.
Note that all observation studies begin the appraisal process at low quality due to design flaws
inherent in observational studies.
1. Is this observational study a prospective case series?

2. Does the strategy for recruiting participants into the study differ across groups?
3. Did the study fail to balance the allocation between the groups or match groups
(e.g., through stratification, matching, propensity scores)?
4. Were important confounding variables not taken into account in the design
and/or analysis (e.g., through matching, stratification, interaction terms,
multivariate analysis, or other statistical adjustment such as instrumental
variables)?
5. Was the length of follow-up different across study groups?
6. Other Bias?
Upgrading Observational Study Quality Questions

1. Is there a large magnitude of effect?
2. Influence of All Plausible Residual Confounding
3. Dose-Response Gradient
Observational Study Design Quality Key

DEFINING THE STRENGTH OF THE RECOMMENDATIONS

Judging the strength of evidence is only a stepping stone towards arriving at the strength of a
guideline recommendation. The strength of recommendation also takes into account the quality,
quantity, and the trade-off between the benefits and harms of a treatment, the magnitude of a
treatments effect, and whether there is data on critical outcomes.
Strength of recommendation expresses the degree of confidence one can have in a

recommendation. As such, the strength expresses how possible it is that a recommendation will
be overturned by future evidence. It is very difficult for future evidence to overturn a
recommendation that is based on many high quality randomized controlled trials that show a
32
large effect. It is much more likely that future evidence will overturn recommendations derived
from a few small case series. Consequently, recommendations based on the former kind of
evidence are given a high strength of recommendation and recommendations based on the latter
kind of evidence are given a low strength.
To develop the strength of a recommendation, AAOS staff first assigned a preliminary strength
for each recommendation that took only the final strength of evidence (including quality and
applicability) and the quantity of evidence (see Table 1).
Table 1. Strength of Recommendation Descriptions

Overall
Strength of
Strength Evidence Description of Evidence Quality Strength Visual
Evidence from two or more High quality
Strong Strong studies with consistent findings for
recommending for or against the intervention.
Evidence from two or more Moderate
quality studies with consistent findings, or
Moderate Moderate evidence from a single High quality study
for recommending for or against the
intervention.
Evidence from two or more Low quality
studies with consistent findings or evidence
Low Strength from a single Moderate quality study
Evidence or recommending for against the intervention or
Limited
Conflicting diagnostic or the evidence is insufficient or
Evidence conflicting and does not allow a
recommendation for or against the
intervention.
There is no supporting evidence. In the
absence of reliable evidence, the guideline
development group is making a
Consensus No Evidence
recommendation based on their clinical
opinion. Consensus statements are published
in a separate, complimentary document.
WORDING OF THE FINAL RECOMMENDATIONS

To prevent bias in the way recommendations are worded, the AAOS uses specific predetermined
language stems that are governed by the evidence strengths. Each recommendation was written
using language that accounts for the final strength of the recommendation. This language, and
the corresponding strength, is shown in Table 2.
33
Table 2. AAOS Guideline Language Stems
Guideline Language Strength of Recommendation
Strong evidence supports that the practitioner
Strong
should/should not do X, because
Moderate evidence supports that the practitioner
Moderate
could/could not do X, because
Limited evidence supports that the practitioner
Limited
might/might not do X, because
In the absence of reliable evidence, it is the
opinion of this guideline development group Consensus*
that*
*Consensus based recommendations are made according to specific criteria. These criteria can be found
in Appendix VII.
APPLYING THE RECOMMENDATIONS TO CLINICAL PRACTICE

To increase the practicality and applicability of the guideline recommendations in this document,
the information listed in Table 3 provides assistance in interpreting the correlation between the
strength of a recommendation and patient counseling time, use of decision aids, and the impact
of future research
Table 3. Clinical Applicability: Interpreting the Strength of a Recommendation

Strength of Patient Counseling Impact of Future
Recommendation (Time) Decision Aids Research
Least Important, unless
the evidence supports
Strong Least no difference between Not likely to change
two alternative
interventions
Less likely to
Moderate Less Less Important
change
Change
Limited More Important
possible/anticipated
Consensus Most Most Important Impact unknown
VOTING ON THE RECOMMENDATIONS

The recommendations and their strength were voted on by the guideline development group
members during the final meeting. If disagreement between the guideline development group
occurred, there was further discussion to see whether the disagreement(s) could be resolved.
Recommendations were approved and adopted in instances where a simple majority (60%) of the
guideline development group voted to approve.
34
STATISTICAL METHODS
ANALYSIS OF DIAGNOSTIC DATA
Likelihood ratios, sensitivity, specificity and 95% confidence intervals were calculated to
determine the accuracy of diagnostic modalities based on two by two diagnostic contingency
tables extracted from the included studies. When summary values of sensitivity, specificity, or
other diagnostic performance measures were reported, estimates of the diagnostic contingency
table were used to calculate likelihood ratios.
Likelihood ratios (LR) indicate the magnitude of the change in probability of disease due to a
given test result. For example, a positive likelihood ratio of 10 indicates that a positive test result
is 10 times more common in patients with disease than in patients without disease. Likelihood
ratios are interpreted according to previously published values, as seen in Table 4 below.
Table 4. Interpreting Likelihood Ratios

Positive Likelihood Negative Likelihood
Interpretation
Ratio Ratio
>10 <0.1 Large and conclusive change in probability
5-10 0.1-0.2 Moderate change in probability
Small (but sometimes important change in
2-5 0.2-0.5
probability)
1-2 0.5-1 Small (and rarely important) change in probability
ANALYSIS OF INTERVENTION/PREVENTION DATA

When possible, we recalculate the results reported in individual studies and compile them to
answer the recommendations. The results of all statistical analysis conducted by the AAOS
Clinical Practice Guidelines Unit are conducted using SAS 9.4. SAS was used to determine the
magnitude, direction, and/or 95% confidence intervals of the treatment effect. For data reported
as means (and associated measures of dispersion) the mean difference between groups and the
95% confidence interval was calculated and a two-tailed t-test of independent groups was used to
determine statistical significance. When published studies report measures of dispersion other
than the standard deviation the value was estimated to facilitate calculation of the treatment
effect. In studies that report standard errors or confidence intervals the standard deviation was
back-calculated. In some circumstances statistical testing was conducted by the authors and
measures of dispersion were not reported. In the absence of measures of dispersion, the results of
the statistical analyses conducted by the authors (i.e. the p-value) are considered as evidence. For
proportions, we report the proportion of patients that experienced an outcome along with the
percentage of patients that experienced an outcome. The variance of the arcsine difference was
used to determine statistical significance.M7 P-values < 0.05 were considered statistically
significant.
When the data was available, we performed meta-analyses using the random effects method of
DerSimonian and Laird.M8 A minimum of three studies was required for an outcome to be
considered by meta-analysis. Heterogeneity was assessed with the I-squared statistic. Meta-
analyses with I-squared values less than 50% were considered as evidence. Those with I-squared
35
larger than 50% were not considered as evidence for this guideline. All meta-analyses were
performed using SAS 9.4. The arcsine difference was used in meta-analysis of proportions. In
order to overcome the difficulty of interpreting the magnitude of the arcsine difference, a
summary odds ratio is calculated based on random effects meta-analysis of proportions and the
number needed to treat (or harm) is calculated. The standardized mean difference was used for
meta-analysis of means and magnitude was interpreted using Cohens definitions of small,
medium, and large effect.
PEER REVIEW
Following the final meeting, the guideline draft undergoes peer review for additional input from
external content experts. Written comments are provided on the structured review form (see
Appendix VII). All peer reviewers are required to disclose their conflicts of interest.
To guide who participates, the guideline development group identifies specialty societies at the
introductory meeting. Organizations, not individuals, are specified.
The specialty societies are solicited for nominations of individual peer reviewers approximately
six weeks before the final meeting. The peer review period is announced as it approaches and
others interested are able to volunteer to review the draft. The chair of the AAOS committee on
Evidence Based Quality and Value reviews the draft of the guideline prior to dissemination.
Some specialty societies (both orthopaedic and non-orthopaedic) ask their evidence-based
practice (EBP) committee to provide review of the guideline. The organization is responsible for
coordinating the distribution of our materials and consolidating their comments onto one form.
The chair of the external EBP committees provides disclosure of their conflicts of interest (COI)
and manages the potential conflicts of their members.
Again, the AAOS asks for comments to be assembled into a single response form by the
specialty society and for the individual submitting the review to provide disclosure of potentially
conflicting interests. The peer review stage gives external stakeholders an opportunity to provide
evidence-based direction for modifications that they believe have been overlooked. Since the
draft is subject to revisions until its approval by the AAOS Board of Directors as the final step in
the guideline development process, confidentiality of all working drafts is essential.
The manager of the evidence-based medicine unit drafts the initial responses to comments that
address methodology. These responses are then reviewed by the guideline development group
chair and vice-chair, who respond to questions concerning clinical practice and techniques. The
director of the Department of Research and Scientific Affairs provides input as well. All
comments received and the initial drafts of the responses are also reviewed by all members of the
guideline development group. All changes to a recommendation as a result of peer review are
based on the evidence and undergoes majority vote by the guideline development group
members via teleconference. Final revisions are summarized in a detailed report that is made part
of the guideline document throughout the remainder of the review and approval processes.
The AAOS believes in the importance of demonstrating responsiveness to input received during
the peer review process and welcomes the critiques of external specialty societies. Following
final approval of the guideline, all individual responses are posted on our website
36
http://www.aaos.org/guidelines with a point-by-point reply to each non-editorial comment.
Reviewers who wish to remain anonymous notify the AAOS to have their names de-identified;
their comments, our responses, and their COI disclosures are still posted.
Review of the Management of Carpal tunnel syndrome guideline was requested of 18

organizations. Seven returned comments on the structured review form (see Appendix IX).
PUBLIC COMMENTARY
After modifying the draft in response to peer review, the guideline was subjected to a thirty day
period of Public Commentary. Commentators consist of members of the AAOS Board of
Directors (BOD), members of the Council on Research and Quality (CORQ), members of the
Board of Councilors (BOC), and members of the Board of Specialty Societies (BOS). The
guideline is automatically forwarded to the AAOS BOD and CORQ so that they may review it
and provide comment prior to being asked to approve the document. Members of the BOC and
BOS are solicited for interest. If they request to see the document, it is forwarded to them for
comment. Based on these bodies, over 200 commentators have the opportunity to provide input
into this guideline. Three members returned public comments.
THE AAOS GUIDELINE APPROVAL PROCESS

This final guideline draft must be approved by the AAOS Committee on Evidence Based Quality
and Value Committee, the AAOS Council on Research and Quality, and the AAOS Board of
Directors. These decision-making bodies are described in Appendix II and are not designated to
modify the contents. Their charge is to approve or reject its publication by majority vote.
REVISION PLANS
This guideline represents a cross-sectional view of current treatment and may become outdated
as new evidence becomes available. This guideline will be revised in accordance with new
evidence, changing practice, rapidly emerging treatment options, and new technology. This
guideline will be updated or withdrawn in five years in accordance with the standards of the
National Guideline Clearinghouse.
GUIDELINE DISSEMINATION PLANS

The primary purpose of the present document is to provide interested readers with full
documentation about not only our recommendations, but also about how we arrived at those
recommendations.
37
To view all AAOS published guideline recommendations in a user-friendly app, please visit
www.orthoguidelines.org.
Shorter versions of the guideline are available in other venues. Publication of most guidelines is
announced by an Academy press release, articles authored by the guideline development group
and published in the Journal of the American Academy of Orthopaedic Surgeons, and articles
published in AAOS Now. Most guidelines are also distributed at the AAOS Annual Meeting in
various venues such as on Academy Row and at Committee Scientific Exhibits.
Selected guidelines are disseminated by webinar, an Online Module for the Orthopaedic
Knowledge Online website, Radio Media Tours, Media Briefings, and by distributing them at
relevant Continuing Medical Education (CME) courses and at the AAOS Resource Center.
Other dissemination efforts outside of the AAOS will include submitting the guideline to the
National Guideline Clearinghouse and distributing the guideline at other medical specialty
societies meetings.
38
V. Overview of Articles by Recommendation*
*Note, some articles were applicable to multiple recommendations
39
VI. FULL GUIDELINE RECOMMENDATIONS
PHYSICAL EXAM GUIDELINE RECOMMENDATIONS

A. OBSERVATION
Strong evidence supports Thenar atrophy is strongly associated with ruling-in
carpal tunnel syndrome, but poorly associated with ruling-out carpal tunnel
syndrome.

Description: Evidence from two or more High quality studies with consistent findings for recommending for or
There were two high quality (Claes, 2013; Naranjo, 2007) and two moderate quality studies
(Gomes, 2006; Makanji, 2014) with strong evidence that the presence of thenar atrophy can rule
in the diagnosis of CTS. Pooling the results into a meta-analysis demonstrated a strong
association with electrodiagnostic studies (EDS) that used the criteria for the diagnosis of CTS
established by the American Association of Electrodiagnostic Medicine (AANEM). The
individual studies, as well as the meta-analysis, showed that the absence of thenar atrophy did
not rule out the diagnosis of CTS. The meta-analysis did not include two moderate quality
studies (De Krom, 1990 or Gerr, 1998) because of variations in the electrodiagnostic test
methods and also because of the availability of higher quality evidence examining the utility of
thenar atrophy. The study by Claes was somewhat limited by its exclusion of the patients with
severe thenar atrophy. The studies also did not clearly differentiate loss of thenar muscle bulk on
a neurogenic basis versus disuse atrophy, for example in cases of trapeziometacarpal joint
osteoarthritis.
B. PHYSICAL SIGNS
Strong evidence supports not using the Phalen Test, Tinel Sign, Flick Sign, or
Upper limb neurodynamic/nerve tension test (ULNT) criterion A/B as independent
physical examination maneuvers to diagnose carpal tunnel syndrome, because
alone, each has a poor or weak association with ruling-in or ruling-out carpal
tunnel syndrome.

Rationale
Evidence from five high quality studies (Gok, 2008; Naranjo, 2007; Vanti, 2011; Vanti, 2012;
Wainner, 2005) and one moderate quality study (Tan, 2012) supports not using the Phalen Test,
Tinel Sign, Flick Sign, or ULNT criterion A/B as independent physical examination maneuvers
40
to rule in or rule out the diagnosis of carpal tunnel syndrome. Each of these studies showed poor
agreement with electrodiagnostic tests as the reference standard. The EDS criteria in some
instances used the AANEM criteria and in others general EDS methods. A meta-analysis of the
performance of the Tinel sign and Phalen test also demonstrated poor agreement to this reference
standard.
C. MANEUVERS
Moderate evidence supports not using the following as independent physical
examination maneuvers to diagnose carpal tunnel syndrome, because alone, each
has a poor or weak association with ruling-in or ruling-out carpal tunnel syndrome:
Carpal Compression test
Reverse Phalen Test
Thenar Weakness or Thumb Abduction Weakness or Abductor Pollicis
Brevis Manual Muscle Testing
2-point discrimination
Semmes-Weinstein Monofilament Test
CTS-Relief Maneuver (CTS-RM)
Pin Prick Sensory Deficit; thumb or index or middle finger
ULNT Criterion C
Tethered median nerve stress test
Vibration perception tuning fork
Scratch collapse test
Luthy sign
Pinwheel

Description: Evidence from two or more Moderate quality studies with consistent findings, or evidence from a
Rationale
Several moderate and high quality studies provided a moderate level of evidence to suggest that
the various tests listed above were not found to have been used as individual tests to rule in or
rule out the diagnosis of CTS. CTS-RM had a moderate association to the reference standard
when ruling-in CTS according to one high quality study (Gok, 2008) however the
generalizability of these results is unclear because the study sample only contained female
subjects. Meta-analysis could not be performed on any of these studies due to inconsistent
reporting or lack of sufficient evidence. The reference standard for comparison was the use of
either electrodiagnostic studies (EDS) following AANEM criteria or other general EDS methods.
There is conflicting evidence of whether or not combining tests helps to rule in or rule out the
diagnosis of CTS, as the test combinations were not validated or weighted to ensure reliability,
41
accuracy, and/or clinical relevance; any valid scales are evaluated in the diagnostic scales
recommendation.
Risks and Harms of Implementing the Physical Exam and History Interview
Recommendations
There are no known harms associated with implementing these recommendations.
Future Research
Future studies should define diagnostic reference standard. The development of standardized
diagnostic scales and stand-alone maneuvers or tests should be evaluated against a reference
standard. Studies should include appropriate blinding as well as timing between tests to allow
for unbiased and accurate assessments.
42
STUDY QUALITY TABLE OF PHYSICAL EXAM AND HISTORY INTERVIEW RECOMMENDATIONS
Table 5. Diagnostic Quality Evaluations
Representative Clear Selection Detailed Enough to Reference Standard Identifies Target Other
Study Blinding Inclusion Strength
Population Criteria Replicate Condition Bias?
Bilkis,S., 2012 Include Moderate Quality
Bland,J.D., 2000 Include Moderate Quality
Boland,R.A., 2009 Include Moderate Quality
Claes,F., 2013 Include High Quality
Dale,A.M., 2011 Include Moderate Quality
De Krom,M.C., 1990 Include Moderate Quality
De,Smet L., 1995 Include Moderate Quality
El,Miedany Y., 2008 Include Moderate Quality
Gerr,F., 1998 Include Moderate Quality
Gok,H., 2008 Include High Quality
Gomes,I., 2006 Include Moderate Quality
Hansen,P.A., 2004 Include Moderate Quality
Heller,L., 1986 Include Moderate Quality
Karl,A.I., 2001 Include Moderate Quality
Katz,J.N., 1990 Include High Quality
Katz,J.N., 1991 Include Moderate Quality
Kaul,M.P., 2000 Include High Quality
Kaul,M.P., 2001 Include Moderate Quality
Khosrawi,S., 2012 Include Low Quality
Kuhlman,K.A., 1997 Include Moderate Quality
MacDermid,J.C., 1997 Include Moderate Quality
Makanji,H.S., 2014 Include Moderate Quality
Naranjo,A., 2007 Include High Quality
Ntani,G., 2013 Include High Quality
Padua,L., 1999 Include Moderate Quality
Pagel,K.J., 2002 Include High Quality
Raudino,F., 2000 Include Moderate Quality
43
Study Blinding Inclusion Strength
Population Criteria Replicate Condition Bias?
Tan,S.V., 2012 Include Moderate Quality
Vanti,C., 2011 Include High Quality
Wainner,R.S., 2005 Include High Quality
Weber,R.A., 2000 Include Moderate Quality
Witt,J.C., 2004 Include Moderate Quality
44
RESULTS
SUMMARY OF DATA FINDINGS
TABLE 6: SUMMARY OF FINDINGS- INDEX TEST VERSUS AANEM REFERENCED EDS
High Quality Moderate Quality
*De Krom,M.C., 1990
El,Miedany Y., 2008
*Hansen,P.A., 2004
Wainner,R.S., 2005
Makanji,H.S., 2014
Boland,R.A., 2009
*Bland,J.D., 2000
Naranjo,A., 2007
Raudino,F., 2000
Gomes,I., 2006
Padua,L., 1999
Witt,J.C., 2004
Tan,S.V., 2012
*Gerr,F., 1998
Vanti,C., 2011
Vanti,C., 2012
Claes,F., 2013
Gok,H., 2008
Index Test Rule In/Out Meta-Analysis

RULE IN NA
Carpal Compression Test (CCT)
RULE OUT NA
RULE IN NA
Flick Sign
RULE OUT NA
RULE IN
Phalen Test
RULE OUT
RULE IN NA
Reverse Phalen Test
RULE OUT NA
RULE IN NA
Thenar Weakness
RULE OUT NA
RULE IN NA
Thumb Abduction Weakness
RULE OUT NA
RULE IN
Thenar Atrophy
RULE OUT
RULE IN
Tinel Sign
RULE OUT
RULE IN NA
ULNT1; criterion A
RULE OUT NA
RULE IN NA
ULNT1; criterion B
RULE OUT NA
Table only displays index tests with more than one article of supporting evidence
*EDS method used in the study does not directly reference AAEM criteria and cannot be included in meta-analysis
45
TABLE 7: SUMMARY OF FINDINGS- INDEX TEST VERSUS GENERAL EDS METHODS
LR + LR -
>10 <0.1 In "STRONG" agreement with the reference standard
>5 but <10 >0.1 but <0.2 In "MODERATE" agreement with the reference standard
>2 and <5 >0.2 but <0.5 In "WEAK" agreement with the reference standard
<2 >0.5 In "POOR" agreement with the reference standard
High Quality Moderate Quality Low Quality
MacDermid,J.C., 1997 (1)
MacDermid,J.C., 1997 (2)

De Krom,M.C., 1990
Kuhlman,K.A., 1997
Dale,A.M., 2011 (1)
Dale,A.M., 2011 (2)
Dale,A.M., 2011 (3)
Dale,A.M., 2011 (4)
Dale,A.M., 2011 (5)
Dale,A.M., 2011 (6)
Hansen,P.A., 2004
Katz,J.N., 1990 (B)
Khosrawi,S., 2012
De,Smet L., 1995
Kaul,M.P., 2001
Pagel,K.J., 2002
Katz,J.N., 1991
Ntani,G., 2013
Heller,L., 1986
Bilkis,S., 2012
Gerr,F., 1998
RULE IN NA
2 Point Discrimination
RULE OUT NA
RULE IN NA
Carpal Compression Test (CCT)
RULE OUT NA
RULE IN
Phalen Test (PT)
RULE OUT
RULE IN
Tinel Sign (TS)
RULE OUT
RULE IN
Phalen Test and Tinel Sign
RULE OUT
RULE IN NA
Phalen Test or Tinel Sign
RULE OUT NA
Semmes-Weinstein RULE IN NA
Monofilament Test (SWMF) RULE OUT NA
RULE IN NA
Thenar Weakness
RULE OUT NA
Authors with parenthetical numbers indicate a change in method of EDS, alternate limbs, or alternate examiner
Authors with parenthetical letters indicate a unique study with the same author and year as another study listed in the guideline
46
DETAILED DATA FINDINGS
TABLE 8: HIGH QUALITY STUDIES- PICO 1 (PHYSICAL TESTS VERSUS REFERENCE STANDARD)
Outcome Outcomes Group1 Group2 Rule Rule
Reference (Index Patient Threshold Reported (Reference Group1 (Reference Group2 In Out
Title Quality Test) Characteristics Notes By Standard) N Standard) N PPV|NPV Sens|Spec LR+|LR- Test Test
Claes,F., High CTS Positive clinically at least 2 of Subjects index pos; 99 index neg; 57 0.82|0.14 0.62|0.31 0.90|1.22 POOR POOR
2013 Quality (2 Point diagnosed CTS 4 abnormal 2point; 2point;
Discrimination) suspects EDS SWMF; both SWMF; both
parameters (Nerve (Nerve
Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
referenced) referenced)
2013 Quality (2 Point diagnosed CTS 4 abnormal 2point; 2point;
Discrimination suspects EDS SWMF; both SWMF; both
and Semmes- parameters (Nerve (Nerve
Weinstein Conduction Conduction
Monofilament Studies Studies
Test (SWMF) (NCS); (NCS);
1) AANEM AANEM
2013 Quality (Semmes- diagnosed CTS 4 abnormal 2point; 2point;
Weinstein suspects EDS SWMF; both SWMF; both
Monofilament parameters (Nerve (Nerve
Test (SWMF) Conduction Conduction
1) Studies Studies
(NCS); (NCS);
AANEM AANEM
Claes,F., High CTS Positive clinically at least 2 of Subjects index pos; 36 index neg; 120 0.97|0.21 0.27|0.96 7.00|0.76 MODERATE POOR
2013 Quality (Thenar diagnosed CTS 4 abnormal Gender/Sex Gender/Sex
Atrophy) suspects EDS F, M; Hand F, M; Hand
parameters R, L; thenar R, L; thenar
atrophy; atrophy;
weakness; OP weakness; OP
weakness weakness
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
47
Claes,F., High CTS Positive clinically at least 2 of Subjects index pos; 46 index neg; 110 0.96|0.22 0.34|0.92 4.40|0.72 WEAK POOR
2013 Quality (Thenar diagnosed CTS 4 abnormal Gender/Sex Gender/Sex
Weakness) suspects EDS F, M; Hand F, M; Hand
atrophy; atrophy;
weakness; OP weakness; OP
weakness weakness
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Gok,H., 2008 High CTS Positive all female Subjects index pos; 51 index neg; 36 0.92|0.69 0.81|0.86 5.88|0.22 MODERATE WEAK
Quality (CTS-RM: subjects with flick sign; flick sign;
Relief CTS symptoms relief relief
maneuver) maneuver maneuver
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Gok,H., 2008 High CTS Positive all female Subjects index pos; 40 index neg; 47 0.95|0.57 0.66|0.93 9.50|0.37 MODERATE WEAK
Quality (CTS-RM: subjects with flick sign; flick sign;
Relief CTS symptoms relief relief
maneuver and maneuver maneuver
Flick Sign) (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Gok,H., 2008 High CTS Positive all female Subjects index pos; 46 index neg; 41 0.87|0.56 0.69|0.79 3.33|0.39 WEAK WEAK
Quality (Flick Sign) subjects with flick sign; flick sign;
CTS symptoms relief relief
maneuver maneuver
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
48
Katz,J.N., High CTS Positive discomfort referenced Subjects index pos; 27 index neg; 83 0.52|0.64 0.32|0.80 1.62|0.85 POOR POOR
1990 (B) Quality (2 Point patients sensory and PT; TS; 2 PT; TS; 2
Discrimination) suspected of motor point; point;
CTS cutoffs combinations; combinations;
combinations combinations
with katz with katz
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
1990 (B) Quality (Phalen Test) patients sensory and PT; TS; 2 PT; TS; 2
suspected of motor point; point;
with katz with katz
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
Katz,J.N., High CTS Positive discomfort referenced Subjects index pos; 33 index neg; 77 0.67|0.71 0.50|0.83 3.00|0.60 WEAK POOR
1990 (B) Quality (Phalen Test patients sensory and PT; TS; 2 PT; TS; 2
and Katz Hand suspected of motor point; point;
Diagram; CTS cutoffs combinations; combinations;
classic or combinations combinations
probable) with katz with katz
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
1990 (B) Quality (Phalen Test patients sensory and PT; TS; 2 PT; TS; 2
and Tinel Sign) suspected of motor point; point;
with katz with katz
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
49
Katz,J.N., High CTS Positive discomfort referenced Subjects index pos; 77 index neg; 33 0.47|0.76 0.82|0.38 1.32|0.48 POOR WEAK
1990 (B) Quality (Phalen Test or patients sensory and PT; TS; 2 PT; TS; 2
Katz Hand suspected of motor point; point;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
1990 (B) Quality (Phalen Test or patients sensory and PT; TS; 2 PT; TS; 2
Tinel Sign) suspected of motor point; point;
with katz with katz
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
1990 (B) Quality (Tinel Sign) patients sensory and PT; TS; 2 PT; TS; 2
suspected of motor point; point;
with katz with katz
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
1990 (B) Quality (Tinel Sign and patients sensory and PT; TS; 2 PT; TS; 2
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
50
1990 (B) Quality (Tinel Sign or patients sensory and PT; TS; 2 PT; TS; 2
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
Kaul,M.P., High CTS Positive CTS suspected multiple Subjects index pos; 47 index neg; 55 0.62|0.47 0.50|0.59 1.22|0.85 POOR POOR
2000 Quality (Tethered veterans parameters TMST TMST
Median Stress used within (Nerve (Nerve
Test (TMST)) NCS Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with determined Extremities index pos; 78 index neg; 27 0.78|0.30 0.76|0.32 1.12|0.74 POOR POOR
2007 Quality (Phalen Test) suspected CTS NCS and PT, TS, PT, TS,
US cutoffs PT/TS (Nerve PT/TS (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with determined Extremities index pos; 81 index neg; 24 0.83|0.46 0.84|0.44 1.50|0.37 POOR WEAK
2007 Quality (Phalen Test suspected CTS NCS and PT, TS, PT, TS,
and Tinel Sign) US cutoffs PT/TS (Nerve PT/TS (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with determined Extremities index pos; 4 index neg; 101 1.00|0.25 0.05|1.00 10.00|0.95 STRONG POOR
2007 Quality (Thenar suspected CTS NCS and thenar thenar
Atrophy) US cutoffs atrophy atrophy
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
51
Naranjo,A., High CTS Positive 68 patients with determined Extremities index pos; 74 index neg; 31 0.80|0.32 0.74|0.40 1.23|0.66 POOR POOR
2007 Quality (Tinel Sign) suspected CTS NCS and PT, TS, PT, TS,
US cutoffs PT/TS (Nerve PT/TS (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Ntani,G., High CTS Positive responders SNC Extremities index pos; 865 index neg; 696 0.89|0.18 0.57|0.56 1.32|0.76 POOR POOR
2013 Quality (Phalen Test) from all abnormality TS; PT TS; PT
suspected CTS (Nerve (Nerve
out-patients Conduction Conduction
Studies Studies
(NCS); (NCS);
Sensory Sensory
Nerve Nerve
(SNC)) (SNC))
2013 Quality (Thenar from all abnormality thenar thenar
Weakness) suspected CTS weakness; weakness;
out-patients pain (Nerve pain (Nerve
Studies Studies
(NCS); (NCS);
Sensory Sensory
Nerve Nerve
(SNC)) (SNC))
2013 Quality (Tinel Sign) from all abnormality TS; PT TS; PT
suspected CTS (Nerve (Nerve
out-patients Conduction Conduction
Studies Studies
(NCS); (NCS);
Sensory Sensory
Nerve Nerve
(SNC)) (SNC))
52
Pagel,K.J., High CTS Positive symptoms of two cutoff Subjects index pos; 104 index neg; 9 0.57|0.89 0.98|0.15 1.16|0.11 POOR MODERATE
2002 Quality (Semmes- suspected CTS values for SWMF 1, 2 SWMF 1, 2
Weinstein each (Nerve (Nerve
Monofilament SWMF Conduction Conduction
Test (SWMF) method; Studies Studies
1) NCS by (NCS)) (NCS))
palm diff
median to
ulnar
latency
Pagel,K.J., High CTS Positive symptoms of two cutoff Subjects index pos; 15 index neg; 98 0.53|0.47 0.13|0.87 1.01|1.00 POOR POOR
2002 Quality (Semmes- suspected CTS values for SWMF 1, 2 SWMF 1, 2
Weinstein each (Nerve (Nerve
Monofilament SWMF Conduction Conduction
Test (SWMF) method; Studies Studies
2) NCS by (NCS)) (NCS))
palm diff
median to
ulnar
latency
Tan,S.V., Moderate CTS Positive limbs of 100 at least 2 Extremities index pos; 65 index neg; 135 0.65|0.58 0.42|0.77 1.86|0.75 POOR POOR
2012 Quality (Phalen Test) CTS suspects abnormal PT; TS PT; TS
EDS (Nerve (Nerve
parameters Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
Tan,S.V., Moderate CTS Positive limbs of 100 at least 2 Extremities index pos; 39 index neg; 161 0.72|0.56 0.28|0.89 2.60|0.80 WEAK POOR
2012 Quality (Tinel Sign) CTS suspects abnormal PT; TS PT; TS
EDS (Nerve (Nerve
parameters Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
53
Vanti,C., High CTS Positive 47 clinical CTS symptoms Subjects index pos; 19 index neg; 25 0.68|0.56 0.54|0.70 1.81|0.65 POOR POOR
2011 Quality (ULNT1; suspects; 3 did and ULNT1, A, ULNT1, A,
criterion A) not complete reduced A/B/C (Nerve A/B/C (Nerve
tests scv-wp Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
Vanti,C., High CTS Positive 47 clinical CTS symptoms Subjects index pos; 39 index neg; 5 0.56|0.60 0.92|0.15 1.08|0.56 POOR POOR
2011 Quality (ULNT1; suspects; 3 did and ULNT1, A, ULNT1, A,
criterion A, B, not complete reduced A/B/C (Nerve A/B/C (Nerve
and C) tests scv-wp Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
Vanti,C., High CTS Positive limbs of 47 Extremities index pos; 24 index neg; 60 0.58|0.65 0.40|0.80 1.96|0.75 POOR POOR
2012 Quality (ULNT1; patients ULNT1, A, ULNT1, A,
criterion A) B, C (Nerve B, C (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
criterion B) B, C (Nerve B, C (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
criterion C) B, C (Nerve B, C (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
54
Wainner,R.S., High CTS Positive CTS and Subjects index pos; 11 index neg; 71 0.45|0.68 0.18|0.89 1.61|0.92 POOR POOR
2005 Quality (Abductor cervical ULNT1, A, ULNT1, A,
Pollicis Brevis radiculopathy B; TS, TS 2; B; TS, TS 2;
Manual Muscle suspects CCT; PT; CCT; PT;
Testing) Flick (Nerve Flick (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (Carpal cervical ULNT1, A, ULNT1, A,
Compression radiculopathy B; TS, TS 2; B; TS, TS 2;
Test (CCT)) suspects CCT; PT; CCT; PT;
Flick (Nerve Flick (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Wainner,R.S., High CTS Positive CTS and Subjects index pos; 46 index neg; 36 0.50|0.86 0.82|0.57 1.93|0.31 POOR WEAK
2005 Quality (Flick Sign) cervical ULNT1, A, ULNT1, A,
radiculopathy B; TS, TS 2; B; TS, TS 2;
suspects CCT; PT; CCT; PT;
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (Phalen Test) cervical ULNT1, A, ULNT1, A,
Studies Studies
(NCS); (NCS);
AANEM AANEM
55
2005 Quality (Sensory cervical ULNT1, A, ULNT1, A,
Deficit; pin radiculopathy B; TS, TS 2; B; TS, TS 2;
prick; index suspects CCT; PT; CCT; PT;
finger) Flick (Nerve Flick (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
prick; middle suspects CCT; PT; CCT; PT;
finger) Flick (Nerve Flick (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Wainner,R.S., High CTS Positive CTS and Subjects index pos; 34 index neg; 48 0.53|0.79 0.64|0.70 2.17|0.51 WEAK POOR
prick; thumb) suspects CCT; PT; CCT; PT;
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (Tinel Sign) cervical ULNT1, A, ULNT1, A,
Studies Studies
(NCS); (NCS);
AANEM AANEM
56
2005 Quality (Tinel Sign 2) cervical ULNT1, A, ULNT1, A,
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (ULNT1; cervical ULNT1, A, ULNT1, A,
criterion A) radiculopathy B; TS, TS 2; B; TS, TS 2;
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (ULNT1; cervical ULNT1, A, ULNT1, A,
criterion B) radiculopathy B; TS, TS 2; B; TS, TS 2;
Studies Studies
(NCS); (NCS);
AANEM AANEM
57
TABLE 9: MODERATE QUALITY STUDIES- PICO 1 (PHYSICAL TESTS VERSUS REFERENCE STANDARD)
Bilkis,S., 2012 Moderate CTS Positive 37 patients with determined Extremities index pos; PT; 39 index neg; PT; 27 1.00|0.74 0.85|1.00 10.00|0.15 STRONG MODERATE
Quality (Modified comorbidities mixed nerve MPT (Nerve MPT (Nerve
Phalen Test) excluded NCS cutoffs Conduction Conduction
Studies (NCS)) Studies (NCS))
Bilkis,S., 2012 Moderate CTS Positive 37 patients with determined Extremities index pos; PT; 23 index neg; PT; 43 1.00|0.47 0.50|1.00 10.00|0.50 STRONG WEAK
Quality (Phalen Test) comorbidities mixed nerve MPT (Nerve MPT (Nerve
excluded NCS cutoffs Conduction Conduction
Bland,J.D., 2000 Moderate CTS Positive 7768 East Kent sensory and Extremities index pos; Flick 4093 index neg; Flick 4130 0.64|0.50 0.56|0.59 1.37|0.74 POOR POOR
Quality (Flick Sign) referrals to motor latency (Nerve Conduction (Nerve Conduction
NCS lab for cutoffs Studies (NCS)) Studies (NCS))
suspected CTS
Boland,R.A., Moderate CTS Positive 43 hands of referenced Extremities index pos; PT; 10 index neg; PT; 76 1.00|0.16 0.14|1.00 10.00|0.86 STRONG POOR
2009 Quality (Modified CTS suspects median and MCCT; PT or MCCT; PT or
Carpal mixed nerve MCCT with no MCCT with no
Compression cutoffs thenar sensory thenar sensory
Test (MCCT)) deficit (Nerve deficit (Nerve
Studies (NCS); Studies (NCS);
AANEM AANEM
Boland,R.A., Moderate CTS Positive 43 hands of referenced Extremities index pos; PT; 9 index neg; PT; 77 1.00|0.16 0.12|1.00 10.00|0.88 STRONG POOR
2009 Quality (Modified CTS suspects median and MCCT; PT or MCCT; PT or
Carpal mixed nerve MCCT with no MCCT with no
Compression cutoffs thenar sensory thenar sensory
Test (MCCT) deficit (Nerve deficit (Nerve
and no thenar Conduction Conduction
sensory deficit) Studies (NCS); Studies (NCS);
AANEM AANEM
Boland,R.A., Moderate CTS Positive 43 hands of referenced Extremities index pos; PT; 50 index neg; PT; 36 0.94|0.25 0.64|0.75 2.54|0.49 WEAK WEAK
2009 Quality (Phalen Test) CTS suspects median and MCCT; PT or MCCT; PT or
mixed nerve MCCT with no MCCT with no
cutoffs thenar sensory thenar sensory
deficit (Nerve deficit (Nerve
AANEM AANEM
58
Boland,R.A., Moderate CTS Positive 43 hands of referenced Extremities index pos; PT; 44 index neg; PT; 42 0.93|0.21 0.55|0.75 2.22|0.59 WEAK POOR
2009 Quality (Phalen Test CTS suspects median and MCCT; PT or MCCT; PT or
and no thenar mixed nerve MCCT with no MCCT with no
sensory deficit) cutoffs thenar sensory thenar sensory
deficit (Nerve deficit (Nerve
AANEM AANEM
Dale,A.M., 2011 Moderate CTS Positive 1108 recruits sensory, Extremities index pos; LEFT 423 index neg; LEFT 685 0.02|0.99 0.64|0.62 1.68|0.59 POOR POOR
(1) Quality (At least Phalen from 11 motor, and HAND; PT; TS; HAND; PT; TS;
Test, Tinel occupations of MUDS SWMF1; SWMF1;
Sign, or potential CTS cutoffs combinations combinations
Semmes- risk (Nerve Conduction (Nerve Conduction
Weinstein Studies (NCS) and Studies (NCS) and
Monofilament Katz Hand Katz Hand
Test 1) Diagram; classic or Diagram; classic or
probable) probable)
(1) Quality (Phalen Test) from 11 motor, and HAND; PT; TS; HAND; PT; TS;
occupations of MUDS SWMF1; SWMF1;
potential CTS cutoffs combinations combinations
risk (Nerve Conduction (Nerve Conduction
Studies (NCS) and Studies (NCS) and
Katz Hand Katz Hand
Diagram; classic or Diagram; classic or
probable) probable)
Dale,A.M., 2011 Moderate CTS Positive 1108 recruits sensory, Extremities index pos; LEFT 32 index neg; LEFT 1076 0.06|0.99 0.18|0.97 6.65|0.84 MODERATE POOR
(1) Quality (Phalen Test from 11 motor, and HAND; PT; TS; HAND; PT; TS;
and Semmes- occupations of MUDS SWMF1; SWMF1;
Weinstein potential CTS cutoffs combinations combinations
Monofilament risk (Nerve Conduction (Nerve Conduction
Test 1) Studies (NCS) and Studies (NCS) and
Katz Hand Katz Hand
probable) probable)
Dale,A.M., 2011 Moderate CTS Positive 1108 recruits sensory, Extremities index pos; LEFT 25 index neg; LEFT 1083 0.04|0.99 0.09|0.98 4.16|0.93 WEAK POOR
and Tinel Sign) occupations of MUDS SWMF1; SWMF1;
Katz Hand Katz Hand
probable) probable)
59
Dale,A.M., 2011 Moderate CTS Positive 1108 recruits sensory, Extremities index pos; LEFT 8 index neg; LEFT 1100 0.13|0.99 0.09|0.99 14.25|0.91 STRONG POOR
(1) Quality (Phalen Test, from 11 motor, and HAND; PT; TS; HAND; PT; TS;
Tinel Sign, and occupations of MUDS SWMF1; SWMF1;
Semmes- potential CTS cutoffs combinations combinations
Weinstein risk (Nerve Conduction (Nerve Conduction
Monofilament Studies (NCS) and Studies (NCS) and
Test 1) Katz Hand Katz Hand
probable) probable)
(1) Quality (Semmes- from 11 motor, and HAND; PT; TS; HAND; PT; TS;
Weinstein occupations of MUDS SWMF1; SWMF1;
Monofilament potential CTS cutoffs combinations combinations
Test (SWMF) risk (Nerve Conduction (Nerve Conduction
1) Studies (NCS) and Studies (NCS) and
Katz Hand Katz Hand
probable) probable)
(1) Quality (Tinel Sign) from 11 motor, and HAND; PT; TS; HAND; PT; TS;
Katz Hand Katz Hand
probable) probable)
Dale,A.M., 2011 Moderate CTS Positive 1108 recruits sensory, Extremities index pos; LEFT 39 index neg; LEFT 1069 0.05|0.99 0.18|0.97 5.39|0.85 MODERATE POOR
(1) Quality (Tinel Sign and from 11 motor, and HAND; PT; TS; HAND; PT; TS;
Semmes- occupations of MUDS SWMF1; SWMF1;
Katz Hand Katz Hand
probable) probable)
Weinstein Studies (NCS)) Studies (NCS))
Monofilament
Test 1)
60
Test 1) Studies (NCS)) Studies (NCS))
Monofilament Studies (NCS)) Studies (NCS))
Test 1)
1) Studies (NCS)) Studies (NCS))
61
Dale,A.M., 2011 Moderate CTS Positive 1108 recruits sensory, Extremities index pos; RIGHT 443 index neg; RIGHT 665 0.37|0.79 0.54|0.65 1.57|0.70 POOR POOR
Weinstein Studies (NCS)) Studies (NCS))
Monofilament
Test 1)
Dale,A.M., 2011 Moderate CTS Positive 1108 recruits sensory, Extremities index pos; RIGHT 51 index neg; RIGHT 1057 0.49|0.73 0.08|0.97 2.52|0.95 WEAK POOR
Monofilament Studies (NCS)) Studies (NCS))
Test 1)
1) Studies (NCS)) Studies (NCS))
62
Weinstein Studies (NCS) and Studies (NCS) and
Monofilament Katz Hand Katz Hand
Test 1) Diagram; classic or Diagram; classic or
probable) probable)
Katz Hand Katz Hand
probable) probable)
Dale,A.M., 2011 Moderate CTS Positive 1108 recruits sensory, Extremities index pos; RIGHT 51 index neg; RIGHT 1057 0.14|0.98 0.29|0.96 7.19|0.74 MODERATE POOR
Katz Hand Katz Hand
probable) probable)
Katz Hand Katz Hand
probable) probable)
63
probable) probable)
Dale,A.M., 2011 Moderate CTS Positive 1108 recruits sensory, Extremities index pos; RIGHT 342 index neg; RIGHT 766 0.05|0.99 0.67|0.70 2.22|0.48 WEAK WEAK
1) Studies (NCS) and Studies (NCS) and
Katz Hand Katz Hand
probable) probable)
Katz Hand Katz Hand
probable) probable)
Katz Hand Katz Hand
probable) probable)
Dale,A.M., 2011 Moderate CTS Positive 76 clinically sensory, Extremities index pos; 44 index neg; 32 0.16|0.88 0.64|0.43 1.12|0.84 POOR POOR
(5) Quality (At least Phalen suspected motor, and SYMPT: LEFT SYMPT: LEFT
Test, Tinel symptomatic MUDS HAND; PT; TS; HAND; PT; TS;
Sign, or hands cutoffs SWMF1; SWMF1;
Semmes- combinations combinations
Weinstein (Nerve Conduction (Nerve Conduction
probable) probable)
64
(5) Quality (Phalen Test) suspected motor, and SYMPT: LEFT SYMPT: LEFT
symptomatic MUDS HAND; PT; TS; HAND; PT; TS;
hands cutoffs SWMF1; SWMF1;
(Nerve Conduction (Nerve Conduction
Katz Hand Katz Hand
probable) probable)
(5) Quality (Phalen Test suspected motor, and SYMPT: LEFT SYMPT: LEFT
and Semmes- symptomatic MUDS HAND; PT; TS; HAND; PT; TS;
Weinstein hands cutoffs SWMF1; SWMF1;
Monofilament combinations combinations
Test 1) (Nerve Conduction (Nerve Conduction
Katz Hand Katz Hand
probable) probable)
(5) Quality (Phalen Test suspected motor, and SYMPT: LEFT SYMPT: LEFT
and Tinel Sign) symptomatic MUDS HAND; PT; TS; HAND; PT; TS;
Katz Hand Katz Hand
probable) probable)
Dale,A.M., 2011 Moderate CTS Positive 76 clinically sensory, Extremities index pos; 2 index neg; 74 0.50|0.86 0.09|0.98 5.91|0.92 MODERATE POOR
(5) Quality (Phalen Test, suspected motor, and SYMPT: LEFT SYMPT: LEFT
Tinel Sign, and symptomatic MUDS HAND; PT; TS; HAND; PT; TS;
Semmes- hands cutoffs SWMF1; SWMF1;
Weinstein combinations combinations
Monofilament (Nerve Conduction (Nerve Conduction
Katz Hand Katz Hand
probable) probable)
65
(5) Quality (Semmes- suspected motor, and SYMPT: LEFT SYMPT: LEFT
Weinstein symptomatic MUDS HAND; PT; TS; HAND; PT; TS;
Monofilament hands cutoffs SWMF1; SWMF1;
Test (SWMF) combinations combinations
1) (Nerve Conduction (Nerve Conduction
Katz Hand Katz Hand
probable) probable)
(5) Quality (Tinel Sign) suspected motor, and SYMPT: LEFT SYMPT: LEFT
Katz Hand Katz Hand
probable) probable)
(5) Quality (Tinel Sign and suspected motor, and SYMPT: LEFT SYMPT: LEFT
Semmes- symptomatic MUDS HAND; PT; TS; HAND; PT; TS;
Katz Hand Katz Hand
probable) probable)
(6) Quality (At least Phalen suspected motor, and SYMPT: RIGHT SYMPT: RIGHT
Test, Tinel symptomatic MUDS HAND; PT; TS; HAND; PT; TS;
Sign, or hands cutoffs SWMF1; SWMF1;
Semmes- combinations combinations
Weinstein (Nerve Conduction (Nerve Conduction
probable) probable)
66
(6) Quality (Phalen Test) suspected motor, and SYMPT: RIGHT SYMPT: RIGHT
Katz Hand Katz Hand
probable) probable)
Dale,A.M., 2011 Moderate CTS Positive 113 clinically sensory, Extremities index pos; 19 index neg; 94 0.32|0.84 0.29|0.86 2.02|0.83 WEAK POOR
(6) Quality (Phalen Test suspected motor, and SYMPT: RIGHT SYMPT: RIGHT
and Semmes- symptomatic MUDS HAND; PT; TS; HAND; PT; TS;
Katz Hand Katz Hand
probable) probable)
(6) Quality (Phalen Test suspected motor, and SYMPT: RIGHT SYMPT: RIGHT
and Tinel Sign) symptomatic MUDS HAND; PT; TS; HAND; PT; TS;
Katz Hand Katz Hand
probable) probable)
Dale,A.M., 2011 Moderate CTS Positive 113 clinically sensory, Extremities index pos; 5 index neg; 108 0.40|0.82 0.10|0.97 2.92|0.94 WEAK POOR
(6) Quality (Phalen Test, suspected motor, and SYMPT: RIGHT SYMPT: RIGHT
Tinel Sign, and symptomatic MUDS HAND; PT; TS; HAND; PT; TS;
Semmes- hands cutoffs SWMF1; SWMF1;
Weinstein combinations combinations
Monofilament (Nerve Conduction (Nerve Conduction
Katz Hand Katz Hand
probable) probable)
67
(6) Quality (Semmes- suspected motor, and SYMPT: RIGHT SYMPT: RIGHT
Weinstein symptomatic MUDS HAND; PT; TS; HAND; PT; TS;
Monofilament hands cutoffs SWMF1; SWMF1;
Test (SWMF) combinations combinations
1) (Nerve Conduction (Nerve Conduction
Katz Hand Katz Hand
probable) probable)
(6) Quality (Tinel Sign) suspected motor, and SYMPT: RIGHT SYMPT: RIGHT
Katz Hand Katz Hand
probable) probable)
(6) Quality (Tinel Sign and suspected motor, and SYMPT: RIGHT SYMPT: RIGHT
Semmes- symptomatic MUDS HAND; PT; TS; HAND; PT; TS;
Katz Hand Katz Hand
probable) probable)
De Krom,M.C., Moderate CTS Positive random DML and Extremities index pos; Flick; 27 index neg; Flick; 66 0.63|0.59 0.39|0.80 1.89|0.77 POOR POOR
1990 Quality (Abductor selection of DSL with PT; TS; RPT; PT; TS; RPT;
Pollicis Brevis general pop referenced CCT; Luthy; CCT; Luthy;
Paresis) with 50 that normal values Hypagalsia; Hypagalsia;
admitted to Hyperpathia; Hyperpathia;
persistent CTS Thenar; OP; APB; Thenar; OP; APB;
symptoms tourniquet (Nerve tourniquet (Nerve
1990 Quality (Carpal selection of DSL with PT; TS; RPT; PT; TS; RPT;
Compression general pop referenced CCT; Luthy; CCT; Luthy;
Test (CCT)) with 50 that normal values Hypagalsia; Hypagalsia;
68
1990 Quality (Flick Sign) selection of DSL with PT; TS; RPT; PT; TS; RPT;
general pop referenced CCT; Luthy; CCT; Luthy;
with 50 that normal values Hypagalsia; Hypagalsia;
1990 Quality (Hypalgesia; selection of DSL with PT; TS; RPT; PT; TS; RPT;
pinwheel) general pop referenced CCT; Luthy; CCT; Luthy;
De Krom,M.C., Moderate CTS Positive random DML and Extremities index pos; Flick; 16 index neg; Flick; 77 0.69|0.57 0.25|0.90 2.45|0.84 WEAK POOR
1990 Quality (Hyperpathia; selection of DSL with PT; TS; RPT; PT; TS; RPT;
pinwheel) general pop referenced CCT; Luthy; CCT; Luthy;
1990 Quality (Luthy Sign) selection of DSL with PT; TS; RPT; PT; TS; RPT;
1990 Quality (Opponens selection of DSL with PT; TS; RPT; PT; TS; RPT;
Pollicis Paresis) general pop referenced CCT; Luthy; CCT; Luthy;
69
1990 Quality (Phalen Test) selection of DSL with PT; TS; RPT; PT; TS; RPT;
1990 Quality (Reverse selection of DSL with PT; TS; RPT; PT; TS; RPT;
Phalen Test) general pop referenced CCT; Luthy; CCT; Luthy;
De Krom,M.C., Moderate CTS Positive random DML and Extremities index pos; thenar 10 index neg; thenar 83 0.70|0.55 0.16|0.94 2.60|0.90 WEAK POOR
1990 Quality (Thenar selection of DSL with atrophy (Nerve atrophy (Nerve
Atrophy) general pop referenced Conduction Conduction
with 50 that normal values Studies (NCS)) Studies (NCS))
admitted to
persistent CTS
symptoms
1990 Quality (Tinel Sign) selection of DSL with PT; TS; RPT; PT; TS; RPT;
1990 Quality (Tourniquet selection of DSL with PT; TS; RPT; PT; TS; RPT;
Test) general pop referenced CCT; Luthy; CCT; Luthy;
70
De,Smet L., Moderate CTS Positive 54 confirmed Slowing Extremities index pos; PT; 42 index neg; PT; 24 0.81|0.17 0.63|0.33 0.94|1.11 POOR POOR
1995 Quality (Durkan Test) CTS limbs; 12 conduction Durkan (Nerve Durkan (Nerve
symptomatic velocity and Conduction Conduction
unconfirmed DML Studies (NCS) and Studies (NCS) and
Electromyography Electromyography
(EMG)) (EMG))
De,Smet L., Moderate CTS Positive 54 confirmed Slowing Extremities index pos; PT; 57 index neg; PT; 9 0.86|0.44 0.91|0.33 1.36|0.28 POOR WEAK
1995 Quality (Phalen Test) CTS limbs; 12 conduction Durkan (Nerve Durkan (Nerve
symptomatic velocity and Conduction Conduction
unconfirmed DML Studies (NCS) and Studies (NCS) and
(EMG)) (EMG))
El,Miedany Y., Moderate CTS Positive clinically comparative, Subjects index pos; PT; TS; 120 index neg; PT; TS; 112 0.70|0.11 0.46|0.25 0.61|2.17 POOR POOR
2008 Quality (Carpal diagnosed CTS sensory, or RPT; CCT (Nerve RPT; CCT (Nerve
Compression suspects; large motor Conduction Conduction
Test (CCT)) tenosynovitis abnormality Studies (NCS); Studies (NCS);
prevalence AANEM AANEM
2008 Quality (Phalen Test) diagnosed CTS sensory, or RPT; CCT (Nerve RPT; CCT (Nerve
suspects; large motor Conduction Conduction
tenosynovitis abnormality Studies (NCS); Studies (NCS);
2008 Quality (Reverse diagnosed CTS sensory, or RPT; CCT (Nerve RPT; CCT (Nerve
Phalen Test) suspects; large motor Conduction Conduction
2008 Quality (Tinel Sign) diagnosed CTS sensory, or RPT; CCT (Nerve RPT; CCT (Nerve
suspects; large motor Conduction Conduction
Gerr,F., 1998 Moderate CTS Positive (2 60 symptomatic sensory, Extremities index pos; PT; TS; 21 index neg; PT; TS; 94 0.43|0.49 0.16|0.79 0.76|1.06 POOR POOR
Quality Point patient hands motor, and vib perception; vib perception;
Discrimination) suspected of mixed nerve 2point (Nerve 2point (Nerve
CTS cutoffs Conduction Conduction
(EMG)) (EMG))
71
Gerr,F., 1998 Moderate CTS Positive 60 symptomatic sensory, Extremities index pos; PT; TS; 48 index neg; PT; TS; 67 0.52|0.52 0.44|0.60 1.11|0.93 POOR POOR
Quality (Phalen Test) patient hands motor, and vib perception; vib perception;
suspected of mixed nerve 2point (Nerve 2point (Nerve
(EMG)) (EMG))
Gerr,F., 1998 Moderate CTS Positive 60 symptomatic sensory, Extremities index pos; thenar 15 index neg; thenar 100 0.60|0.52 0.16|0.90 1.53|0.94 POOR POOR
Quality (Thenar patient hands motor, and weakness; thenar weakness; thenar
Atrophy) suspected of mixed nerve atrophy (Nerve atrophy (Nerve
(EMG)) (EMG))
Gerr,F., 1998 Moderate CTS Positive 60 symptomatic sensory, Extremities index pos; thenar 34 index neg; thenar 81 0.62|0.56 0.37|0.78 1.64|0.81 POOR POOR
Quality (Thenar patient hands motor, and weakness; thenar weakness; thenar
Weakness) suspected of mixed nerve atrophy (Nerve atrophy (Nerve
(EMG)) (EMG))
Gerr,F., 1998 Moderate CTS Positive 60 symptomatic sensory, Extremities index pos; PT; TS; 19 index neg; PT; TS; 96 0.42|0.49 0.14|0.81 0.74|1.06 POOR POOR
Quality (Tinel Sign) patient hands motor, and vib perception; vib perception;
suspected of mixed nerve 2point (Nerve 2point (Nerve
(EMG)) (EMG))
Gerr,F., 1998 Moderate CTS Positive 60 symptomatic sensory, Extremities index pos; PT; TS; 30 index neg; PT; TS; 85 0.67|0.56 0.35|0.83 2.04|0.78 WEAK POOR
Quality (Vibration patient hands motor, and vib perception; vib perception;
Perception; suspected of mixed nerve 2point (Nerve 2point (Nerve
tuning fork; CTS cutoffs Conduction Conduction
index finger) Studies (NCS) and Studies (NCS) and
(EMG)) (EMG))
Gomes,I., 2006 Moderate CTS Positive subset of total sensory, Extremities index pos; PT; TS; 442 index neg; PT; TS; 485 0.59|0.73 0.66|0.66 1.94|0.51 POOR POOR
Quality (At least Phalen 3907 limbs motor, and RPT; PT, RPT, or RPT; PT, RPT, or
Test, Tinel examined from mixed nerve TS (Nerve TS (Nerve
Sign, or NCS referred cutoffs Conduction Conduction
Reverse Phalen patients Studies (NCS); Studies (NCS);
Test) AANEM AANEM
72
Gomes,I., 2006 Moderate CTS Positive subset of total sensory, Extremities index pos; PT; TS; 366 index neg; PT; TS; 561 0.60|0.70 0.56|0.73 2.07|0.60 WEAK POOR
Quality (Phalen Test) 3907 limbs motor, and RPT; PT, RPT, or RPT; PT, RPT, or
examined from mixed nerve TS (Nerve TS (Nerve
NCS referred cutoffs Conduction Conduction
patients Studies (NCS); Studies (NCS);
AANEM AANEM
Quality (Reverse 3907 limbs motor, and RPT; PT, RPT, or RPT; PT, RPT, or
Phalen Test) examined from mixed nerve TS (Nerve TS (Nerve
AANEM AANEM
Gomes,I., 2006 Moderate CTS Positive 2535 patients sensory, Extremities index pos; 54 index neg; 873 0.91|0.61 0.13|0.99 13.43|0.88 STRONG POOR
Quality (Thenar referred for motor, and Gender/Sex F, M; Gender/Sex F, M;
Atrophy) NCS from 5 mixed nerve BMI30+; Age40- BMI30+; Age40-
facilities cutoffs 60; Paresthesia; 60; Paresthesia;
Pain; Sensory Pain; Sensory
sympt; weak; sympt; weak;
night; atrophy night; atrophy
AANEM AANEM
Gomes,I., 2006 Moderate CTS Positive 2535 patients sensory, Extremities index pos; 1482 index neg; 2425 0.43|0.63 0.42|0.64 1.17|0.90 POOR POOR
Quality (Thenar referred for motor, and Gender/Sex F, M; Gender/Sex F, M;
Weakness) NCS from 5 mixed nerve BMI30+; Age40- BMI30+; Age40-
facilities cutoffs 60; Paresthesia; 60; Paresthesia;
AANEM AANEM
Quality (Tinel Sign) 3907 limbs motor, and RPT; PT, RPT, or RPT; PT, RPT, or
examined from mixed nerve TS (Nerve TS (Nerve
AANEM AANEM
Hansen,P.A., Moderate CTS Positive referred CTS CSI digit diff Subjects index pos; Flick 47 index neg; Flick 95 0.74|0.37 0.37|0.74 1.44|0.85 POOR POOR
2004 Quality (Flick Sign) suspects result and sign; PT; TS; sign; PT; TS;
DML cutoffs combinations combinations
73
2004 Quality (Flick Sign or suspects result and sign; PT; TS; sign; PT; TS;
Phalen Test) DML cutoffs combinations combinations
2004 Quality (Flick Sign or suspects result and sign; PT; TS; sign; PT; TS;
Tinel Sign) DML cutoffs combinations combinations
2004 Quality (Phalen Test) suspects result and sign; PT; TS; sign; PT; TS;
2004 Quality (Phalen Test or suspects result and sign; PT; TS; sign; PT; TS;
Tinel Sign) DML cutoffs combinations combinations
Hansen,P.A., Moderate CTS Positive referred CTS CSI digit diff Subjects index pos; Flick 30 index neg; Flick 112 0.87|0.38 0.27|0.91 3.22|0.79 WEAK POOR
2004 Quality (Tinel Sign) suspects result and sign; PT; TS; sign; PT; TS;
Heller,L., 1986 Moderate CTS Positive 60 referrals of EMG motor Extremities index pos; PT, TS, 48 index neg; PT, TS, 32 0.81|0.41 0.67|0.59 1.64|0.55 POOR POOR
Quality (Phalen Test) CTS suspects latency PT/TS, PT or TS PT/TS, PT or TS
measure (Electromyography (Electromyography
(EMG)) (EMG))
Heller,L., 1986 Moderate CTS Positive 60 referrals of EMG motor Extremities index pos; PT, TS, 29 index neg; PT, TS, 51 0.93|0.39 0.47|0.91 5.12|0.59 MODERATE POOR
Quality (Phalen Test CTS suspects latency PT/TS, PT or TS PT/TS, PT or TS
and Tinel Sign) measure (Electromyography (Electromyography
(EMG)) (EMG))
Heller,L., 1986 Moderate CTS Positive 60 referrals of EMG motor Extremities index pos; PT, TS, 59 index neg; PT, TS, 21 0.80|0.48 0.81|0.45 1.49|0.42 POOR WEAK
Quality (Phalen Test or CTS suspects latency PT/TS, PT or TS PT/TS, PT or TS
Tinel Sign) measure (Electromyography (Electromyography
(EMG)) (EMG))
Heller,L., 1986 Moderate CTS Positive 60 referrals of EMG motor Extremities index pos; PT, TS, 40 index neg; PT, TS, 40 0.88|0.43 0.60|0.77 2.66|0.51 WEAK POOR
Quality (Tinel Sign) CTS suspects latency PT/TS, PT or TS PT/TS, PT or TS
measure (Electromyography (Electromyography
(EMG)) (EMG))
74
Karl,A.I., 2001 Moderate CTS Positive 96 veterans; 90 palm diff Subjects index pos; LPT 32 index neg; LPT 64 0.59|0.50 0.37|0.71 1.29|0.88 POOR POOR
Quality (Lumbrical men and 6 median to (Nerve Conduction (Nerve Conduction
Provocation women with ulnar latency; Studies (NCS)) Studies (NCS))
Test (LPT)) median D2-D5
symptoms latency; or
motor diff
Katz,J.N., 1991 Moderate CTS Positive (2 CTS referenced Subjects index pos; PT; TS; 16 index neg; PT; TS; 62 0.44|0.63 0.23|0.81 1.24|0.94 POOR POOR
Quality Point symptomatic motor and 2point (Nerve 2point (Nerve
Discrimination) subjects at one sensory Conduction Conduction
hospital latency Studies (NCS)) Studies (NCS))
cutoffs
Katz,J.N., 1991 Moderate CTS Positive CTS referenced Subjects index pos; PT; TS; 53 index neg; PT; TS; 25 0.42|0.68 0.73|0.35 1.14|0.75 POOR POOR
Quality (Phalen Test) symptomatic motor and 2point (Nerve 2point (Nerve
subjects at one sensory Conduction Conduction
cutoffs
Katz,J.N., 1991 Moderate CTS Positive CTS referenced Subjects index pos; PT; TS; 35 index neg; PT; TS; 43 0.54|0.74 0.63|0.67 1.90|0.55 POOR POOR
Quality (Tinel Sign) symptomatic motor and 2point (Nerve 2point (Nerve
subjects at one sensory Conduction Conduction
cutoffs
Kaul,M.P., 2001 Moderate CTS Positive consecutive motor, Subjects index pos; PPT; 63 index neg; PPT; 72 0.67|0.47 0.53|0.62 1.37|0.77 POOR POOR
Quality (Carpal veterans with sensory, and CCT (Nerve CCT (Nerve
Compression CTS symptoms mixed nerve Conduction Conduction
Test (CCT)) latencies and Studies (NCS)) Studies (NCS))
digit diff
Kaul,M.P., 2001 Moderate CTS Positive consecutive motor, Subjects index pos; PPT; 60 index neg; PPT; 74 0.70|0.53 0.55|0.68 1.73|0.66 POOR POOR
Quality (Pressure veterans with sensory, and CCT (Nerve CCT (Nerve
Provocative CTS symptoms mixed nerve Conduction Conduction
Test (PPT)) latencies and Studies (NCS)) Studies (NCS))
digit diff
Kuhlman,K.A., Moderate CTS Positive 143 clinical referenced Extremities index pos; PT; TS; 62 index neg; PT; TS; 166 0.65|0.39 0.28|0.74 1.10|0.97 POOR POOR
1997 Quality (Carpal CTS suspects sensory and Hypesthesia; APB Hypesthesia; APB
Compression motor cutoffs weakness; median weakness; median
Test (CCT)) compression compression
Kuhlman,K.A., Moderate CTS Positive 143 clinical referenced Extremities index pos; PT; TS; 86 index neg; PT; TS; 142 0.85|0.51 0.51|0.85 3.40|0.57 WEAK POOR
1997 Quality (Hypesthesia; CTS suspects sensory and Hypesthesia; APB Hypesthesia; APB
pinwheel) motor cutoffs weakness; median weakness; median
compression compression
75
Kuhlman,K.A., Moderate CTS Positive 143 clinical referenced Extremities index pos; PT; TS; 94 index neg; PT; TS; 134 0.78|0.49 0.51|0.76 2.11|0.64 WEAK POOR
1997 Quality (Phalen Test) CTS suspects sensory and Hypesthesia; APB Hypesthesia; APB
motor cutoffs weakness; median weakness; median
1997 Quality (Thenar CTS suspects sensory and Hypesthesia; APB Hypesthesia; APB
Weakness) motor cutoffs weakness; median weakness; median
1997 Quality (Tinel Sign) CTS suspects sensory and Hypesthesia; APB Hypesthesia; APB
motor cutoffs weakness; median weakness; median
MacDermid,J.C., Moderate CTS Positive referred to various Extremities index pos; PT; 81 index neg; PT; 81 AR 0.87|0.90 8.70|0.14 MODERATE MODERATE
1997 (1) Quality (Phalen Test clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
(Examiner 1)) symptoms compression RPT; TS; TMST; RPT; TS; TMST;
measurements SWMF (Nerve SWMF (Nerve
Studies (NCS), Studies (NCS),
(EMG), and (EMG), and
Clinical Diagnosis) Clinical Diagnosis)
MacDermid,J.C., Moderate CTS Positive referred to various Extremities index pos; PT; 77 index neg; PT; 77 AR 0.72|0.88 6.00|0.32 MODERATE WEAK
1997 (1) Quality (Pinch Test clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
MacDermid,J.C., Moderate CTS Positive referred to various Extremities index pos; PT; 80 index neg; PT; 80 AR 0.65|0.96 16.25|0.36 STRONG WEAK
1997 (1) Quality (Reverse clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
Phalen Test symptoms compression RPT; TS; TMST; RPT; TS; TMST;
(Examiner 1)) measurements SWMF (Nerve SWMF (Nerve
76
MacDermid,J.C., Moderate CTS Positive referred to various Extremities index pos; PT; 79 index neg; PT; 79 AR 0.86|0.60 2.15|0.23 WEAK WEAK
1997 (1) Quality (Semmes- clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
Weinstein symptoms compression RPT; TS; TMST; RPT; TS; TMST;
Monofilament measurements SWMF (Nerve SWMF (Nerve
Test (SWMF) 1 Conduction Conduction
(Examiner 1)) Studies (NCS), Studies (NCS),
MacDermid,J.C., Moderate CTS Positive referred to various Extremities index pos; PT; 80 index neg; PT; 80 AR 0.52|0.92 6.50|0.52 MODERATE POOR
1997 (1) Quality (Tethered clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
Median Stress symptoms compression RPT; TS; TMST; RPT; TS; TMST;
Test (TMST) measurements SWMF (Nerve SWMF (Nerve
(Examiner 1)) Conduction Conduction
1997 (1) Quality (Tinel Sign clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
1997 (1) Quality (Vibration clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
Perception; symptoms compression RPT; TS; TMST; RPT; TS; TMST;
tuning fork; measurements SWMF (Nerve SWMF (Nerve
index finger Conduction Conduction
MacDermid,J.C., Moderate CTS Positive referred to various Extremities index pos; PT; 77 index neg; PT; 77 AR 0.86|0.86 6.14|0.16 MODERATE MODERATE
1997 (2) Quality (Phalen Test clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
77
1997 (2) Quality (Pinch Test clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
1997 (2) Quality (Reverse clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
Phalen Test symptoms compression RPT; TS; TMST; RPT; TS; TMST;
(Examiner 2)) measurements SWMF (Nerve SWMF (Nerve
MacDermid,J.C., Moderate CTS Positive referred to various Extremities index pos; PT; 70 index neg; PT; 70 AR 0.85|0.32 1.25|0.47 POOR WEAK
1997 (2) Quality (Semmes- clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
Weinstein symptoms compression RPT; TS; TMST; RPT; TS; TMST;
Monofilament measurements SWMF (Nerve SWMF (Nerve
Test (SWMF) 1 Conduction Conduction
1997 (2) Quality (Tethered clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
Median Stress symptoms compression RPT; TS; TMST; RPT; TS; TMST;
Test (TMST) measurements SWMF (Nerve SWMF (Nerve
1997 (2) Quality (Tinel Sign clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
78
1997 (2) Quality (Vibration clinic for CTS nerves and Vibration; Pinch; Vibration; Pinch;
Perception; symptoms compression RPT; TS; TMST; RPT; TS; TMST;
tuning fork; measurements SWMF (Nerve SWMF (Nerve
index finger Conduction Conduction
Makanji,H.S., Moderate CTS Positive referred CTS DML and Subjects index pos; Durkan; 69 index neg; Durkan; 19 0.72|0.21 0.77|0.17 0.93|1.33 POOR POOR
2014 Quality (Durkan Test) suspects DSL with PT; Scratch PT; Scratch
referenced Collapse (Nerve Collapse (Nerve
normal values Conduction Conduction
AANEM AANEM
2014 Quality (Phalen Test) suspects DSL with PT; Scratch PT; Scratch
AANEM AANEM
2014 Quality (Scratch suspects DSL with PT; Scratch PT; Scratch
Collapse Test) referenced Collapse (Nerve Collapse (Nerve
AANEM AANEM
Makanji,H.S., Moderate CTS Positive referred CTS DML and Subjects index pos; 13 index neg; 75 0.92|0.29 0.18|0.96 4.25|0.85 WEAK POOR
2014 Quality (Thenar suspects DSL with Gender/Sex F, M; Gender/Sex F, M;
Atrophy) referenced tobacco use (yes); tobacco use (no);
normal values thenar atrophy; thenar atrophy;
thumb abduction thumb abduction
weakness (Nerve weakness (Nerve
AANEM AANEM
79
Makanji,H.S., Moderate CTS Positive referred CTS DML and Subjects index pos; 30 index neg; 58 0.80|0.29 0.37|0.74 1.42|0.85 POOR POOR
2014 Quality (Thumb suspects DSL with Gender/Sex F, M; Gender/Sex F, M;
Abduction referenced tobacco use (yes); tobacco use (no);
Weakness) normal values thenar atrophy; thenar atrophy;
thumb abduction thumb abduction
weakness (Nerve weakness (Nerve
AANEM AANEM
2014 Quality (Tinel Sign) suspects DSL with PT; Scratch PT; Scratch
AANEM AANEM
Padua,L., 1999 Moderate CTS Positive clinically clinical and Extremities index pos; PT 752 index neg; PT 371 0.96|0.08 0.68|0.49 1.33|0.66 POOR POOR
Quality (Phalen Test) suspected NCS from (Nerve Conduction (Nerve Conduction
idiopathic CTS AANEM Studies (NCS) and Studies (NCS) and
patients considered; clinical diagnosis; clinical diagnosis;
min of AANEM AANEM
clinical referenced) referenced)
diagnosis and
various
severities of
NCS testing
results
Raudino,F., Moderate CTS Positive symptomatic sensory and Extremities index pos; PT; TS; 45 index neg; PT; TS; 121 1.00|0.21 0.32|1.00 10.00|0.68 STRONG POOR
2000 Quality (Hypoaesthesia; and motor as stress test; stress test;
pin prick) asymptomatic compared to hypoaesthesia hypoaesthesia
limbs of 83 control group (Nerve Conduction (Nerve Conduction
suspected CTS Studies (NCS); Studies (NCS);
patients that AANEM AANEM
were NCS referenced) referenced)
confirmed
Raudino,F., Moderate CTS Positive symptomatic sensory and Extremities index pos; PT; TS; 85 index neg; PT; TS; 81 0.93|0.25 0.56|0.77 2.45|0.57 WEAK POOR
2000 Quality (Phalen Test) and motor as stress test; stress test;
asymptomatic compared to hypoaesthesia hypoaesthesia
confirmed
80
2000 Quality (Stress Test; and motor as stress test; stress test;
hyperextended asymptomatic compared to hypoaesthesia hypoaesthesia
wrist) limbs of 83 control group (Nerve Conduction (Nerve Conduction
confirmed
Raudino,F., Moderate CTS Positive symptomatic sensory and Extremities index pos; thenar 18 index neg; thenar 148 0.94|0.17 0.12|0.96 3.16|0.91 WEAK POOR
2000 Quality (Thenar and motor as weakness (Nerve weakness (Nerve
Weakness) asymptomatic compared to Conduction Conduction
limbs of 83 control group Studies (NCS); Studies (NCS);
suspected CTS AANEM AANEM
patients that referenced) referenced)
were NCS
confirmed
2000 Quality (Tinel Sign) and motor as stress test; stress test;
asymptomatic compared to hypoaesthesia hypoaesthesia
confirmed
Weber,R.A., Moderate CTS Positive 53 patients with history and Extremities index pos; PSSD 67 index neg; PSSD 39 0.73|0.87 0.91|0.65 2.62|0.14 WEAK MODERATE
2000 Quality (Pressure suspected CTS physical signs (Clinical (Clinical
Specified from one hosp and Diagnosis) Diagnosis)
Sensory Device symptoms
(PSSD))
Witt,J.C., 2004 Moderate CTS Positive referred CTS various NCS Subjects index pos; PT; TS 46 index neg; PT; TS 38 0.24|0.66 0.46|0.42 0.79|1.30 POOR POOR
Quality (Phalen Test) suspects parameters as (Nerve Conduction (Nerve Conduction
needed Studies (NCS); Studies (NCS);
AANEM AANEM
Witt,J.C., 2004 Moderate CTS Positive referred CTS various NCS Subjects index pos; PT; TS 32 index neg; PT; TS 52 0.19|0.65 0.25|0.57 0.58|1.32 POOR POOR
Quality (Tinel Sign) suspects parameters as (Nerve Conduction (Nerve Conduction
needed Studies (NCS); Studies (NCS);
AANEM AANEM
81
TABLE 10: LOW QUALITY STUDIES- PICO 1 (PHYSICAL TESTS VERSUS REFERENCE STANDARD)
Khosrawi,S., Low CTS ALL median to Subjects index pos; 29 index neg; 71 0.34|0.87 0.53|0.77 2.24|0.62 WEAK POOR
2012 Quality Positive PREGNANT ulnar PT/TS PT/TS
(Phalen WOMEN cutoffs (Nerve (Nerve
Test and referenced Conduction Conduction
Tinel Studies Studies
Sign) (NCS)) (NCS))
82
META-ANALYSES
FIGURE 1: GENERAL EDS VERSUS PHALEN TEST AND TINEL SIGN
1
.8
.6
Sensitivity
.4
.2
0
1 .8 .6 .4 .2 0
Specificity
Study estimate Summary point

HSROC curve 95% confidence
region
95% prediction
region
83
FIGURE 2: GENERAL EDS VERSUS PHALEN TEST
1
.8
.6
Sensitivity
.4
.2
0
1 .8 .6 .4 .2 0
Specificity

region
95% prediction
region
84
FIGURE 3: GENERAL EDS VERSUS TINEL SIGN
1
.8
.6
Sensitivity
.4
.2
0
1 .8 .6 .4 .2 0
Specificity

region
95% prediction
region
85
FIGURE 4: EDS AANEM VERSUS PHALEN TEST
1
.8
.6
Sensitivity
.4
.2
0
1 .8 .6 .4 .2 0
Specificity

region
95% prediction
region
86
FIGURE 5: EDS AANEM VERSUS TINEL SIGN
1
.8
.6
Sensitivity
.4
.2
0
1 .8 .6 .4 .2 0
Specificity

region
95% prediction
region
87
FIGURE 6: EDS AANEM VERSUS THENAR ATROPHY
1
.8
.6
Sensitivity
.4
.2
0
1 .8 .6 .4 .2 0
Specificity

region
95% prediction
region
88
HISTORY INTERVIEW GUIDELINE RECOMMENDATIONS
A. HISTORY INTERVIEW TOPICS

Moderate evidence supports not using the following as independent history
interview topics to diagnose carpal tunnel syndrome, because alone, each has a
poor or weak association with ruling-in or ruling-out carpal tunnel syndrome:
Sex/gender
Ethnicity
Bilateral symptoms
Diabetes mellitus
Duration of symptoms
Patient localization of symptoms
Hand dominance
Symptomatic limb
Age
BMI

Rationale
Two high quality studies (Claes, 2013; Katz, 1990) and several moderate quality studies
investigated the relationship between history interview topics and CTS as compared to a
reference standard which was the use of either EDS following AANEM criteria or general EDS
methods. When examined individually, each of the factors listed above had a poor or weak
association with EDS based on the likelihood ratio. Sex/gender data pooled in a meta-analysis,
also showed a poor association with electrodiagnostic testing.
Risks and Harms of Implementing this Recommendation

Future Research
Future studies should evaluate and use standardized language for describing symptoms and their
severity. Standardized scales and stand-alone history interview topics should be evaluated
against a reference standard.
89
B. PATIENT REPORTED NUMBNESS AND PAIN
Limited evidence supports that patients who do not report frequent numbness or
pain might not have carpal tunnel syndrome.

Description: Evidence from one or more Low quality studies with consistent findings or evidence from a single
Moderate quality study recommending for or against the intervention or diagnostic test or the evidence is
insufficient or conflicting and does not allow a recommendation for or against the intervention.
Rationale
One moderate quality study (MacDermid, 1997) found a strong or moderate association between
CTS and patient reporting of frequent numbness or frequent pain.

Future Research
Future studies should evaluate and use standardized language for describing symptoms and their
severity. Standardized scales and stand-alone history interview topics should be evaluated
against a reference standard.
90
STUDY QUALITY TABLE OF HISTORY INTERVIEW GUIDELINE RECOMMENDATIONS
Study Population Criteria Replicate Condition
Blinding
Bias?
Inclusion Strength
Moderate
Becker,J., 2002 Include
Quality
Moderate
Bland,J.D., 2000 Include
Quality
Moderate
Coggon,D., 2013 Include
Quality
Moderate
Dale,A.M., 2011 Include
Quality
Moderate
De Krom,M.C., 1990 Include
Quality
Moderate
El,Miedany Y., 2008 Include
Quality
Moderate
Franzblau,A., 1994 Include
Quality
Moderate
Gerr,F., 1998 Include
Quality
Glowacki,K.A., 1996 Include Low Quality
Moderate
Gomes,I., 2006 Include
Quality
Katz,J.N., 1990 Include High Quality
Moderate
Katz,J.N., 1991 Include
Quality
Khosrawi,S., 2012 Include Low Quality
Lo,J.K., 2002 Include Low Quality
Moderate
MacDermid,J.C., 1997 Include
Quality
Moderate
Makanji,H.S., 2014 Include
Quality
91
Study Population Criteria Replicate Condition
Blinding
Bias?
Inclusion Strength

Ntani,G., 2013 Include High Quality
Moderate
Raudino,F., 2000 Include
Quality
Moderate
Tan,S.V., 2012 Include
Quality
Taylor-Gjevre,R.M., Moderate
Include
2010 Quality
Moderate
Witt,J.C., 2004 Include
Quality
Moderate
Yagci,I., 2010 Include
Quality
Ziswiler,H.R., 2005 Include High Quality
92
RESULTS
Makanji,H.S., 2014
Gomes,I., 2006
Claes,F., 2013
Yagci,I., 2010
RULE IN
Gender/Sex Female
RULE OUT
RULE IN
Gender/Sex Male
RULE OUT
93
Taylor-Gjevre,R.M., 2010
MacDermid,J.C., 1997
Dale,A.M., 2011 (1)
Dale,A.M., 2011 (2)

Katz,J.N., 1990 (B)
Coggon,D., 2013
Bland,J.D., 2000
Becker,J., 2002
RULE IN NA
Bilateral Symptoms
RULE OUT NA
RULE IN NA
Diabetes Mellitus
RULE OUT NA
RULE IN NA
Gender/Sex Female
RULE OUT NA
RULE IN NA
Gender/Sex Male
RULE OUT NA
RULE IN NA
Hand Left
RULE OUT NA
RULE IN NA
Hand Right
RULE OUT NA
RULE IN NA
RULE OUT NA
Authors with parenthetical numbers indicate a change in EDS method/threshold, alternate limbs, or alternate examiner
94
TABLE 14: HIGH QUALITY STUDIES- PICO 2 (HISTORY INTERVIEW TOPICS VERSUS REFERENCE STANDARD)
2013 Quality (Gender/Sex diagnosed CTS 4 abnormal Gender/Sex Gender/Sex
Female) suspects EDS F, M; Hand F, M; Hand
atrophy; atrophy;
weakness; weakness;
OP weakness OP weakness
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Claes,F., High CTS Positive clinically at least 2 of Subjects index pos; 35 index neg; 121 0.97|0.21 0.26|0.96 6.80|0.77 MODERATE POOR
2013 Quality (Gender/Sex diagnosed CTS 4 abnormal Gender/Sex Gender/Sex
Male) suspects EDS F, M; Hand F, M; Hand
atrophy; atrophy;
weakness; weakness;
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
95
2013 Quality (Opponens diagnosed CTS 4 abnormal Gender/Sex Gender/Sex
Pollicis suspects EDS F, M; Hand F, M; Hand
Weakness) parameters R, L; thenar R, L; thenar
atrophy; atrophy;
weakness; weakness;
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2013 Quality (Wrist Left) diagnosed CTS 4 abnormal Gender/Sex Gender/Sex
suspects EDS F, M; Hand F, M; Hand
atrophy; atrophy;
weakness; weakness;
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2013 Quality (Wrist Right) diagnosed CTS 4 abnormal Gender/Sex Gender/Sex
suspects EDS F, M; Hand F, M; Hand
atrophy; atrophy;
weakness; weakness;
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
96
1990 (B) Quality (Age; 40+) patients sensory and neurologist neurologist
suspected of motor assessment; assessment;
CTS cutoffs age 40+; age 40+;
nocturnal nocturnal
symptoms; symptoms;
bilateral bilateral
symptoms symptoms
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
1990 (B) Quality (Bilateral patients sensory and neurologist neurologist
Symptoms) suspected of motor assessment; assessment;
nocturnal nocturnal
symptoms; symptoms;
bilateral bilateral
symptoms symptoms
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
Katz,J.N., High CTS Positive discomfort referenced Subjects index pos; 55 index neg; 55 0.67|0.87 0.84|0.73 3.08|0.22 WEAK WEAK
1990 (B) Quality (Neurologist patients sensory and neurologist neurologist
Assessment; suspected of motor assessment; assessment;
probable or CTS cutoffs age 40+; age 40+;
possible) nocturnal nocturnal
symptoms; symptoms;
bilateral bilateral
symptoms symptoms
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
97
1990 (B) Quality (Nocturnal patients sensory and neurologist neurologist
Symptoms) suspected of motor assessment; assessment;
nocturnal nocturnal
symptoms; symptoms;
bilateral bilateral
symptoms symptoms
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
2013 Quality (Pain; hand) from all abnormality thenar thenar
suspected CTS weakness; weakness;
out-patients pain (Nerve pain (Nerve
Studies Studies
(NCS); (NCS);
Sensory Sensory
Nerve Nerve
(SNC)) (SNC))
Tan,S.V., Moderate CTS Positive limbs of 100 at least 2 Extremities index pos; 160 index neg; 40 0.55|0.73 0.89|0.29 1.25|0.39 POOR WEAK
2012 Quality (Clinical CTS suspects abnormal clinical clinical
symptoms) EDS symptoms symptoms
parameters (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
98
2005 Quality (Age; 45+) cervical history history
radiculopathy questions; questions;
suspects age; clinical age; clinical
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (Behavior of cervical history history
symptoms is radiculopathy questions; questions;
constant) suspects age; clinical age; clinical
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (Behavior of cervical history history
symptoms is radiculopathy questions; questions;
intermittent, suspects age; clinical age; clinical
variable) combinations combinations
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
99
2005 Quality (Do symptoms cervical history history
wake you up at radiculopathy questions; questions;
night) suspects age; clinical age; clinical
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (Does grasping cervical history history
or hand use radiculopathy questions; questions;
tasks worsen suspects age; clinical age; clinical
symptoms) combinations combinations
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (Entire cervical history history
affected limb radiculopathy questions; questions;
or hand feels suspects age; clinical age; clinical
numb) combinations combinations
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
100
2005 Quality (Hand feels fat cervical history history
or swollen) radiculopathy questions; questions;
suspects age; clinical age; clinical
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (Loss of cervical history history
feeling is the radiculopathy questions; questions;
most suspects age; clinical age; clinical
bothersome combinations combinations
symptom) (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (Pain, cervical history history
Numbness, radiculopathy questions; questions;
Tingling are suspects age; clinical age; clinical
most combinations combinations
bothersome (Nerve (Nerve
symptoms) Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
101
2005 Quality (Symptoms are cervical history history
most radiculopathy questions; questions;
bothersome in suspects age; clinical age; clinical
the hand, combinations combinations
finger) (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (Symptoms are cervical history history
most radiculopathy questions; questions;
bothersome in suspects age; clinical age; clinical
the neck, combinations combinations
shoulder/blade, (Nerve (Nerve
arm) Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (Trouble cervical history history
fumbling or radiculopathy questions; questions;
dropping suspects age; clinical age; clinical
objects) combinations combinations
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
102
Ziswiler,H.R., High CTS Positive 71 CTS motor and Extremities index pos; 49 index neg; 52 0.76|0.21 0.47|0.48 0.91|1.10 POOR POOR
2005 Quality (Hand Left) suspects sensory Hand Hand
referred to latency RIGHT, RIGHT,
outpatient clinic cutoff Hand LEFT Hand LEFT
in Switzerland values (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
referenced referenced
and Rated and Rated
Signs and Signs and
Symptoms) Symptoms)
Ziswiler,H.R., High CTS Positive 71 CTS motor and Extremities index pos; 52 index neg; 49 0.79|0.24 0.53|0.52 1.10|0.91 POOR POOR
2005 Quality (Hand Right) suspects sensory Hand Hand
referred to latency RIGHT, RIGHT,
outpatient clinic cutoff Hand LEFT Hand LEFT
in Switzerland values (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Rated and Rated
Signs and Signs and
Symptoms) Symptoms)
103
TABLE 15: MODERATE QUALITY STUDIES- PICO 2 (HISTORY INTERVIEW TOPICS VERSUS REFERENCE STANDARD)
Outcome Outcomes Group1 Grou Group2 Grou Rule Rule
Reference (Index Patient Threshold Reported (Reference p1 (Reference p2 PPV|N Sens|S LR+|L In Out
Title Quality Test) Characteristics Notes By Standard) N Standard) N PV pec R- Test Test
Becker,J., Moderate CTS Positive CTS symptomatic sensory, Subjects index pos; 944 index neg; 828 0.52|0.6 0.62|0.5 1.34|0. POO POOR
2002 Quality (Age; 41-60) subjects referred motor, and Gender/Sex F, Gender/Sex F, 4 4 70 R
for NCS and EMG mixed M; BMI; Age; M; BMI; Age;
from 5 Brazil nerve Diabetes Diabetes
facilities cutoffs (Nerve (Nerve
Studies Studies
(NCS) and (NCS) and
Electromyogr Electromyogr
aphy (EMG)) aphy (EMG))
Becker,J., Moderate CTS Positive CTS symptomatic sensory, Subjects index pos; 322 index neg; 1450 0.66|0.6 0.27|0.8 2.39|0. WEA POOR
2002 Quality (BMI; >30) subjects referred motor, and Gender/Sex F, Gender/Sex F, 0 9 82 K
for NCS and EMG mixed M; BMI; Age; M; BMI; Age;
Studies Studies
(NCS) and (NCS) and
2002 Quality (Diabetes subjects referred motor, and Gender/Sex F, Gender/Sex F, 6 7 98 R
Mellitus) for NCS and EMG mixed M; BMI; Age; M; BMI; Age;
Studies Studies
(NCS) and (NCS) and
104
Becker,J., Moderate CTS Positive CTS symptomatic sensory, Subjects index pos; 1354 index neg; 418 0.51|0.7 0.88|0.3 1.32|0. POO WEAK
2002 Quality (Gender/Sex subjects referred motor, and Gender/Sex F, Gender/Sex F, 8 3 36 R
Female) for NCS and EMG mixed M; BMI; Age; M; BMI; Age;
Studies Studies
(NCS) and (NCS) and
2002 Quality (Gender/Sex subjects referred motor, and Gender/Sex F, Gender/Sex F, 9 7 32 R
Male) for NCS and EMG mixed M; BMI; Age; M; BMI; Age;
Studies Studies
(NCS) and (NCS) and
Bland,J.D., Moderate CTS Positive 7768 East Kent sensory Extremities index pos; 822 index neg; 984 0.68|0.4 0.52|0.6 1.43|0. POO POOR
2000 Quality (Does a splint referrals to NCS and motor Gender/Sex F, Gender/Sex F, 7 4 76 R
relieve lab for suspected latency M; Hand R, M; Hand R,
symptoms) CTS cutoffs L/A; L/A;
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
Gender/Sex Gender/Sex
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
105
2000 Quality (Duration of referrals to NCS and motor Gender/Sex F, Gender/Sex F, 2 1 02 R
Symptoms 0-3 lab for suspected latency M; Hand R, M; Hand R,
months) CTS cutoffs L/A; L/A;
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
Symptoms lab for suspected latency M; Hand R, M; Hand R,
12+ months) CTS cutoffs L/A; L/A;
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
Symptoms 3-6 lab for suspected latency M; Hand R, M; Hand R,
months) CTS cutoffs L/A; L/A;
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
106
Symptoms 6- lab for suspected latency M; Hand R, M; Hand R,
12 months) CTS cutoffs L/A; L/A;
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
2000 Quality (Gender/Sex referrals to NCS and motor Gender/Sex F, Gender/Sex F, 3 1 00 R
Female) lab for suspected latency M; Hand R, M; Hand R,
CTS cutoffs L/A; L/A;
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
2000 Quality (Gender/Sex referrals to NCS and motor Gender/Sex F, Gender/Sex F, 4 9 00 R
Male) lab for suspected latency M; Hand R, M; Hand R,
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
107
2000 Quality (Hand Left or referrals to NCS and motor Gender/Sex F, Gender/Sex F, 3 0 01 R
Ambidextrous lab for suspected latency M; Hand R, M; Hand R,
) CTS cutoffs L/A; L/A;
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
2000 Quality (Hand Right) referrals to NCS and motor Gender/Sex F, Gender/Sex F, 6 0 90 R
lab for suspected latency M; Hand R, M; Hand R,
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
2000 Quality (Symptoms referrals to NCS and motor Gender/Sex F, Gender/Sex F, 2 9 03 R
equal in both lab for suspected latency M; Hand R, M; Hand R,
hands) CTS cutoffs L/A; L/A;
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
108
worse in Left lab for suspected latency M; Hand R, M; Hand R,
Hand) CTS cutoffs L/A; L/A;
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
worse in Right lab for suspected latency M; Hand R, M; Hand R,
Hand) CTS cutoffs L/A; L/A;
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
2000 Quality (Worse referrals to NCS and motor Gender/Sex F, Gender/Sex F, 2 9 04 R
symptoms in lab for suspected latency M; Hand R, M; Hand R,
all fingers CTS cutoffs L/A; L/A;
excluding the symptoms; symptoms;
thumb) history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
109
all fingers CTS cutoffs L/A; L/A;
including the symptoms; symptoms;
thumb) history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
middle and CTS cutoffs L/A; L/A;
ring) symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
ring and CTS cutoffs L/A; L/A;
pinky) symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
110
thumb, index, CTS cutoffs L/A; L/A;
and middle) symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
2000 Quality (Worsening referrals to NCS and motor Gender/Sex F, Gender/Sex F, 7 0 58 R
symptoms at lab for suspected latency M; Hand R, M; Hand R,
night) CTS cutoffs L/A; L/A;
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
symptoms lab for suspected latency M; Hand R, M; Hand R,
during hand CTS cutoffs L/A; L/A;
work) symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
111
symptoms first lab for suspected latency M; Hand R, M; Hand R,
thing in the CTS cutoffs L/A; L/A;
morning) symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
symptoms lab for suspected latency M; Hand R, M; Hand R,
while driving) CTS cutoffs L/A; L/A;
symptoms; symptoms;
history; history;
fingers; fingers;
duration; duration;
(Nerve (Nerve
Studies Studies
(NCS)) (NCS))
Coggon,D., Moderate CTS Positive CTS suspected sensory Subjects index pos; 325 index neg; 520 0.50|0.4 0.35|0.5 0.84|1. POO POOR
2013 Quality (<6 months adults from one nerve demographics demographics 3 8 12 R
since free of hosp referred to conduction and and
numbness, neurophysiology in index symptoms symptoms
tingling, or and (Nerve (Nerve
pain in the between Conduction Conduction
hands for 4+ index and Studies Studies
weeks) pinky (NCS)) (NCS))
>8ms
112
2013 Quality (<7 days in adults from one nerve demographics demographics 7 0 00 R
the past 4 hosp referred to conduction and and
weeks when neurophysiology in index symptoms symptoms
numbness, and (Nerve (Nerve
tingling, or between Conduction Conduction
pain in the index and Studies Studies
hands pinky (NCS)) (NCS))
disturbed >8ms
sleep)
2013 Quality (<7 days in adults from one nerve demographics demographics 5 2 03 R
weeks with neurophysiology in index symptoms symptoms
hands) pinky (NCS)) (NCS))
>8ms
2013 Quality (0 days in the adults from one nerve demographics demographics 2 4 19 R
past 4 weeks hosp referred to conduction and and
when neurophysiology in index symptoms symptoms
disturbed >8ms
sleep)
2013 Quality (0 somatic adults from one nerve occupational occupational 8 7 94 R
symptoms at hosp referred to conduction and non- and non-
least neurophysiology in index occupational occupational
moderately and factors (Nerve factors (Nerve
distressing in between Conduction Conduction
the past week) index and Studies Studies
pinky (NCS)) (NCS))
>8ms
113
2013 Quality (1 somatic adults from one nerve occupational occupational 6 3 01 R
symptom at hosp referred to conduction and non- and non-
pinky (NCS)) (NCS))
>8ms
2013 Quality (1+ years adults from one nerve demographics demographics 9 0 89 R
since free of hosp referred to conduction and and
numbness, neurophysiology in index symptoms symptoms
tingling, or and (Nerve (Nerve
pain in the between Conduction Conduction
hands for 4+ index and Studies Studies
>8ms
2013 Quality (14-28 days in adults from one nerve demographics demographics 3 7 77 R
disturbed >8ms
sleep)
>8ms
114
2013 Quality (2+ somatic adults from one nerve occupational occupational 5 0 07 R
symptoms at hosp referred to conduction and non- and non-
pinky (NCS)) (NCS))
>8ms
2013 Quality (6+ months to adults from one nerve demographics demographics 6 3 98 R
<1 year hosp referred to conduction and and
since free of neurophysiology in index symptoms symptoms
hands for 4+ pinky (NCS)) (NCS))
weeks) >8ms
disturbed >8ms
sleep)
>8ms
115
2013 Quality (Age; 20-29) adults from one nerve demographics demographics 6 2 03 R
hosp referred to conduction and and
neurophysiology in index symptoms symptoms
and (Nerve (Nerve
between Conduction Conduction
index and Studies Studies
pinky (NCS)) (NCS))
>8ms
and (Nerve (Nerve
pinky (NCS)) (NCS))
>8ms
and (Nerve (Nerve
pinky (NCS)) (NCS))
>8ms
and (Nerve (Nerve
pinky (NCS)) (NCS))
>8ms
116
2013 Quality (Age; 60+) adults from one nerve demographics demographics 7 0 99 R
and (Nerve (Nerve
pinky (NCS)) (NCS))
>8ms
2013 Quality (Being very adults from one nerve demographics demographics 6 7 02 R
clumsy due to hosp referred to conduction and and
hand neurophysiology in index symptoms symptoms
symptoms in and (Nerve (Nerve
the past 4 between Conduction Conduction
weeks) index and Studies Studies
pinky (NCS)) (NCS))
>8ms
2013 Quality (BMI; <25) adults from one nerve symptoms symptoms 1 1 22 R
hosp referred to conduction (Nerve (Nerve
neurophysiology in index Conduction Conduction
and Studies Studies
between (NCS)) (NCS))
index and
pinky
>8ms
2013 Quality (BMI; 25+ but adults from one nerve symptoms symptoms 5 2 05 R
<30) hosp referred to conduction (Nerve (Nerve
and Studies Studies
index and
pinky
>8ms
117
2013 Quality (BMI; 30+) adults from one nerve symptoms symptoms 2 7 79 R
hosp referred to conduction (Nerve (Nerve
and Studies Studies
index and
pinky
>8ms
2013 Quality (Current adults from one nerve occupational occupational 4 5 10 R
smoker) hosp referred to conduction and non- and non-
neurophysiology in index occupational occupational
and factors (Nerve factors (Nerve
pinky (NCS)) (NCS))
>8ms
2013 Quality (Diabetes adults from one nerve occupational occupational 7 6 96 R
Mellitus) hosp referred to conduction and non- and non-
pinky (NCS)) (NCS))
>8ms
2013 Quality (Difficulty adults from one nerve demographics demographics 6 7 01 R
fastening hosp referred to conduction and and
buttons or zips neurophysiology in index symptoms symptoms
due to hand and (Nerve (Nerve
symptoms in between Conduction Conduction
the past 4 index and Studies Studies
>8ms
118
2013 Quality (Difficulty adults from one nerve demographics demographics 6 8 00 R
turning taps, hosp referred to conduction and and
using kitchen neurophysiology in index symptoms symptoms
gadgets, and (Nerve (Nerve
sewing, or between Conduction Conduction
doing repairs index and Studies Studies
due to hand pinky (NCS)) (NCS))
symptoms in >8ms
the past 4
weeks)
Coggon,D., Moderate CTS Positive CTS suspected sensory Subjects index pos; 26 index neg; 858 0.73|0.4 0.04|0.9 2.34|0. WEA POOR
2013 Quality (Ethnicity; adults from one nerve demographics demographics 7 8 98 K
Other) hosp referred to conduction and and
and (Nerve (Nerve
pinky (NCS)) (NCS))
>8ms
Coggon,D., Moderate CTS Positive CTS suspected sensory Subjects index pos; 32 index neg; 852 0.75|0.4 0.05|0.9 2.58|0. WEA POOR
2013 Quality (Ethnicity; adults from one nerve demographics demographics 7 8 97 K
South Asian) hosp referred to conduction and and
and (Nerve (Nerve
pinky (NCS)) (NCS))
>8ms
2013 Quality (Ethnicity; adults from one nerve demographics demographics 6 4 47 R
White) hosp referred to conduction and and
and (Nerve (Nerve
pinky (NCS)) (NCS))
>8ms
119
2013 Quality (Ex-smoker) adults from one nerve occupational occupational 8 6 93 R
hosp referred to conduction and non- and non-
pinky (NCS)) (NCS))
>8ms
2013 Quality (Gender/Sex adults from one nerve demographics demographics 7 3 98 R
Female) hosp referred to conduction and and
and (Nerve (Nerve
pinky (NCS)) (NCS))
>8ms
2013 Quality (Gender/Sex adults from one nerve demographics demographics 6 7 01 R
Male) hosp referred to conduction and and
and (Nerve (Nerve
pinky (NCS)) (NCS))
>8ms
2013 Quality (Having minor adults from one nerve demographics demographics 5 4 06 R
accidents (e.g. hosp referred to conduction and and
dropping neurophysiology in index symptoms symptoms
things) due to and (Nerve (Nerve
hand between Conduction Conduction
symptoms in index and Studies Studies
the past 4 pinky (NCS)) (NCS))
weeks) >8ms
120
2013 Quality (Job adults from one nerve occupational occupational 5 5 03 R
dissatisfaction hosp referred to conduction and non- and non-
) neurophysiology in index occupational occupational
pinky (NCS)) (NCS))
>8ms
2013 Quality (Lifting/carryi adults from one nerve occupational occupational 7 1 97 R
ng weights 5+ hosp referred to conduction and non- and non-
kg in one hand neurophysiology in index occupational occupational
in a working and factors (Nerve factors (Nerve
day) between Conduction Conduction
pinky (NCS)) (NCS))
>8ms
2013 Quality (Little choice adults from one nerve occupational occupational 7 7 99 R
in how or hosp referred to conduction and non- and non-
what work is neurophysiology in index occupational occupational
done or in and factors (Nerve factors (Nerve
timetable and between Conduction Conduction
breaks) index and Studies Studies
pinky (NCS)) (NCS))
>8ms
2013 Quality (Little support adults from one nerve occupational occupational 5 1 03 R
from hosp referred to conduction and non- and non-
supervisor or neurophysiology in index occupational occupational
colleagues) and factors (Nerve factors (Nerve
pinky (NCS)) (NCS))
>8ms
121
2013 Quality (Mental adults from one nerve occupational occupational 6 2 03 R
Health; Good) hosp referred to conduction and non- and non-
pinky (NCS)) (NCS))
>8ms
Health; hosp referred to conduction and non- and non-
Intermediate) neurophysiology in index occupational occupational
pinky (NCS)) (NCS))
>8ms
Health; Poor) hosp referred to conduction and non- and non-
pinky (NCS)) (NCS))
>8ms
2013 Quality (Never adults from one nerve occupational occupational 7 9 96 R
smoked) hosp referred to conduction and non- and non-
pinky (NCS)) (NCS))
>8ms
122
2013 Quality (Other adults from one nerve occupational occupational 5 8 04 R
Arthritis) hosp referred to conduction and non- and non-
pinky (NCS)) (NCS))
>8ms
2013 Quality (Other adults from one nerve occupational occupational 7 0 96 R
repeated hosp referred to conduction and non- and non-
movements of neurophysiology in index occupational occupational
wrist/fingers and factors (Nerve factors (Nerve
for >4 hours between Conduction Conduction
per working index and Studies Studies
day) pinky (NCS)) (NCS))
>8ms
2013 Quality (Pain in the adults from one nerve symptoms symptoms 6 9 03 R
elbow in the hosp referred to conduction (Nerve (Nerve
past 4 weeks) neurophysiology in index Conduction Conduction
and Studies Studies
index and
pinky
>8ms
neck in the hosp referred to conduction (Nerve (Nerve
and Studies Studies
index and
pinky
>8ms
123
shoulder in the hosp referred to conduction (Nerve (Nerve
and Studies Studies
index and
pinky
>8ms
2013 Quality (Repeated adults from one nerve occupational occupational 6 8 01 R
bending/straig hosp referred to conduction and non- and non-
htening of neurophysiology in index occupational occupational
elbow for >1 and factors (Nerve factors (Nerve
hour per between Conduction Conduction
working day) index and Studies Studies
pinky (NCS)) (NCS))
>8ms
2013 Quality (Rheumatoid adults from one nerve occupational occupational 6 5 00 R
Arthritis) hosp referred to conduction and non- and non-
pinky (NCS)) (NCS))
>8ms
2013 Quality (Targets, adults from one nerve occupational occupational 7 9 97 R
bonuses, or hosp referred to conduction and non- and non-
deadlines neurophysiology in index occupational occupational
provided by and factors (Nerve factors (Nerve
work) between Conduction Conduction
pinky (NCS)) (NCS))
>8ms
124
2013 Quality (Trouble adults from one nerve demographics demographics 6 5 00 R
writing or hosp referred to conduction and and
typing due to neurophysiology in index symptoms symptoms
hand and (Nerve (Nerve
symptoms in between Conduction Conduction
the past 4 index and Studies Studies
>8ms
2013 Quality (Use of adults from one nerve occupational occupational 3 5 16 R
keyboard or hosp referred to conduction and non- and non-
mouse for >4 neurophysiology in index occupational occupational
hours per and factors (Nerve factors (Nerve
working day) between Conduction Conduction
pinky (NCS)) (NCS))
>8ms
2013 Quality (Work for >1 adults from one nerve occupational occupational 7 7 96 R
hour per hosp referred to conduction and non- and non-
working day neurophysiology in index occupational occupational
with tools that and factors (Nerve factors (Nerve
made the between Conduction Conduction
hands/arms index and Studies Studies
vibrate) pinky (NCS)) (NCS))
>8ms
2013 Quality (Work with adults from one nerve occupational occupational 7 6 95 R
hand above hosp referred to conduction and non- and non-
shoulder neurophysiology in index occupational occupational
height for >1 and factors (Nerve factors (Nerve
hour per between Conduction Conduction
working day) index and Studies Studies
pinky (NCS)) (NCS))
>8ms
125
neck bent hosp referred to conduction and non- and non-
forward for >2 neurophysiology in index occupational occupational
hours per and factors (Nerve factors (Nerve
working day) between Conduction Conduction
pinky (NCS)) (NCS))
>8ms
neck twisted hosp referred to conduction and non- and non-
for >.05 hours neurophysiology in index occupational occupational
per working and factors (Nerve factors (Nerve
day) between Conduction Conduction
pinky (NCS)) (NCS))
>8ms
Dale,A.M., Moderate CTS Positive 1108 recruits from sensory, Extremities index pos; 1108 index neg; 1108 0.24|0.7 0.46|0.4 0.90|1. POO POOR
2011 (1) Quality (Hand Left) 11 occupations of motor, and Hand RIGHT, Hand RIGHT, 2 9 10 R
potential CTS risk MUDS Hand LEFT Hand LEFT
cutoffs (Nerve (Nerve
Studies Studies
(NCS)) (NCS))
2011 (1) Quality (Hand Right) 11 occupations of motor, and Hand RIGHT, Hand RIGHT, 6 1 90 R
Studies Studies
(NCS)) (NCS))
126
2011 (2) Quality (Hand Left) 11 occupations of motor, and Hand RIGHT, Hand RIGHT, 8 0 38 R
Studies Studies
(NCS) and (NCS) and
Katz Hand Katz Hand
Diagram; Diagram;
classic or classic or
probable) probable)
2011 (2) Quality (Hand Right) 11 occupations of motor, and Hand RIGHT, Hand RIGHT, 9 0 62 R
Studies Studies
(NCS) and (NCS) and
Katz Hand Katz Hand
Diagram; Diagram;
probable) probable)
El,Miedany Moderate CTS Positive clinically tenosynovi Subjects index pos; 119 index neg; 113 0.68|0.0 0.44|0.2 0.56|2. POO POOR
Y., 2008 Quality (Tenosynovitis diagnosed CTS tis tenosynovitis tenosynovitis 9 1 69 R
) suspects; large diagnosed (Nerve (Nerve
tenosynovitis with US; Conduction Conduction
prevalence CTS by Studies Studies
NCS (NCS); (NCS);
abnormalit AANEM AANEM
ies in referenced) referenced)
sensory,
motor, or
comparati
ve
127
Franzblau,A. Moderate CTS Positive 408 at risk workers median to Extremities index pos; 106 index neg; 703 0.35|0.8 0.26|0.9 2.52|0. WEA POOR
, 1994 (1) Quality (Distal from various ulnar Handed dom, Handed dom, 5 0 82 K
extremity facilities sensory non-dom; non-dom;
symptoms and peak distal and distal and
nocturnal latency of nocturnal nocturnal
symptoms) >.8ms or sympt (Nerve sympt (Nerve
>.5ms Conduction Conduction
Studies Studies
(NCS); (NCS);
>.5ms) >.5ms)
Franzblau,A. Moderate CTS Positive 408 at risk workers median to Extremities index pos; 408 index neg; 408 0.20|0.8 0.56|0.5 1.15|0. POO POOR
, 1994 (1) Quality (Dominant from various ulnar Handed dom, Handed dom, 5 1 86 R
Hand) facilities sensory non-dom; non-dom;
peak distal and distal and
latency of nocturnal nocturnal
>.8ms or sympt (Nerve sympt (Nerve
Studies Studies
(NCS); (NCS);
>.5ms) >.5ms)
, 1994 (1) Quality (Non- from various ulnar Handed dom, Handed dom, 0 9 15 R
Dominant facilities sensory non-dom; non-dom;
Hand) peak distal and distal and
Studies Studies
(NCS); (NCS);
>.5ms) >.5ms)
128
Franzblau,A. Moderate CTS Positive 408 at risk workers median to Extremities index pos; 74 index neg; 735 0.32|0.8 0.23|0.9 3.18|0. WEA POOR
, 1994 (2) Quality (Distal from various ulnar Handed dom, Handed dom, 9 3 83 K
extremity facilities sensory non-dom; non-dom;
symptoms and peak distal and distal and
nocturnal latency of nocturnal nocturnal
symptoms) >.8ms or sympt (Nerve sympt (Nerve
Studies Studies
(NCS); (NCS);
>.8ms) >.8ms)
, 1994 (2) Quality (Dominant from various ulnar Handed dom, Handed dom, 2 1 87 R
Hand) facilities sensory non-dom; non-dom;
peak distal and distal and
Studies Studies
(NCS); (NCS);
>.8ms) >.8ms)
, 1994 (2) Quality (Non- from various ulnar Handed dom, Handed dom, 0 9 13 R
Dominant facilities sensory non-dom; non-dom;
Hand) peak distal and distal and
Studies Studies
(NCS); (NCS);
>.8ms) >.8ms)
129
Gomes,I., Moderate CTS Positive 2535 patients sensory, Extremities index pos; 2130 index neg; 1777 0.45|0.6 0.62|0.5 1.26|0. POO POOR
2006 Quality (Age; 40-60) referred for NCS motor, and Gender/Sex F, Gender/Sex F, 8 1 74 R
from 5 facilities mixed M; BMI30+; M; BMI30+;
nerve Age40-60; Age40-60;
cutoffs Paresthesia; Paresthesia;
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Gomes,I., Moderate CTS Positive 2535 patients sensory, Extremities index pos; 762 index neg; 3145 0.60|0.6 0.30|0.8 2.31|0. WEA POOR
2006 Quality (BMI; 30+) referred for NCS motor, and Gender/Sex F, Gender/Sex F, 6 7 81 K
from 5 facilities mixed M; BMI30+; M; BMI30+;
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
130
Gomes,I., Moderate CTS Positive 2535 patients sensory, Extremities index pos; 2948 index neg; 959 0.44|0.7 0.85|0.3 1.23|0. POO WEAK
2006 Quality (Gender/Sex referred for NCS motor, and Gender/Sex F, Gender/Sex F, 7 1 48 R
Female) from 5 facilities mixed M; BMI30+; M; BMI30+;
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2006 Quality (Gender/Sex referred for NCS motor, and Gender/Sex F, Gender/Sex F, 6 9 23 R
Male) from 5 facilities mixed M; BMI30+; M; BMI30+;
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
131
2006 Quality (Pain; upper referred for NCS motor, and Gender/Sex F, Gender/Sex F, 1 4 63 R
limb) from 5 facilities mixed M; BMI30+; M; BMI30+;
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2006 Quality (Paresthesia; referred for NCS motor, and Gender/Sex F, Gender/Sex F, 1 1 37 R
upper limb) from 5 facilities mixed M; BMI30+; M; BMI30+;
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
132
2006 Quality (Sensory referred for NCS motor, and Gender/Sex F, Gender/Sex F, 3 6 32 R
Symptoms; from 5 facilities mixed M; BMI30+; M; BMI30+;
hand) nerve Age40-60; Age40-60;
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2006 Quality (Worsening referred for NCS motor, and Gender/Sex F, Gender/Sex F, 4 1 56 R
symptoms at from 5 facilities mixed M; BMI30+; M; BMI30+;
night) nerve Age40-60; Age40-60;
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Katz,J.N., Moderate CTS Positive CTS symptomatic referenced Subjects index pos; 54 index neg; 24 0.46|0.7 0.83|0.4 1.38|0. POO WEAK
1991 Quality (Occupation; subjects at one motor and Occupation Occupation 9 0 42 R
exposed to hospital sensory (Nerve (Nerve
pinching, latency Conduction Conduction
grasping, wrist cutoffs Studies Studies
flexion, or (NCS)) (NCS))
vibration)
133
Lo,J.K., Moderate CTS Positive charts of all motor, Subjects index pos; 17 index neg; 331 0.35|0.5 0.04|0.9 0.58|1. POO POOR
2002 Quality (Employment; patients suspected mixed, employment; employment; 1 4 03 R
Disability) of CTS referred to sensory referral referral
outpatient EDS lab nerve source (Nerve source (Nerve
cutoffs Conduction Conduction
referenced Studies Studies
(NCS); (NCS);
AANEM AANEM
Employed) of CTS referred to sensory referral referral
(NCS); (NCS);
AANEM AANEM
Homemaker) of CTS referred to sensory referral referral
(NCS); (NCS);
AANEM AANEM
Lo,J.K., Moderate CTS Positive charts of all motor, Subjects index pos; 56 index neg; 292 0.77|0.5 0.25|0.9 3.50|0. WEA POOR
2002 Quality (Employment; patients suspected mixed, employment; employment; 7 3 80 K
Retired) of CTS referred to sensory referral referral
(NCS); (NCS);
AANEM AANEM
134
Student) of CTS referred to sensory referral referral
(NCS); (NCS);
AANEM AANEM
Unemployed) of CTS referred to sensory referral referral
(NCS); (NCS);
AANEM AANEM
Unknown) of CTS referred to sensory referral referral
(NCS); (NCS);
AANEM AANEM
2002 Quality (Referral; patients suspected mixed, employment; employment; 3 8 95 R
Family of CTS referred to sensory referral referral
Physician) outpatient EDS lab nerve source (Nerve source (Nerve
(NCS); (NCS);
AANEM AANEM
135
Hand Clinic) of CTS referred to sensory referral referral
(NCS); (NCS);
AANEM AANEM
Neurology) of CTS referred to sensory referral referral
(NCS); (NCS);
AANEM AANEM
Other) of CTS referred to sensory referral referral
(NCS); (NCS);
AANEM AANEM
Physiatry) of CTS referred to sensory referral referral
(NCS); (NCS);
AANEM AANEM
136
Rheumatology of CTS referred to sensory referral referral
) outpatient EDS lab nerve source (Nerve source (Nerve
(NCS); (NCS);
AANEM AANEM
MacDermid, Moderate CTS Positive referred to clinic various Extremities index pos; 42 index neg; 42 0.36|0.5 0.42|0.4 0.74|1. POO POOR
J.C., 1997 Quality (Hand for CTS symptoms nerves and numb; pain; numb; pain; 0 4 33 R
Symptoms compressi night sympt; night sympt;
Only) on hand only hand only
measurem (Nerve (Nerve
ents Conduction Conduction
Studies Studies
(NCS), (NCS),
aphy (EMG), aphy (EMG),
and Clinical and Clinical
Diagnosis) Diagnosis)
MacDermid, Moderate CTS Positive referred to clinic various Extremities index pos; 48 index neg; 36 0.75|1.0 1.00|0.7 4.00|0. WEA STRONG
J.C., 1997 Quality (Numbness; for CTS symptoms nerves and numb; pain; numb; pain; 0 5 00 K
frequent) compressi night sympt; night sympt;
on hand only hand only
Studies Studies
(NCS), (NCS),
137
MacDermid, Moderate CTS Positive referred to clinic various Extremities index pos; 71 index neg; 13 0.49|0.9 0.97|0.2 1.30|0. POO MODER
J.C., 1997 Quality (Pain; for CTS symptoms nerves and numb; pain; numb; pain; 2 5 11 R ATE
frequent) compressi night sympt; night sympt;
on hand only hand only
Studies Studies
(NCS), (NCS),
MacDermid, Moderate CTS Positive referred to clinic various Extremities index pos; 39 index neg; 45 0.69|0.8 0.75|0.7 3.00|0. WEA WEAK
J.C., 1997 Quality (Worsening for CTS symptoms nerves and numb; pain; numb; pain; 0 5 33 K
symptoms at compressi night sympt; night sympt;
night) on hand only hand only
Studies Studies
(NCS), (NCS),
Makanji,H.S. Moderate CTS Positive referred CTS DML and Subjects index pos; 55 index neg; 33 0.69|0.1 0.58|0.2 0.79|1. POO POOR
, 2014 Quality (Gender/Sex suspects DSL with Gender/Sex F, Gender/Sex F, 8 6 59 R
Female) referenced M; tobacco M; tobacco
normal use (yes); use (no);
values thenar thenar
atrophy; atrophy;
thumb thumb
abduction abduction
weakness weakness
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
138
, 2014 Quality (Gender/Sex suspects DSL with Gender/Sex F, Gender/Sex F, 1 4 79 R
Male) referenced M; tobacco M; tobacco
atrophy; atrophy;
thumb thumb
abduction abduction
weakness weakness
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
, 2014 Quality (Tobacco Use) suspects DSL with Gender/Sex F, Gender/Sex F, 7 6 98 R
referenced M; tobacco M; tobacco
atrophy; atrophy;
thumb thumb
abduction abduction
weakness weakness
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Pastare,D., Moderate CTS Positive 66 CTS suspected sensory, Extremities index pos; 66 index neg; 31 0.82|0.4 0.76|0.5 1.65|0. POO WEAK
2009 Quality (Clinical patients referred to motor, and clinical clinical 5 4 44 R
Diagnosis; 2 Neuro lab in LINT diagnosis, 2+ diagnosis, 2+
or more Singapore hosp cutoffs sympt (Nerve sympt (Nerve
symptoms) Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
139
Taylor- Moderate CTS Positive clinically motor, Subjects index pos; 139 index neg; 72 0.57|0.4 0.65|0.3 0.98|1. POO POOR
Gjevre,R.M., Quality (Bilateral diagnosed CTS mixed, Gender/Sex; Gender/Sex; 2 3 04 R
2010 Symptoms) suspects referred sensory bilateral; bilateral;
for NCS nerve dominance; dominance;
latency hand (Nerve hand (Nerve
(NCS)) (NCS))
Gjevre,R.M., Quality (Dominant diagnosed CTS mixed, Gender/Sex; Gender/Sex; 3 1 99 R
2010 Hand; Left) suspects referred sensory bilateral; bilateral;
(NCS)) (NCS))
Gjevre,R.M., Quality (Dominant diagnosed CTS mixed, Gender/Sex; Gender/Sex; 0 9 12 R
2010 Hand; Right) suspects referred sensory bilateral; bilateral;
(NCS)) (NCS))
Gjevre,R.M., Quality (Gender/Sex diagnosed CTS mixed, Gender/Sex; Gender/Sex; 0 4 12 R
2010 Female) suspects referred sensory bilateral; bilateral;
(NCS)) (NCS))
140
Gjevre,R.M., Quality (Gender/Sex diagnosed CTS mixed, Gender/Sex; Gender/Sex; 4 6 96 R
2010 Male) suspects referred sensory bilateral; bilateral;
(NCS)) (NCS))
Gjevre,R.M., Quality (Hand Left) diagnosed CTS mixed, Gender/Sex; Gender/Sex; 5 0 93 R
2010 suspects referred sensory bilateral; bilateral;
(NCS)) (NCS))
Gjevre,R.M., Quality (Hand Right) diagnosed CTS mixed, Gender/Sex; Gender/Sex; 1 7 07 R
2010 suspects referred sensory bilateral; bilateral;
(NCS)) (NCS))
Taylor- Moderate CTS Positive clinically motor, Extremities index pos; 72 index neg; 350 0.38|0.5 0.14|0.8 0.67|1. POO POOR
Gjevre,R.M., Quality (Non- diagnosed CTS mixed, symptomatic symptomatic 1 0 08 R
2010 Symptomatic suspects referred sensory hands (Nerve hands (Nerve
Hand) for NCS nerve Conduction Conduction
latency Studies Studies
cutoffs (NCS)) (NCS))
referenced
Taylor- Moderate CTS Positive clinically motor, Extremities index pos; 350 index neg; 72 0.49|0.6 0.86|0.2 1.08|0. POO POOR
Gjevre,R.M., Quality (Symptomatic diagnosed CTS mixed, symptomatic symptomatic 3 0 67 R
2010 Hand) suspects referred sensory hands (Nerve hands (Nerve
for NCS nerve Conduction Conduction
latency Studies Studies
cutoffs (NCS)) (NCS))
referenced
141
Witt,J.C., Moderate CTS Positive referred CTS various Subjects index pos; 65 index neg; 19 0.22|0.4 0.58|0.1 0.69|2. POO POOR
2004 Quality (Clinical suspects NCS clinical clinical 7 5 78 R
diagnosis) parameters diagnosis diagnosis
as needed (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Yagci,I., Moderate CTS Positive DPN PATIENT motor, Subjects index pos; 14 index neg; 33 0.79|0.6 0.50|0.8 4.17|0. WEA POOR
2010 Quality (Gender/Sex POPULATION mixed, Gender/Sex F, Gender/Sex F, 7 8 57 K
Female) referred to EDS sensory M (Nerve M (Nerve
lab nerve Conduction Conduction
cutoffs Studies Studies
referenced (NCS); (NCS);
AANEM AANEM
Yagci,I., Moderate CTS Positive DPN PATIENT motor, Subjects index pos; 33 index neg; 14 0.33|0.2 0.50|0.1 0.57|4. POO POOR
2010 Quality (Gender/Sex POPULATION mixed, Gender/Sex F, Gender/Sex F, 1 2 17 R
Male) referred to EDS sensory M (Nerve M (Nerve
lab nerve Conduction Conduction
cutoffs Studies Studies
referenced (NCS); (NCS);
AANEM AANEM
142
TABLE 16: LOW QUALITY STUDIES- PICO 2 (HISTORY INTERVIEW TOPICS VERSUS REFERENCE STANDARD)
Reference (Index Patient Threshold Reported (Reference p1 (Reference p2 PPV|NP Sens|Sp LR+|L In Out
Title Quality Test) Characteristics Notes By Standard) N Standard) N V ec R- Test Test
Glowacki,K. Low CTS 167 clinically motor and Extremities index pos; 136 index neg; 91 0.90|0.0 0.58|0.1 0.72|2.2 POO POO
A., 1996 Quality Positive diagnosed CTS sensory workers non-workers 3 9 2 R R
(Workers' surgical patients latency comp comp
Compensat cutoff (Surgical (Surgical
ion) values Relief of Relief of
Symptoms; Symptoms;
resolved or resolved or
improved) improved)
Khosrawi,S., Low CTS ALL median to Subjects index pos; 40 index neg; 60 0.28|0.8 0.58|0.6 1.62|0.6 POO POO
2012 Quality Positive PREGNANT ulnar clinical clinical 7 4 6 R R
(Clinical WOMEN cutoffs symptoms symptoms
Symptoms) referenced (Nerve (Nerve
Studies Studies
(NCS)) (NCS))
143
META-ANALYSES
FIGURE 7: EDS AANEM VERSUS FEMALE GENDER/SEX
1
.8
.6
Sensitivity
.4
.2
0
1 .8 .6 .4 .2 0
Specificity

region
95% prediction
region
144
FIGURE 8: EDS AANEM VERSUS MALE GENDER/SEX
1
.8
.6
Sensitivity
.4
.2
0
1 .8 .6 .4 .2 0
Specificity

region
95% prediction
region
145
IMAGING GUIDELINE RECOMMENDATIONS
A. HAND-HELD NERVE CONDUCTION STUDY (NCS)

Limited evidence supports that a hand-held nerve conduction study (NCS) device
might be used for the diagnosis of carpal tunnel syndrome.

Rationale
There was one moderate quality study (Tan, 2012) evaluating the use of a hand-held NCS device
for the diagnosis of CTS. This study showed that a handheld NCS device can rule in or rule out
the diagnosis of CTS, in patients with typical symptoms of CTS, using EDS following AANEM
criteria as the reference standard. The hand-held NCS device closely parallels the severity of
disease compared with the neurological assessment as well.

The user should be aware of the limitations and specific utility of these devices. They should not
be used in patients that have symptoms or signs that might suggest an alternative diagnosis or in
patients who have weakness or atrophy. Use of the hand-held NCS device in those with
alternative diagnosis to CTS or motor deficit may result in missed or delayed diagnosis.
Future Research
More high quality studies are needed to confirm the utility of this method in comparisoned to
electrodiagnostic studies.
B. MRI
Moderate evidence supports not routinely using MRI for the diagnosis of carpal
tunnel syndrome.

Rationale
There was one high quality study (Jarvik, 2002) evaluating MRI for the diagnosis of CTS.
Findings on MRI had a weak or poor association as a rule out test for CTS as compared to a
classic or probable hand pain diagram and nerve conduction study. Only severe fascicular
swelling, severe flexor tenosynovitis, or severe increased muscle signal had a strong association
with CTS, suggesting that MRI would be insensitive in identifying the diagnosis of CTS in the
majority of patients in whom these findings would be unlikely to be present.
146
Future Research
In order for imaging modalities to be effective in diagnosis of CTS consensus on the optimal
location for the measurements and threshold values for parameters such as cross-sectional area
are required.
C. DIAGNOSTIC ULTRASOUND
Limited evidence supports not routinely using ultrasound for the diagnosis of
carpal tunnel syndrome.

Rationale
There were five high quality (Naranjo, 2007; Moran, 2009; Ziswiler, 2005; Wong, 2004; Claes,
2013) and seven moderate quality studies (Abdel Ghaffar, 2012; Dejaco, 2013; Fowler, 2014;
Hashemi, 2009; Moghtaderi, 2012; Nakamichi, 2002; Pastare, 2009) evaluating ultrasound for
the diagnosis of CTS compared with EDS as the reference standard. These studies showed
conflicting results regarding the utility of ultrasound (US) as either a rule in or rule out test in the
diagnosis of CTS. In general, there was variation between the studies for the cut-off value for
making the diagnosis or for exclusion of CTS. The ideal location for measuring the cross-
sectional area (CSA) of the median nerve for indicating the diagnosis of CTS also varied
between studies. There is a general agreement that a CSA greater than 12-13 mm is strongly
correlated with EDS. As a rule out study for CTS, there is a strong correlation with CSA below
8 mm. One moderate quality (Abdel Ghaffar, 2012) and one low quality study (Mallouhi, 2006)
suggest that a US measurement of nerve hypervascularity may have a strong association as a rule
out study for CTS.

Future Research
In order for imaging modalities to be effective in diagnosis of CTS consensus on the optimal
location for the measurements and threshold values for parameters such as cross-sectional area
are required. Further high quality studies are needed to determine the utility of hypervascularity
of the median nerve by ultrasound in the diagnosis of CTS.
147
STUDY QUALITY TABLE OF IMAGING MODALITIES
TABLE 17. DIAGNOSTIC QUALITY EVALUATIONS
Clear Detailed Reference Standard
Representative Other
Study Selection Enough to Identifies Target Blinding Inclusion Strength
Population Bias?
Criteria Replicate Condition
Abdel Ghaffar,M.K., Moderate
Include
2012 Quality
Beckenbaugh,R.D.,
Include Low Quality
1995
Moderate
Dejaco,C., 2013 Include
Quality
Deniz,F.E., 2012 Include Low Quality
Moderate
Fowler,J.R., 2014 Include
Quality
Franzblau,A., 1994 Include High Quality
Glowacki,K.A., 1996 Include Low Quality
Moderate
Hashemi,A.-H., 2009 Include
Quality
Jarvik,J.G., 2002 Include High Quality
Moderate
Kang,E.K., 2008 Include
Quality
Kaul,M.P., 2002 Include Low Quality
Lo,J.K., 2002 Include Low Quality
Mallouhi,A., 2006 Include Low Quality
Missere,M., 1999 Include Low Quality
Moderate
Moghtaderi,A., 2012 Include
Quality
148
Population Bias?
Moran,L., 2009 Include High Quality
Moderate
Nakamichi,K., 2002 Include
Quality
Moderate
Pastare,D., 2009 Include
Quality
Sheean,G.L., 1995 Include Low Quality
Smith,T., 1998 Include Low Quality
Moderate
Stalberg,E., 2000 Include
Quality
Moderate
Swen,W.A., 2001 Include
Quality
Moderate
Szopinski,K., 2011 Include
Quality
Moderate
Tan,S.V., 2012 Include
Quality
Moderate
Weber,R.A., 2000 Include
Quality
Moderate
Werner,R.A., 1994 Include
Quality
Moderate
Werner,R.A., 1995 Include
Quality
Wong,S.M., 2004 Include High Quality
Moderate
Yazdchi,M., 2012 Include
Quality
149
Population Bias?
Ziswiler,H.R., 2005 Include High Quality
150
RESULTS
LR + LR -
Wong,S.M., 2004 (1)

Naranjo,A., 2007 (1)
Tan,S.V., 2012 (1)
Tan,S.V., 2012 (2)
Fowler,J.R., 2014
Pastare,D., 2009
RULE IN NA
Hand held NCS
RULE OUT NA
RULE IN NA
Ultrasound; CSA inlet; >9mm sq
RULE OUT NA
RULE IN NA
Ultrasound; CSA proximal inlet; >10mm sq
RULE OUT NA
151
LR + LR -
Moderate Quality Low Quality
Abdel Ghaffar,M.K., 2012
Mallouhi,A., 2006
RULE IN NA
Ultrasound; nerve edema
RULE OUT NA
RULE IN NA
Ultrasound; nerve hypervascularization
RULE OUT NA
152
TABLE 20: HIGH QUALITY STUDIES- PICO 3 (IMAGING MODALITIES VERSUS REFERENCE STANDARD)
Claes,F., High CTS Positive clinically at least 2 of 4 Subjects index pos; 89 index neg; 67 0.97|0.34 0.66|0.88 5.73|0.38 MODERATE WEAK
2013 Quality (Ultrasound; diagnosed CTS abnormal EDS CSA (Nerve CSA (Nerve
CSA inlet) suspects parameters Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
Franzblau,A., High CTS Positive manufacturing confirmed Subjects index pos; 34 index neg; 48 0.26|0.88 0.60|0.63 1.61|0.64 POOR POOR
1994 (1) Quality (Current workers in median CPT (Nerve CPT (Nerve
Perception Michigan with mononeuropathy Conduction Conduction
Threshold complaints of by NCS only Studies Studies
(CPT)) CTS (NCS); (NCS);
>.5ms) >.5ms)
Franzblau,A., High CTS Positive manufacturing median to ulnar Subjects index pos; 35 index neg; 48 0.11|0.96 0.67|0.60 1.66|0.56 POOR POOR
1994 (2) Quality (Current workers in sensory peak CPT (Nerve CPT (Nerve
Perception Michigan with latency of >.5ms Conduction Conduction
Threshold complaints of Studies Studies
(CPT)) CTS (NCS); (NCS);
>.5ms and >.5ms and
Clinical Clinical
Symptoms) Symptoms)
Jarvik,J.G., High CTS Positive CTS suspects median to ulnar Subjects index pos; . index neg; . AR 0.92|0.28 1.28|0.29 POOR WEAK
2002 Quality (Any MRI from 5 sites in sensory peak MRI MRI
abnormality) Seattle and mixed nerve parameters parameters
latency (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
153
Jarvik,J.G., High CTS Positive CTS suspects median to ulnar Subjects index pos; . index neg; . AR 0.58|0.72 2.07|0.58 WEAK POOR
2002 Quality (Any severe from 5 sites in sensory peak MRI MRI
MRI Seattle and mixed nerve parameters parameters
abnormality) latency (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
Jarvik,J.G., High CTS Positive CTS suspects median to ulnar Subjects index pos; . index neg; . AR 0.45|0.76 1.88|0.72 POOR POOR
2002 Quality (MRI; from 5 sites in sensory peak MRI MRI
Bowing of Seattle and mixed nerve parameters parameters
flexor latency (Nerve (Nerve
retinaculum) Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
2002 Quality (MRI; Deep from 5 sites in sensory peak MRI MRI
palmar Seattle and mixed nerve parameters parameters
bursitis) latency (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
154
Fascicular Seattle and mixed nerve parameters parameters
swelling) latency (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
2002 Quality (MRI; Fat in from 5 sites in sensory peak MRI MRI
the carpal Seattle and mixed nerve parameters parameters
tunnel) latency (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
Flattening of Seattle and mixed nerve parameters parameters
median latency (Nerve (Nerve
nerve) Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
155
2002 Quality (MRI; Flexor from 5 sites in sensory peak MRI MRI
tenosynovitis) Seattle and mixed nerve parameters parameters
latency (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
Jarvik,J.G., High CTS Positive CTS suspects median to ulnar Subjects index pos; . index neg; . AR 0.88|0.39 1.44|0.31 POOR WEAK
Increased Seattle and mixed nerve parameters parameters
median nerve latency (Nerve (Nerve
signal) Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
Increased Seattle and mixed nerve parameters parameters
muscle latency (Nerve (Nerve
signal) Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
156
2002 Quality (MRI; Severe from 5 sites in sensory peak MRI MRI
bowing of Seattle and mixed nerve parameters parameters
flexor latency (Nerve (Nerve
retinaculum) Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
deep palmar Seattle and mixed nerve parameters parameters
bursitis) latency (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
Jarvik,J.G., High CTS Positive CTS suspects median to ulnar Subjects index pos; . index neg; . AR 0.11|1.00 10.00|0.89 STRONG POOR
fascicular Seattle and mixed nerve parameters parameters
swelling) latency (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
157
flattening of Seattle and mixed nerve parameters parameters
median latency (Nerve (Nerve
nerve) Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
flexor Seattle and mixed nerve parameters parameters
tenosynovitis) latency (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
level of fat in Seattle and mixed nerve parameters parameters
the carpal latency (Nerve (Nerve
tunnel) Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
158
Severely Seattle and mixed nerve parameters parameters
increased latency (Nerve (Nerve
median nerve Conduction Conduction
signal) Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
Severely Seattle and mixed nerve parameters parameters
increased latency (Nerve (Nerve
muscle Conduction Conduction
signal) Studies Studies
(NCS); (NCS);
AANEM AANEM
and Katz and Katz
Hand Hand
Diagram; Diagram;
probable) probable)
Moran,L., High CTS Positive 46 CTS motor, mixed, Extremities index pos; 55 index neg; 15 0.78|0.53 0.86|0.40 1.43|0.35 POOR WEAK
2009 Quality (Ultrasound; suspected sensory nerve CSA via 2 CSA via 2
CSA inlet; manual workers cutoffs formulas and formulas and
Automatic (catering and referenced cutoffs cutoffs
Tracing; cleaning) (Nerve (Nerve
>11mm sq) referred to Conduction Conduction
ortho dept Studies Studies
(NCS); (NCS);
AANEM AANEM
159
Moran,L., High CTS Positive 46 CTS motor, mixed, Extremities index pos; 32 index neg; 38 0.94|0.47 0.60|0.90 6.00|0.44 MODERATE WEAK
Automatic (catering and referenced cutoffs cutoffs
Tracing; cleaning) (Nerve (Nerve
>13mm sq) referred to Conduction Conduction
(NCS); (NCS);
AANEM AANEM
Moran,L., High CTS Positive 46 CTS motor, mixed, Extremities index pos; 32 index neg; 38 0.97|0.50 0.62|0.95 12.40|0.40 STRONG WEAK
Elipse (catering and referenced cutoffs cutoffs
Formula; cleaning) (Nerve (Nerve
>12.3mm sq) referred to Conduction Conduction
(NCS); (NCS);
AANEM AANEM
Moran,L., High CTS Positive 46 CTS motor, mixed, Extremities index pos; 57 index neg; 13 0.81|0.69 0.92|0.45 1.67|0.18 POOR MODERATE
Elipse (catering and referenced cutoffs cutoffs
Formula; cleaning) (Nerve (Nerve
>9.8mm sq) referred to Conduction Conduction
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; 75 index neg; 30 0.84|0.43 0.79|0.52 1.64|0.41 POOR WEAK
2007 Quality (Ultrasound; suspected CTS determined US US
bowing of cutoffs locations; locations;
flexor nerve nerve
retinaculum) swelling swelling
to physical to physical
tests (Nerve tests (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
160
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; 17 index neg; 88 0.76|0.24 0.16|0.84 1.02|1.00 POOR POOR
compression cutoffs locations; locations;
in nerve nerve
longitudinal swelling swelling
view) combinations combinations
Studies Studies
(NCS); (NCS);
AANEM AANEM
CSA inlet; cutoffs locations; locations;
>10mm sq) nerve nerve
swelling swelling
Studies Studies
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; 58 index neg; 47 0.88|0.38 0.64|0.72 2.28|0.50 WEAK POOR
swelling swelling
Studies Studies
(NCS); (NCS);
AANEM AANEM
161
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; 47 index neg; 58 0.94|0.38 0.55|0.88 4.58|0.51 WEAK POOR
swelling swelling
Studies Studies
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; 33 index neg; 72 1.00|0.35 0.41|1.00 10.00|0.59 STRONG POOR
swelling swelling
Studies Studies
(NCS); (NCS);
AANEM AANEM
swelling swelling
Studies Studies
(NCS); (NCS);
AANEM AANEM
162
swelling swelling
Studies Studies
(NCS); (NCS);
AANEM AANEM
swelling swelling
Studies Studies
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; 99 index neg; 6 0.80|0.83 0.99|0.20 1.23|0.06 POOR STRONG
swelling swelling
Studies Studies
(NCS); (NCS);
AANEM AANEM
163
>9.7mm sq) nerve nerve
swelling swelling
Studies Studies
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; . index neg; . AR 0.86|0.40 1.44|0.34 POOR WEAK
>9.7mm sq nerve nerve
and BCTQ swelling swelling
>3) combinations combinations
Studies Studies
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; . index neg; . AR 0.94|0.40 1.56|0.16 POOR MODERATE
and bowing swelling swelling
of flexor combinations combinations
retinaculum) to physical to physical
Studies Studies
(NCS); (NCS);
AANEM AANEM
164
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; . index neg; . AR 1.00|0.25 1.33|0.00 POOR STRONG
and swelling swelling
compression combinations combinations
in to physical to physical
longitudinal tests (Nerve tests (Nerve
view) Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Phalen swelling swelling
Test) combinations combinations
Studies Studies
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; . index neg; . AR 0.93|0.43 1.62|0.18 POOR MODERATE
and symptom swelling swelling
duration >24 combinations combinations
months) to physical to physical
Studies Studies
(NCS); (NCS);
AANEM AANEM
165
and Tinel swelling swelling
Sign) combinations combinations
Studies Studies
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; . index neg; . AR 1.00|0.67 2.99|0.00 WEAK STRONG
>9.7mm sq, nerve nerve
neg Tinel swelling swelling
Sign, and neg combinations combinations
Phalen Test) to physical to physical
Studies Studies
(NCS); (NCS);
AANEM AANEM
>9.7mm sq, nerve nerve
pos Tinel swelling swelling
Sign, and pos combinations combinations
Phalen Test) to physical to physical
Studies Studies
(NCS); (NCS);
AANEM AANEM
166
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; 93 index neg; 12 0.83|0.75 0.96|0.36 1.50|0.10 POOR MODERATE
swelling swelling
Studies Studies
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; 65 index neg; 40 0.89|0.45 0.73|0.72 2.59|0.38 WEAK WEAK
CSA max; cutoffs locations; locations;
swelling swelling
Studies Studies
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; 56 index neg; 49 0.91|0.41 0.64|0.80 3.19|0.45 WEAK WEAK
CSA outlet; cutoffs locations; locations;
swelling swelling
Studies Studies
(NCS); (NCS);
AANEM AANEM
167
CSA cutoffs locations; locations;
proximal nerve nerve
inlet; swelling swelling
>10.1mm sq) combinations combinations
Studies Studies
(NCS); (NCS);
AANEM AANEM
Naranjo,A., High CTS Positive 68 patients with ROC curve Extremities index pos; 65 index neg; 40 0.80|0.30 0.65|0.48 1.25|0.73 POOR POOR
flattening cutoffs locations; locations;
index) nerve nerve
swelling swelling
Studies Studies
(NCS); (NCS);
AANEM AANEM
Tan,S.V., Moderate CTS Positive limbs of 100 at least 2 Extremities index pos; . index neg; . AR 0.85|0.90 8.50|0.17 MODERATE MODERATE
2012 (1) Quality (Hand held CTS suspects abnormal EDS hand held hand held
NCS parameters NCS (Nerve NCS (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Tan,S.V., Moderate CTS Positive limbs of 100 at least 2 Extremities index pos; . index neg; . AR 0.84|0.89 7.64|0.18 MODERATE MODERATE
2012 (2) Quality (Hand held CTS suspects abnormal EDS hand held hand held
NCS parameters NCS (Nerve NCS (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
168
Wong,S.M., High CTS Positive 120 CTS sensory and Extremities index pos; 121 index 72 0.92|0.68 0.83|0.83 4.89|0.21 WEAK WEAK
2004 Quality (Ultrasound; suspects motor latency US CSA >.9 neg;US CSA
CSA referred to one cutoffs (Nerve >.9 (Nerve
proximal hospital Conduction Conduction
inlet; >10mm Studies Studies
sq) (NCS); (NCS);
AANEM AANEM
Wong,S.M., High CTS Positive 120 CTS sensory and Extremities index pos; 150 index 43 0.83|0.77 0.93|0.56 2.10|0.13 WEAK MODERATE
2004 Quality (Ultrasound; suspects motor latency US CSA >.9 neg;US CSA
CSA referred to one cutoffs (Nerve >.9 (Nerve
proximal hospital Conduction Conduction
inlet; >9mm Studies Studies
sq) (NCS); (NCS);
AANEM AANEM
Ziswiler,H.R., High CTS Positive 71 CTS motor and Extremities index pos; 67 index neg; 34 0.94|0.59 0.82|0.83 4.91|0.22 WEAK WEAK
2005 Quality (Ultrasound; suspects sensory latency CSA max; CSA max;
CSA max; referred to cutoff values various various
>10mm sq) outpatient clinic cutoff levels cutoff levels
in Switzerland (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Rated and Rated
Signs and Signs and
Symptoms) Symptoms)
Ziswiler,H.R., High CTS Positive 71 CTS motor and Extremities index pos; 43 index neg; 58 0.98|0.38 0.54|0.96 12.38|0.48 STRONG WEAK
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Rated and Rated
Signs and Signs and
Symptoms) Symptoms)
169
Ziswiler,H.R., High CTS Positive 71 CTS motor and Extremities index pos; 34 index neg; 67 1.00|0.34 0.44|1.00 10.00|0.56 STRONG POOR
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Rated and Rated
Signs and Signs and
Symptoms) Symptoms)
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Rated and Rated
Signs and Signs and
Symptoms) Symptoms)
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Rated and Rated
Signs and Signs and
Symptoms) Symptoms)
170
Ziswiler,H.R., High CTS Positive 71 CTS motor and Extremities index pos; 96 index neg; 5 0.80|0.80 0.99|0.17 1.20|0.07 POOR STRONG
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Rated and Rated
Signs and Signs and
Symptoms) Symptoms)
Ziswiler,H.R., High CTS Positive 71 CTS motor and Extremities index pos; 93 index neg; 8 0.82|0.75 0.97|0.26 1.32|0.10 POOR STRONG
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Rated and Rated
Signs and Signs and
Symptoms) Symptoms)
Ziswiler,H.R., High CTS Positive 71 CTS motor and Extremities index pos; 80 index neg; 21 0.88|0.62 0.90|0.57 2.06|0.18 WEAK MODERATE
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Rated and Rated
Signs and Signs and
Symptoms) Symptoms)
171
Ziswiler,H.R., High CTS Positive 71 CTS motor and Extremities index pos; 74 index neg; 27 0.91|0.59 0.86|0.70 2.82|0.20 WEAK WEAK
Studies Studies
(NCS); (NCS);
AANEM AANEM
and Rated and Rated
Signs and Signs and
Symptoms) Symptoms)
172
TABLE 21: MODERATE QUALITY STUDIES- PICO 3 (IMAGING MODALITIES VERSUS REFERENCE STANDARD)
Outcome Outcomes Group1 Group Group2 Group Rule Rule
Reference (Index Patient Threshold Reported (Reference 1 (Reference 2 PPV|NP Sens|Sp LR+|LR In Out
Title Quality Test) Characteristics Notes By Standard) N Standard) N V ec - Test Test
Abdel Modera CTS Positive 41 suspected motor, Extremities index pos; US 40 index neg; US 13 0.95|0.2 0.79|0.6 1.98|0.3 POOR WEAK
Ghaffar,M.K te (Ultrasound; CTS patients mixed, factors (Nerve factors (Nerve 3 0 5
., 2012 Quality bowing of flexor from one hosp sensory Conduction Conduction
retinaculum) nerve Studies (NCS)) Studies (NCS))
cutoffs
referenced
Abdel Modera CTS Positive 41 suspected motor, Extremities index pos; US 48 index neg; US 5 0.94|0.4 0.94|0.4 1.56|0.1 POOR MODERA
Ghaffar,M.K te (Ultrasound; CSA CTS patients mixed, factors (Nerve factors (Nerve 0 0 6 TE
., 2012 Quality inlet; >11mm sq) from one hosp sensory Conduction Conduction
nerve Studies (NCS)) Studies (NCS))
cutoffs
referenced
Abdel Modera CTS Positive 41 suspected motor, Extremities index pos; US 42 index neg; US 11 0.95|0.2 0.83|0.6 2.08|0.2 WEAK WEAK
Ghaffar,M.K te (Ultrasound; nerve CTS patients mixed, factors (Nerve factors (Nerve 7 0 8
., 2012 Quality edema) from one hosp sensory Conduction Conduction
nerve Studies (NCS)) Studies (NCS))
cutoffs
referenced
Abdel Modera CTS Positive 41 suspected motor, Extremities index pos; US 49 index neg; US 4 0.96|0.7 0.98|0.6 2.45|0.0 WEAK STRONG
Ghaffar,M.K te (Ultrasound; nerve CTS patients mixed, factors (Nerve factors (Nerve 5 0 3
., 2012 Quality hypervascularizati from one hosp sensory Conduction Conduction
on) nerve Studies (NCS)) Studies (NCS))
cutoffs
referenced
Dejaco,C., Modera CTS Positive 135 patients with ranked as Extremities index pos; US . index neg; US . AR 0.94|0.5 2.09|0.1 WEAK MODERA
2013 te (Ultrasound; CSA suspected CTS; CTS by CSA levels CSA levels 5 2 TE
Quality difference asymptomatic neurologist (Clinical (Clinical
between CsL and hands included based on Diagnosis and Diagnosis and
CsP; >2.5mm sq) NCS and Nerve Nerve
clinical Conduction Conduction
assessment Studies (NCS); Studies (NCS);
>90% >90%
neurologist neurologist
confidence) confidence)
173
Dejaco,C., Modera CTS Positive 135 patients with ranked as Extremities index pos; US . index neg; US . AR 0.42|0.9 5.89|0.6 MODERA POOR
between CsL and hands included based on Diagnosis and Diagnosis and
>90% >90%
Dejaco,C., Modera CTS Positive 135 patients with ranked as Extremities index pos; US . index neg; US . AR 0.96|0.3 1.41|0.1 POOR MODERA
between CsR and hands included based on Diagnosis and Diagnosis and
>90% >90%
between CsR and hands included based on Diagnosis and Diagnosis and
>90% >90%
Dejaco,C., Modera CTS Positive 135 patients with ranked as Extremities index pos; US . index neg; US . AR 0.93|0.1 1.11|0.4 POOR WEAK
2013 te (Ultrasound; CSA suspected CTS; CTS by CSA levels CSA levels 7 4
between CsS and hands included based on Diagnosis and Diagnosis and
CsP; >.5mm sq) NCS and Nerve Nerve
>90% >90%
174
between CsS and hands included based on Diagnosis and Diagnosis and
>90% >90%
Dejaco,C., Modera CTS Positive 135 patients with ranked as Extremities index pos; US . index neg; US . AR 0.36|0.9 4.33|0.7 WEAK POOR
Quality Inlet (CsS); asymptomatic neurologist (Clinical (Clinical
>12.8mm sq) hands included based on Diagnosis and Diagnosis and
NCS and Nerve Nerve
>90% >90%
Quality Inlet (CsS); asymptomatic neurologist (Clinical (Clinical
NCS and Nerve Nerve
>90% >90%
Quality max (CsL); asymptomatic neurologist (Clinical (Clinical
NCS and Nerve Nerve
>90% >90%
175
Quality max (CsL); asymptomatic neurologist (Clinical (Clinical
NCS and Nerve Nerve
>90% >90%
Quality proximal inlet asymptomatic neurologist (Clinical (Clinical
(CsR); >13.8mm hands included based on Diagnosis and Diagnosis and
sq) NCS and Nerve Nerve
>90% >90%
Quality proximal inlet asymptomatic neurologist (Clinical (Clinical
(CsR); >9.8mm hands included based on Diagnosis and Diagnosis and
sq) NCS and Nerve Nerve
>90% >90%
Dejaco,C., Modera CTS Positive 135 patients with ranked as Extremities index pos; US . index neg; US . AR 0.91|0.5 1.84|0.1 POOR MODERA
Quality ratio between CsL asymptomatic neurologist (Clinical (Clinical
and CSA proximal hands included based on Diagnosis and Diagnosis and
pronator quadrus NCS and Nerve Nerve
(CsP); >1.3) clinical Conduction Conduction
>90% >90%
176
Quality ratio between CsL asymptomatic neurologist (Clinical (Clinical
and CSA proximal hands included based on Diagnosis and Diagnosis and
pronator quadrus NCS and Nerve Nerve
(CsP); >1.81) clinical Conduction Conduction
>90% >90%
Quality ratio between CsR asymptomatic neurologist (Clinical (Clinical
and CsP; >1.25) hands included based on Diagnosis and Diagnosis and
NCS and Nerve Nerve
>90% >90%
Dejaco,C., Modera CTS Positive 135 patients with ranked as Extremities index pos; US . index neg; US . AR 0.56|0.9 6.88|0.4 MODERA WEAK
Quality ratio between CsR asymptomatic neurologist (Clinical (Clinical
NCS and Nerve Nerve
>90% >90%
Quality ratio between CsS asymptomatic neurologist (Clinical (Clinical
NCS and Nerve Nerve
>90% >90%
177
Quality ratio between CsS asymptomatic neurologist (Clinical (Clinical
NCS and Nerve Nerve
>90% >90%
Fowler,J.R., Modera CTS Positive referred for EDS DML Subjects index pos; US 52 index neg; US 33 0.90|0.7 0.85|0.8 5.13|0.1 MODERA MODERA
2014 te (Ultrasound; CSA 4.2ms+ or CSA (Nerve CSA (Nerve 6 3 7 TE TE
Quality proximal inlet; DSL Conduction Conduction
>10mm sq) 3.2ms+ Studies (NCS); Studies (NCS);
AANEM AANEM
Hashemi,A.- Modera CTS Positive 50 CTS suspects NCV of Extremities index pos; US 60 index neg; US 40 0.80|0.8 0.91|0.7 3.55|0.1 WEAK MODERA
H., 2009 te (Ultrasound; CSA referred to the median (Nerve (Nerve 8 4 3 TE
Quality max; >10mm sq) hospital nerve in Conduction Conduction
carpal Studies (NCS)) Studies (NCS))
tunnel and
ring finger
Kang,E.K., Modera CTS Positive all women; 31 motor, Extremities index pos; 34 index neg; CPT 26 0.59|0.6 0.69|0.5 1.53|0.5 POOR POOR
2008 te (Current patients referred mixed, CPT (Nerve (Nerve 5 5 7
Quality Perception for NCS sensory Conduction Conduction
Threshold (CPT)) nerve Studies (NCS); Studies (NCS);
cutoffs AANEM AANEM
referenced referenced) referenced)
Lo,J.K., Modera CTS Positive charts of all motor, Subjects index pos; 48 index neg; 300 0.92|0.5 0.26|0.9 11.65|0. STRONG POOR
2002 te (Electromyograph patients mixed, EMG (Nerve EMG (Nerve 8 8 76
Quality y (EMG); APB suspected of sensory Conduction Conduction
deinnervation CTS referred to nerve Studies (NCS); Studies (NCS);
potentials) outpatient EDS cutoffs AANEM AANEM
lab referenced referenced) referenced)
Moghtaderi, Modera CTS Positive CTS moderate or motor, Subjects index pos; 16 index neg; CSA 63 0.81|0.6 0.36|0.9 5.18|0.6 MODERA POOR
A., 2012 te (Ultrasound; CSA severe patients mixed, CSA prox and prox and distal 3 3 9 TE
Quality distal outlet; from one clinic sensory distal (Nerve (Nerve
>13.5mm sq) vs upper limb nerve Conduction Conduction
pain controls cutoffs Studies (NCS); Studies (NCS);
referenced AANEM AANEM
178
Moghtaderi, Modera CTS Positive CTS moderate or motor, Subjects index pos; 34 index neg; CSA 45 0.88|0.8 0.83|0.9 8.96|0.1 MODERA MODERA
A., 2012 te (Ultrasound; CSA severe patients mixed, CSA prox and prox and distal 7 1 8 TE TE
Quality proximal inlet; from one clinic sensory distal (Nerve (Nerve
>11.5mm sq) vs upper limb nerve Conduction Conduction
pain controls cutoffs Studies (NCS); Studies (NCS);
Nakamichi,K Modera CTS Positive 275 clinically sensory Extremities index pos; US 47 index neg; US 367 0.85|0.2 0.13|0.9 2.15|0.9 WEAK POOR
., 2002 te (Ultrasound; CSA diagnosed CTS and motor CSA locations CSA locations 9 4 2
Quality inlet) patients latency (Nerve (Nerve
AANEM AANEM
Nakamichi,K Modera CTS Positive 275 clinically sensory Extremities index pos; US 20 index neg; US 394 0.45|0.2 0.03|0.9 0.31|1.0 POOR POOR
Quality mid) patients latency (Nerve (Nerve
AANEM AANEM
Quality mid and CSA patients latency (Nerve (Nerve
inlet) cutoffs Conduction Conduction
AANEM AANEM
Quality outlet) patients latency (Nerve (Nerve
AANEM AANEM
Quality outlet and CSA patients latency (Nerve (Nerve
inlet) cutoffs Conduction Conduction
AANEM AANEM
179
Quality outlet and CSA patients latency (Nerve (Nerve
mid) cutoffs Conduction Conduction
AANEM AANEM
Quality outlet, CSA mid, patients latency (Nerve (Nerve
and CSA inlet) cutoffs Conduction Conduction
AANEM AANEM
., 2002 te (Ultrasound; no diagnosed CTS and motor CSA locations CSA locations 1 8 5
Quality CSA abnormality patients latency (Nerve (Nerve
at distal, mid, or cutoffs Conduction Conduction
proximal) Studies (NCS); Studies (NCS);
AANEM AANEM
Pastare,D., Modera CTS Positive 66 CTS sensory, Extremities index pos; 50 index neg; CSA 47 0.96|0.5 0.68|0.9 8.79|0.3 MODERA WEAK
2009 te (Ultrasound; CSA suspected motor, and CSA proximal proximal 1 2 5 TE
Quality inlet; >9mm sq) patients referred LINT (Nerve (Nerve
to Neuro lab in cutoffs Conduction Conduction
Singapore hosp Studies (NCS); Studies (NCS);
AANEM AANEM
Stalberg,E., Modera CTS Positive Only 178 hands motor, Extremities index pos; CT 49 index neg; CT 129 0.90|0.9 0.92|0.9 23.83|0. STRONG STRONG
2000 te (Automatic Carpal readable on CT mixed, tester (Nerve tester (Nerve 7 6 09
Quality Tunnel Tester) tester; 136 sensory Conduction Conduction
patients with nerve Studies (NCS); Studies (NCS);
presumptive cutoffs AANEM AANEM
CTS diagnosis referenced referenced) referenced)
180
Swen,W.A., Modera CTS Positive 63 symptomatic Surgical Subjects index pos; 58 index neg; 5 0.78|0.6 0.96|0.1 1.18|0.2 POOR WEAK
2001 te (Distal Sensory patients visiting relief on NCS; DSL; NCS; DSL; 0 9 3
Quality Latency (DSL) neuro clinic VAS scale; CSA (Surgical CSA (Surgical
difference from motor, Relief of Relief of
Ulnar; digit 4) mixed, Symptoms; Symptoms; 90+
sensory 90+ percent percent
nerve improvement improvement
cutoffs on VAS scale on VAS scale
referenced after 3 months) after 3 months)
for NCS
Swen,W.A., Modera CTS Positive 63 symptomatic Surgical Subjects index pos; 59 index neg; 4 0.78|0.7 0.98|0.1 1.20|0.1 POOR MODERA
2001 te (Nerve patients visiting relief on NCS; DSL; NCS; DSL; 5 9 1 TE
Quality Conduction neuro clinic VAS scale; CSA (Surgical CSA (Surgical
Studies (NCS); motor, Relief of Relief of
AANEM mixed, Symptoms; Symptoms; 90+
referenced) sensory 90+ percent percent
for NCS
Swen,W.A., Modera CTS Positive 63 symptomatic Surgical Subjects index pos; 39 index neg; 24 0.85|0.4 0.70|0.6 1.87|0.4 POOR WEAK
2001 te (Ultrasound; CSA patients visiting relief on NCS; DSL; NCS; DSL; 2 3 8
Quality inlet; Elipse neuro clinic VAS scale; CSA (Surgical CSA (Surgical
Formula; >10mm motor, Relief of Relief of
sq) mixed, Symptoms; Symptoms; 90+
sensory 90+ percent percent
for NCS
Szopinski,K. Modera CTS Positive 76 patients with motor and Extremities index pos; CS 124 index neg; CS 15 0.85|0.1 0.89|0.1 0.98|1.1 POOR POOR
, 2011 te (Ultrasound; cross clinical sensory shape shape 3 0 6
Quality sectional shape; diagnosis of latency and triangular, non triangular, non
non-triangular) CTS velocity triangular triangular
cutoff (Nerve (Nerve
values Conduction Conduction
AANEM AANEM
181
Szopinski,K. Modera CTS Positive 76 patients with motor and Extremities index pos; CS 15 index neg; CS 124 0.87|0.1 0.11|0.9 1.16|0.9 POOR POOR
, 2011 te (Ultrasound; cross clinical sensory shape shape 5 0 8
Quality sectional shape; diagnosis of latency and triangular, non triangular, non
triangular) CTS velocity triangular triangular
cutoff (Nerve (Nerve
AANEM AANEM
Weber,R.A., Modera CTS Positive 53 patients with history and Extremities index pos; 67 index neg; NCS 39 0.64|0.7 0.80|0.5 1.73|0.3 POOR WEAK
2000 te (Nerve suspected CTS physical NCS (Clinical (Clinical 2 4 8
Quality Conduction from one hosp signs and Diagnosis) Diagnosis)
Studies (NCS); symptoms
AANEM
referenced)
Werner,R.A., Modera CTS Positive 130 line workers median to Subjects index pos; VT 8 index neg; VT 121 0.13|0.7 0.04|0.9 0.57|1.0 POOR POOR
1994 te (Vibratory at a company ulnar (Nerve (Nerve 9 3 3
Quality Threshold) with complaints sensory Conduction Conduction
of symptoms; 1 peak Studies (NCS)) Studies (NCS))
was unable to latency of
get NCS due to >.5ms
cast
Werner,R.A., Modera CTS Positive patients recruited median to Subjects index pos; VT 80 index neg; VT 87 0.31|0.8 0.61|0.5 1.40|0.6 POOR POOR
1995 te (Vibratory from 2 ulnar Jetzer (Nerve Jetzer (Nerve 2 6 9
Quality Threshold; Jetzer manufacturing sensory Conduction Conduction
Index) plants; current peak Studies (NCS)) Studies (NCS))
symptoms not latency of
required >.5ms
Yazdchi,M., Modera CTS Positive 90 CTS motor and Extremities index pos; US 121 index neg; US 59 0.92|0.2 0.72|0.6 1.79|0.4 POOR WEAK
2012 te (Ultrasound; CSA suspected sensory variations variations 5 0 7
Quality inlet; >12.5mm patients latency (Nerve (Nerve
sq) responses Conduction Conduction
Studies (NCS) Studies (NCS)
and and
Electromyogra Electromyograp
phy (EMG)) hy (EMG))
182
Quality outlet; >11.5mm patients latency (Nerve (Nerve
sq) responses Conduction Conduction
and and
Quality proximal inlet; patients latency (Nerve (Nerve
>11.5mm sq) responses Conduction Conduction
and and
183
TABLE 22: LOW QUALITY STUDIES- PICO 3 (IMAGING MODALITIES VERSUS REFERENCE STANDARD)
Beckenbaugh,R. Low CTS Positive 45 CTS sensory, Extremities index pos; hand 63 index neg; hand 1 0.89|1.0 1.00|0.1 1.14|0.0 POOR STRONG
D., 1995 Quality (Hand Held suspected motor, and held EMG; ML held EMG; ML 0 3 0
Electroneurome patients mixed cutoffs cutoffs
ter; motor nerve (Electromyogra (Electromyogra
latency cutoffs phy (EMG)) phy (EMG))
>2.8ms)
Beckenbaugh,R. Low CTS Positive 45 CTS sensory, Extremities index pos; hand 59 index neg; hand 5 0.93|0.8 0.98|0.5 1.96|0.0 POOR STRONG
>3.2ms)
Beckenbaugh,R. Low CTS Positive 45 CTS sensory, Extremities index pos; hand 55 index neg; hand 9 0.96|0.6 0.95|0.7 3.79|0.0 WEAK STRONG
>3.7ms)
Beckenbaugh,R. Low CTS Positive 45 CTS sensory, Extremities index pos; hand 49 index neg; hand 15 0.98|0.4 0.86|0.8 6.86|0.1 MODERA MODERA
D., 1995 Quality (Hand Held suspected motor, and held EMG; ML held EMG; ML 7 8 6 TE TE
>3.9ms)
Beckenbaugh,R. Low CTS Positive 45 CTS sensory, Extremities index pos; hand 39 index neg; hand 25 0.97|0.2 0.68|0.8 5.43|0.3 MODERA WEAK
D., 1995 Quality (Hand Held suspected motor, and held EMG; ML held EMG; ML 8 8 7 TE
>4.3ms)
Beckenbaugh,R. Low CTS Positive 45 CTS sensory, Extremities index pos; hand 29 index neg; hand 35 1.00|0.2 0.52|1.0 10.00|0. STRONG WEAK
>4.7ms)
Deniz,F.E., Low CTS Positive patients referred Subjects index pos; MRI; 39 index neg; MRI; 39 AR 0.68|0.8 5.08|0.3 MODERA WEAK
2012 Quality (CT; Distal to Neuro CT; EMG CT; EMG 7 7 TE
Area) services for (Clinical (Clinical
suspected CTS Diagnosis) Diagnosis)
184
Deniz,F.E., Low CTS Positive patients referred Subjects index pos; MRI; 39 index neg; MRI; 39 AR 0.71|0.7 2.82|0.3 WEAK WEAK
2012 Quality (CT; Distal to Neuro CT; EMG CT; EMG 5 9
Density) services for (Clinical (Clinical
Deniz,F.E., Low CTS Positive patients referred Subjects index pos; MRI; 39 index neg; MRI; 39 AR 0.97|0.4 1.82|0.0 POOR STRONG
2012 Quality (CT; Proximal to Neuro CT; EMG CT; EMG 7 6
2012 Quality (CT; Proximal to Neuro CT; EMG CT; EMG 0 1
Density) services for (Clinical (Clinical
Deniz,F.E., Low CTS Positive patients referred Subjects index pos; MRI; 69 index neg; MRI; 69 AR 0.91|0.8 4.84|0.1 WEAK MODERA
2012 Quality (Electromyogra to Neuro CT; EMG CT; EMG 1 1 TE
phy (EMG)) services for (Clinical (Clinical
2012 Quality (MRI; Distal to Neuro CT; EMG CT; EMG 0 4
Deniz,F.E., Low CTS Positive patients referred Subjects index pos; MRI; 50 index neg; MRI; 50 AR 0.88|0.4 1.46|0.3 POOR WEAK
2012 Quality (MRI; Distal to Neuro CT; EMG CT; EMG 0 1
Intensity) services for (Clinical (Clinical
Deniz,F.E., Low CTS Positive patients referred Subjects index pos; MRI; 50 index neg; MRI; 50 AR 0.43|1.0 10.00|0. STRONG POOR
2012 Quality (MRI; Proximal to Neuro CT; EMG CT; EMG 0 58
2012 Quality (MRI; Proximal to Neuro CT; EMG CT; EMG 0 1
Intensity) services for (Clinical (Clinical
Glowacki,K.A., Low CTS Positive 93 clinically motor and Extremities index pos; EDS; 99 index neg; EDS; 27 0.93|0.0 0.79|0.2 1.01|0.9 POOR POOR
1996 Quality (Electrodiagnos diagnosed CTS sensory emg/ncs emg/ncs 7 2 6
tic Studies; surgical patients latency and (Surgical Relief (Surgical Relief
NCS/EMG; undergoing EDS velocity of Symptoms; of Symptoms;
AANEM cutoff resolved or resolved or
referenced) values improved) improved)
185
Kaul,M.P., 2002 Low CTS Positive obtainable palm diff Subjects index pos; 2L- 78 index neg; 2L- 51 0.92|0.8 0.92|0.8 7.85|0.0 MODERA STRONG
Quality (2L-INT) responses from rates INT (Nerve INT (Nerve 8 8 9 TE
158 subjects referenced Conduction Conduction
palm-diff) palm-diff)
Mallouhi,A., Low CTS Positive clinically motor, Extremities index pos; US 149 index neg; US 57 0.92|0.3 0.80|0.6 2.26|0.3 WEAK WEAK
2006 Quality (Ultrasound; suspected CTS mixed, edema; US edema; US 9 5 1
nerve edema) suspects from sensory hypervascular hypervascular
database nerve (Nerve (Nerve
referenced Studies (NCS)) Studies (NCS))
Mallouhi,A., Low CTS Positive clinically motor, Extremities index pos; US 174 index neg; US 32 0.94|0.7 0.95|0.7 3.24|0.0 WEAK STRONG
2006 Quality (Ultrasound; suspected CTS mixed, edema; US edema; US 5 1 7
nerve suspects from sensory hypervascular hypervascular
hypervasculariz database nerve (Nerve (Nerve
ation) cutoffs Conduction Conduction
referenced Studies (NCS)) Studies (NCS))
Missere,M., Low CTS Positive 45 workers motor, Extremities index pos; US 61 index neg; US 29 0.36|0.8 0.85|0.3 1.39|0.3 POOR WEAK
1999 Quality (Ultrasound; M recruited for mixed, M index (M M index (M 6 9 9
Index) potential job sensory space decrease) space increase)
risk of CTS nerve (Electromyogra (Electromyogra
cutoffs phy (EMG)) phy (EMG))
referenced
Sheean,G.L., Low CTS Positive virtually motor, Extremities index pos; 2L- 49 index neg; 2L- 17 0.98|0.9 0.98|0.9 16.65|0. STRONG STRONG
1995 Quality (2L-INT; consecutive mixed, INT-DML INT-DML 4 4 02
DML) suspected CTS sensory (Nerve (Nerve
patients nerve Conduction Conduction
cutoffs Studies (NCS); Studies (NCS);
Smith,T., 1998 Low CTS Positive CTS suspected SCN Subjects index pos; EMG 44 index neg; EMG 38 0.84|0.9 0.93|0.8 5.55|0.0 MODERA STRONG
Quality (Electromyogra patients referred cutoffs SNC (Nerve SNC (Nerve 2 3 9 TE
phy (EMG); to neuro dept Conduction Conduction
Sensory Nerve Studies (NCS); Studies (NCS);
Conduction Sensory Nerve Sensory Nerve
(SNC); Needle; Conduction Conduction
AANEM (SNC); Surface; (SNC); Surface;
referenced) AANEM AANEM
186
DIAGNOSTIC SCALES
Moderate evidence supports that diagnostic questionnaires and/or electrodiagnostic
studies could be used to aid the diagnosis of carpal tunnel syndrome.

Rationale
The evaluation of diagnostic tools, either scales based on clinically acquired information from
the history and physical examination, or electrodiagnostic tests, requires a clear consensus on a
reference standard against which the performance of these diagnostic tests can be compared. This
type of consensus still does not exist with respect to carpal tunnel syndrome. It is recognized that
electrodiagnostic testing has long been considered to represent a reference standard but this
assumption is untenable because these tests clearly have false positive and negative results.
Beyond this there simply is no consensus supporting any single diagnostic tool as a reference
standard. Where clinical diagnostic scales are taken as the reference standard, electrodiagnostic
tests may demonstrate poor sensitivity and specificity. The same is true of clinical diagnostic
scales when electrodiagnostic tests are taken as the reference standard. Agreement between
electrodiagnostic tests and clinical diagnostic tests, regardless of which is taken as the reference
standard, is also complicated by the binary nature of the comparison. Electrodiagnostic data is,
by and large, continuous in nature and so establishing a hard cutoff point to compare to clinical
diagnostic scales seems potentially arbitrary. At least one of the clinical diagnostic scales, the
CTS-6, attempts to address this by defining the diagnosis in probabilistic terms as a continuous
variable. Given this set of circumstances the Workgroup sought to evaluate the role of clinical
diagnostic tests and electrodiagnostic testing in the evaluation of CTS in the context in which
they are used, in other words, in clinical settings where a patient presents with complaints that
might be attributable to this condition.
There were two clinical diagnostic tests studied in high quality investigations, the Katz Hand
Diagram and the CTS-6. The Boston Carpal Tunnel Scale, a status instrument most frequently
used to measure outcomes of treatment for CTS was also evaluated in two high quality studies.
In comparison to electrodiagnostic testing Katz et al demonstrated high sensitivity (0.96) and

good negative predictive value (0.91) for the classic, probable or possible designations
however, positive predictive value and specificity were low. This indicates that, using
electrodiagnostic testing as a reference standard, the Katz Hand Diagram used in this way had
more value as a rule out test. Sensitivity decreased and specificity increased if comparison to
electrodiagnostic tests was made only using classic or probable results. Sensitivity decreased
further and specificity was commensurately increased when only classic results were
compared to electrodiagnostic testing. Defined using only classic or classic or probable
results the Katz Hand Diagram was considered weak or poor as either a rule in or rule out
test. Vanti made similar observations using AANEM electrodiagnostic definitions for CTS in
demonstrating that the classic or probable results functioned as a strong rule out test.
187
Graham took a different approach to evaluating the respective roles of electrodiagnostic testing
and the CTS-6, an instrument that expresses the probability of CTS. The pre-test probability of
CTS was established using the CTS-6 and then the post-test probability after electrodiagnostic
testing was estimated using likelihood ratios established with two electrodiagnostic standards for
CTS, one lax (with higher sensitivity and lower specificity) and one stringent (with lower
sensitivity and higher specificity). This study showed that the changes in probability after
electrodiagnostic testing, using either electrodiagnostic definition, were small and probably
below a clinically relevant standard. This suggests that the most appropriate setting for
electrodiagnostic testing is where there is uncertainty about the clinical diagnosis.
There were two high quality studies evaluating the Boston Carpal Tunnel Syndrome
Questionnaire (Wainner, Naranjo). Both of these studies used electrodiagnostic tests as the
reference standard. The results were consistent in both studies in showing that this instrument
functioned as either a weak or poor rule in or rule out test. This may have been due to the
fact that the scale was actually developed as a status instrument rather than as a diagnostic scale.

While diagnostic scales/questionnaires can be used for the clinical assessment of CTS, they may
be unable to exclude other etiologies that could mimic CTS (such as cervical radiculopathy), or
identify other disorders (such as polyneuropathy) that may affect the decision making process
regarding therapy. Where indicated, appropriate clinical evaluation for alternative diagnoses
should be carried out. Electrodiagnostic testing may be of most value when the clinical diagnosis
is unclear or when atypical features exist.
Future Research
Establishing consensus on a reference standard for the diagnosis for CTS is the most important
research goal in this area.
188
QUALITY TABLE OF DIAGNOSTIC SCALES
Study Representative Population Clear Selection Criteria Detailed Enough to Replicate Reference Standard Identifies Target Condition Blinding Other Bias? Inclusion Strength
Atroshi,I., 2003 Include Moderate Quality

Bland,J.D., 2014 Include Low Quality
Bonauto,D.K., 2008 Include Moderate Quality
Calfee,R.P., 2012 Include Moderate Quality
Cartwright,M.S., 2013 Include Moderate Quality
Dale,A.M., 2011 Include Moderate Quality
Dhong,E.S., 2000 Include Moderate Quality
Fowler,J.R., 2014 Include Moderate Quality
Franzblau,A., 1994 Include Moderate Quality
Gomes,I., 2006 Include Moderate Quality
Graham,B., 2008 Include High Quality
Hems,T.E., 2009 Include Moderate Quality
Katz,J.N., 1990 (A) Include Moderate Quality
Katz,J.N., 1990 (B) Include High Quality
Katz,J.N., 1990 (C) Include High Quality
Katz,J.N., 1991 Include Moderate Quality
Kuhlman,K.A., 1997 Include Moderate Quality
Lo,J.K., 2009 Include High Quality
Makanji,H.S., 2014 Include Moderate Quality
Padua,L., 1999 Include Moderate Quality
Stevens,J.C., 1997 Include Moderate Quality
Westerman,D., 2012 Include High Quality
Yagci,I., 2010 Include Moderate Quality
189
RESULTS
LR + LR -
Bonauto,D.K., 2008
Wainner,R.S., 2005
Makanji,H.S., 2014
Fowler,J.R., 2014
Gomes,I., 2006
Vanti,C., 2012
Yagci,I., 2010
RULE IN NA
**CTS-6; Stringent; 80+%
RULE OUT NA
RULE IN
Katz Hand Diagram; classic or probable
RULE OUT
RULE IN NA
Katz Hand Diagram; classic
RULE OUT NA
**As displayed in the full data sheet, Graham,B., 2008 presents a high quality article with varying methodology to
evaluate the utility of CTS-6 as compared to EDS AAEM as well
190
Cartwright,M.S., 2013 (1)

Calfee,R.P., 2012 (1)
Calfee,R.P., 2012 (2)
Calfee,R.P., 2012 (3)
Katz,J.N., 1990 (A)

Katz,J.N., 1990 (B)
Katz,J.N., 1990 (C)
Dale,A.M., 2011
Katz,J.N., 1991
RULE IN NA
Katz Hand Diagram; classic
RULE OUT NA
RULE IN
Katz Hand Diagram; classic or probable
RULE OUT
RULE IN NA
Katz Hand Diagram; classic, probable, or possible
RULE OUT NA
TABLE 26: HIGH QUALITY STUDIES: PICO 4 (DIAGNOSTIC SCALES VERSUS REFERENCE STANDARD)
Outcomes Coefficient of Average
Reference Patient Threshold reported Group1 (Reference Group Group2 (Reference Group Change in Probability
Title Quality Outcome (Index Test) Characteristics Notes by: Standard) 1N Standard) 2N (Pre-Post Test) SD
index pos; CTS 6 index neg; CTS 6

Stringent
patients referred to stringent (Nerve stringent (Nerve
Graham,B., High CTS Positive (CTS-6; Sensory
EDS lab in a Subjects Conduction Studies 104 Conduction Studies 39 -0.02 0.1
2008 Quality Stringent; 80+%) Latency
tertiary care center (NCS); AAEM (NCS); AAEM
2.27+ms
index pos; CTS 6 very index neg; CTS 6 very

Stringent
patients referred to stringent (Nerve stringent (Nerve
Graham,B., High CTS Positive (CTS-6; Sensory
EDS lab in a Subjects Conduction Studies 84 Conduction Studies 59 -0.02 0.1
2008 Quality Very Stringent; 90+%) Latency
tertiary care center (NCS); AAEM (NCS); AAEM
2.27+ms
index pos; CTS 6 index neg; CTS 6

patients referred to Lax Sensory stringent (Nerve stringent (Nerve
Graham,B., High CTS Positive (CTS-6;
EDS lab in a Latency Subjects Conduction Studies 104 Conduction Studies 39 -0.06 0.2
2008 Quality Stringent; 80+%)
tertiary care center >2ms (NCS); AAEM (NCS); AAEM
index pos; CTS 6 very index neg; CTS 6 very

patients referred to Lax Sensory stringent (Nerve stringent (Nerve
Graham,B., High CTS Positive (CTS-6;
EDS lab in a Latency Subjects Conduction Studies 84 Conduction Studies 59 -0.01 0.1
2008 Quality Very Stringent; 90+%)
tertiary care center >2ms (NCS); AAEM (NCS); AAEM
192
1990 (B) Quality (Katz Hand patients sensory and katz (Nerve katz (Nerve
Diagram; suspected of motor cutoffs Conduction Conduction
classic or CTS Studies Studies
probable) (NCS)) (NCS))
Katz,J.N., High CTS Positive 110 suspected motor Extremities index pos; 30 index neg; 115 0.60|0.70 0.34|0.87 2.60|0.76 WEAK POOR
1990 (C) Quality (Katz Hand CTS patients latency, katz levels katz levels
Diagram; referred to one sensory (Nerve (Nerve
classic) hosp latency, and Conduction Conduction
sensory Studies Studies
velocity (NCS)) (NCS))
cutoffs
Katz,J.N., High CTS Positive 110 suspected motor Extremities index pos; 59 index neg; 86 0.58|0.78 0.64|0.73 2.36|0.49 WEAK WEAK
classic or hosp latency, and Conduction Conduction
probable) sensory Studies Studies
velocity (NCS)) (NCS))
cutoffs
Katz,J.N., High CTS Positive 110 suspected motor Extremities index pos; 122 index neg; 23 0.42|0.91 0.96|0.23 1.25|0.17 POOR MODERATE
classic, hosp latency, and Conduction Conduction
probable, or sensory Studies Studies
possible) velocity (NCS)) (NCS))
cutoffs
Lo,J.K., 2009 High CTS Positive all CTS sensory, Subjects index pos; 164 index neg; 114 0.32|0.16 0.36|0.14 0.41|4.62 POOR POOR
Quality (Clinical suspects chosen motor, or clinical clinical
point-score from a group of combination point-score point-score
system; >10) 348 as the of system; >10 system; >10
patients with abnormalities = CTS = CTS
highest risk (Nerve (Nerve
factors for CTS Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
193
Naranjo,A., High CTS Positive 68 patients with BCTQ cutoff Extremities index pos; 37 index neg; 68 0.76|0.24 0.35|0.64 0.97|1.02 POOR POOR
2007 Quality (Boston suspected CTS at >3 BCTQ FSS, BCTQ FSS,
Carpal SSS (Nerve SSS (Nerve
Tunnel Conduction Conduction
Questionnaire Studies Studies
(BCTQ); (NCS); (NCS);
Functional AANEM AANEM
severity referenced) referenced)
scale)
Naranjo,A., High CTS Positive 68 patients with BCTQ cutoff Extremities index pos; 49 index neg; 56 0.80|0.27 0.49|0.60 1.22|0.85 POOR POOR
2007 Quality (Boston suspected CTS at >3 BCTQ FSS, BCTQ FSS,
Carpal SSS (Nerve SSS (Nerve
Tunnel Conduction Conduction
Questionnaire Studies Studies
(BCTQ); (NCS); (NCS);
Symptom AANEM AANEM
severity referenced) referenced)
scale)
Vanti,C., 2012 High CTS Positive limbs of 47 Extremities index pos; 62 index neg; 22 0.56|1.00 1.00|0.45 1.81|0.00 POOR STRONG
Quality (Katz Hand patients katz (Nerve katz (Nerve
Diagram; Conduction Conduction
classic or Studies Studies
probable) (NCS); (NCS);
AANEM AANEM
2005 Quality (Boston cervical BCTQ FSS, BCTQ FSS,
Carpal radiculopathy SSS; katz; SSS; katz;
Tunnel suspects wrist ratio wrist ratio
Questionnaire (Nerve (Nerve
(BCTQ); Conduction Conduction
Functional Studies Studies
severity (NCS); (NCS);
scale; >2.5) AANEM AANEM
194
2005 Quality (Boston cervical BCTQ FSS, BCTQ FSS,
Carpal radiculopathy SSS; katz; SSS; katz;
Tunnel suspects wrist ratio wrist ratio
Questionnaire (Nerve (Nerve
(BCTQ); Conduction Conduction
Symptom Studies Studies
severity (NCS); (NCS);
scale; >1.9) AANEM AANEM
2005 Quality (Katz Hand cervical BCTQ FSS, BCTQ FSS,
Diagram; radiculopathy SSS; katz; SSS; katz;
classic or suspects wrist ratio wrist ratio
probable) (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (Wrist Ratio cervical BCTQ FSS, BCTQ FSS,
Index; >.67) radiculopathy SSS; katz; SSS; katz;
suspects wrist ratio wrist ratio
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
2005 Quality (Clinical cervical history history
Prediction radiculopathy questions; questions;
Rule; 2 or suspects age; clinical age; clinical
more pos combinations combinations
tests) (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
195
Wainner,R.S., High CTS Positive CTS and Subjects index pos; 49 index neg; 29 0.51|0.97 0.96|0.54 2.08|0.07 WEAK STRONG
Studies Studies
(NCS); (NCS);
AANEM AANEM
Wainner,R.S., High CTS Positive CTS and Subjects index pos; 29 index neg; 49 0.69|0.88 0.77|0.83 4.44|0.28 WEAK WEAK
Studies Studies
(NCS); (NCS);
AANEM AANEM
Wainner,R.S., High CTS Positive CTS and Subjects index pos; 6 index neg; 72 0.83|0.71 0.19|0.98 10.00|0.82 STRONG POOR
Rule; all 5 suspects age; clinical age; clinical
pos tests; combinations combinations
sympt (Nerve (Nerve
improve by Conduction Conduction
shaking, WR Studies Studies
>.67, SSS (NCS); (NCS);
>1.9, thumb AANEM AANEM
deficit, age referenced) referenced)
>45)
196
Westerman,D., High CTS Positive CTS suspected 2 of 3 Subjects index pos; 84 index neg; 35 0.94|0.57 0.84|0.80 4.20|0.20 WEAK MODERATE
2012 Quality (Clinical referrals; 3 did abnormalities clinical clinical
Prediction; not receive among prediction prediction
History and reference sensory, (ranked by (ranked by
Physical; standard motor and case history case history
CTS vs evaluation mixed nerve and physical and physical
Uncertain or evals exam) exam)
No CTS) (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
197
TABLE 27: MODERATE QUALITY STUDIES: PICO 4 (DIAGNOSTIC SCALES VERSUS REFERENCE STANDARD)
Atroshi,I., Moderate CTS 254 physical Subjects index pos; 188 index neg; 66 0.44|0.8 0.90|0.3 1.39|0.2 POOR WEAK
2003 Quality Positive symptomatic tests, katz katz 6 5 8
(Katz Hand responders to a signs, and (Clinical (Clinical
Diagram; mass survey history Diagnosis) Diagnosis)
classic or mailing
probable) completed the
hand diagram
Bonauto,D. Moderate CTS workers from motor and Subjects index pos; 24 index neg; 229 0.63|0.5 0.14|0.9 2.24|0.9 WEAK POOR
K., 2008 Quality Positive various sites sensory katz levels katz levels 9 4 2
(Katz Hand with current latency (Nerve (Nerve
Diagram; hand symptoms cutoff Conduction Conduction
classic) values Studies Studies
(NCS); (NCS);
AANEM AANEM
Bonauto,D. Moderate CTS workers from motor and Subjects index pos; 56 index neg; 197 0.48|0.5 0.25|0.8 1.25|0.9 POOR POOR
classic or values Studies Studies
probable) (NCS); (NCS);
AANEM AANEM
Bonauto,D. Moderate CTS workers from motor and Subjects index pos; 127 index neg; 126 0.52|0.6 0.61|0.5 1.45|0.6 POOR POOR
classic, values Studies Studies
probable, or (NCS); (NCS);
possible) AANEM AANEM
198
Calfee,R.P., Moderate CTS CTS suspects Subjects index pos; 57 index neg; 162 0.30|0.7 0.33|0.7 1.40|0.8 POOR POOR
2012 (1) Quality Positive with hand katz; katz; 9 6 8
(Katz Hand symptoms from MNDS MNDS
Diagram; a group of total, long, total, long,
classic or workers index, index,
probable) thumb thumb
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
Distal Distal
Motor Motor
Latency Latency
(DML)) (DML))
(Median symptoms from MNDS MNDS
Nerve Digit a group of total, long, total, long,
Score workers index, index,
(MNDS); 2 thumb thumb
digits) (Nerve (Nerve
Studies Studies
(NCS); (NCS);
Distal Distal
Motor Motor
Latency Latency
(DML)) (DML))
199
(MNDS); thumb thumb
Index (Nerve (Nerve
finger) Conduction Conduction
Studies Studies
(NCS); (NCS);
Distal Distal
Motor Motor
Latency Latency
(DML)) (DML))
(MNDS); thumb thumb
Long (Nerve (Nerve
Studies Studies
(NCS); (NCS);
Distal Distal
Motor Motor
Latency Latency
(DML)) (DML))
200
(MNDS); thumb thumb
Thumb) (Nerve (Nerve
Studies Studies
(NCS); (NCS);
Distal Distal
Motor Motor
Latency Latency
(DML)) (DML))
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
Distal Distal
Sensory Sensory
Latency Latency
(DSL)) (DSL))
201
Calfee,R.P., Moderate CTS CTS suspects Subjects index pos; 76 index neg; 140 0.58|0.7 0.54|0.7 2.29|0.6 WEAK POOR
Studies Studies
(NCS); (NCS);
Distal Distal
Sensory Sensory
Latency Latency
(DSL)) (DSL))
(MNDS); thumb thumb
Index (Nerve (Nerve
Studies Studies
(NCS); (NCS);
Distal Distal
Sensory Sensory
Latency Latency
(DSL)) (DSL))
202
Calfee,R.P., Moderate CTS CTS suspects Subjects index pos; 91 index neg; 126 0.59|0.7 0.67|0.7 2.45|0.4 WEAK WEAK
(MNDS); thumb thumb
Long (Nerve (Nerve
Studies Studies
(NCS); (NCS);
Distal Distal
Sensory Sensory
Latency Latency
(DSL)) (DSL))
(MNDS); thumb thumb
Studies Studies
(NCS); (NCS);
Distal Distal
Sensory Sensory
Latency Latency
(DSL)) (DSL))
203
(Nerve (Nerve
Studies Studies
(NCS); (NCS);
Median- Median-
Ulnar Ulnar
Sensory Sensory
Difference Difference
(MUD)) (MUD))
Studies Studies
(NCS); (NCS);
Median- Median-
Ulnar Ulnar
Sensory Sensory
(MUD)) (MUD))
204
(MNDS); thumb thumb
Index (Nerve (Nerve
Studies Studies
(NCS); (NCS);
Median- Median-
Ulnar Ulnar
Sensory Sensory
(MUD)) (MUD))
Calfee,R.P., Moderate CTS CTS suspects Subjects index pos; 91 index neg; 122 0.54|0.8 0.67|0.7 2.24|0.4 WEAK WEAK
(MNDS); thumb thumb
Long (Nerve (Nerve
Studies Studies
(NCS); (NCS);
Median- Median-
Ulnar Ulnar
Sensory Sensory
(MUD)) (MUD))
205
(MNDS); thumb thumb
Studies Studies
(NCS); (NCS);
Median- Median-
Ulnar Ulnar
Sensory Sensory
(MUD)) (MUD))
Cartwright, Moderate CTS Latino manual median to Subjects index pos; 34 index neg; 479 0.50|0.6 0.10|0.9 2.11|0.9 WEAK POOR
M.S., 2013 Quality Positive workers ulnar katz (Nerve katz (Nerve 9 5 4
(1) (Katz Hand community sensory Conduction Conduction
Diagram; sampled from 4 peak Studies Studies
classic or counties latency of (NCS); (NCS);
probable) >.8ms, >.5ms) >.5ms)
>.5ms, or
>.6ms
>.5ms, or
>.6ms
>.5ms, or
>.6ms
206
Dale,A.M., Moderate CTS 1108 recruits sensory, Extremities index pos; 62 index neg; 2154 0.56|0.3 0.02|0.9 0.65|1.0 POOR POOR
2011 Quality Positive from 11 motor, and katz (Nerve katz (Nerve 3 6 1
(Katz Hand occupations of MUDS Conduction Conduction
Diagram; potential CTS cutoffs Studies Studies
classic or risk (NCS)) (NCS))
probable)
Dhong,E.S., Moderate CTS 138 patients; sensory Extremities index pos; 222 index neg; 0 0.93|. 1.00|0.0 1.00|0.6 POOR POOR
2000 Quality Positive 95% latency BCTQ 0 INDEX 0 0
(Modified housewives who and FSS, SSS NEG
Boston failed splint amplitude (Nerve CASES;
Carpal treatment and Conduction BCTQ
Tunnel had clinical Studies FSS, SSS
Questionnai diagnosis (NCS); (Nerve
re (BCTQ); AANEM Conduction
Functional referenced) Studies
severity (NCS);
scale) AANEM
referenced)
Dhong,E.S., Moderate CTS 138 patients; sensory Extremities index pos; 222 index neg; 0 0.93|. 1.00|0.0 1.00|0.6 POOR POOR
2000 Quality Positive 95% latency BCTQ 0 INDEX 0 0
(Modified housewives who and FSS, SSS NEG
Boston failed splint amplitude (Nerve CASES;
Carpal treatment and Conduction BCTQ
Tunnel had clinical Studies FSS, SSS
Questionnai diagnosis (NCS); (Nerve
re (BCTQ); AANEM Conduction
Symptom referenced) Studies
severity (NCS);
scale) AANEM
referenced)
Fowler,J.R., Moderate CTS referred to EDS 80 percent Subjects index pos; 55 index neg; 30 0.89|0.8 0.89|0.8 4.45|0.1 WEAK MODERA
2014 Quality Positive prob; score CTS 6 CTS 6 0 0 4 TE
(CTS-6; of 12+ stringent stringent
Stringent; (Nerve (Nerve
80+%) Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
207
Franzblau,A Moderate CTS 408 at risk median to Extremities index pos; 59 index neg; 757 0.27|0.8 0.11|0.9 1.75|0.9 POOR POOR
., 1994 (1) Quality Positive workers from ulnar modified modified 3 4 5
(Modified various facilities sensory katz katz
Katz Hand peak variations variations
Diagram; latency of (Nerve (Nerve
classic) >.8ms or Conduction Conduction
>.5ms Studies Studies
(NCS); (NCS);
>.8ms) >.8ms)
classic or >.8ms or Conduction Conduction
probable) >.5ms Studies Studies
(NCS); (NCS);
>.8ms) >.8ms)
classic, >.8ms or Conduction Conduction
probable, or >.5ms Studies Studies
possible) (NCS); (NCS);
>.8ms) >.8ms)
Franzblau,A Moderate CTS 408 at risk median to Extremities index pos; 59 index neg; 757 0.42|0.8 0.17|0.9 3.46|0.8 WEAK POOR
(Modified various facilities sensory Katz Katz
classic) >.8ms or Conduction Conduction
>.5ms Studies Studies
(NCS); (NCS);
>.5ms) >.5ms)
208
Franzblau,A Moderate CTS 408 at risk median to Extremities index pos; 91 index neg; 725 0.33|0.8 0.21|0.9 2.31|0.8 WEAK POOR
classic or >.8ms or Conduction Conduction
probable) >.5ms Studies Studies
(NCS); (NCS);
>.5ms) >.5ms)
classic, >.8ms or Conduction Conduction
probable, or >.5ms Studies Studies
possible) (NCS); (NCS);
>.5ms) >.5ms)
Gomes,I., Moderate CTS 2535 patients sensory, Extremities index pos; 2436 index neg; 1471 0.50|0.7 0.80|0.4 1.55|0.4 POOR WEAK
2006 Quality Positive referred for motor, and katz (Nerve katz (Nerve 9 9 2
(Katz Hand NCS from 5 mixed Conduction Conduction
Diagram; facilities nerve Studies Studies
classic or cutoffs (NCS); (NCS);
probable) AANEM AANEM
Hems,T.E., Moderate CTS group of motor and Subjects index pos; 74 index neg; 17 0.91|0.6 0.92|0.6 2.36|0.1 WEAK MODERA
2009 Quality Positive patients with sensory Bland Bland 5 1 3 TE
(Bland clinically latency Questionna Questionna
Questionnai unconfirmed cutoffs ire (Nerve ire (Nerve
re; 6+) CTS among a Conduction Conduction
group of Studies Studies
suspected (NCS)) (NCS))
patients
209
Hems,T.E., Moderate CTS group of motor and Subjects index pos; 66 index neg; 25 0.91|0.4 0.82|0.6 2.47|0.2 WEAK WEAK
2009 Quality Positive patients with sensory Bland Bland 8 7 7
patients
Hems,T.E., Moderate CTS group of motor and Subjects index pos; 57 index neg; 34 0.91|0.3 0.71|0.7 2.56|0.4 WEAK WEAK
patients
Hems,T.E., Moderate CTS group of motor and Subjects index pos; 59 index neg; 32 0.88|0.3 0.71|0.6 1.83|0.4 POOR WEAK
re; CTS among a Conduction Conduction
Symptom group of Studies Studies
Score Only; suspected (NCS)) (NCS))
6+) patients
Katz,J.N., Moderate CTS 63 random no Extremities index pos; 32 index neg; 53 1.00|0.1 0.43|1.0 10.00|0. STRONG POOR
1990 (A) Quality Positive patients from a threshold katz levels katz levels 9 0 57
(Katz Hand group with for NCS (Nerve (Nerve
Diagram; upper extremity evidence; Conduction Conduction
classic) symptoms one Studies Studies
clinical (NCS) and (NCS) and
confirmati Clinical Clinical
on Diagnosis) Diagnosis)
(response
to
treatment)
210
Katz,J.N., Moderate CTS 63 random no Extremities index pos; 61 index neg; 24 0.98|0.3 0.80|0.9 8.00|0.2 MODERA WEAK
1990 (A) Quality Positive patients from a threshold katz levels katz levels 8 0 2 TE
classic or symptoms one Studies Studies
probable) clinical (NCS) and (NCS) and
confirmati Clinical Clinical
(response
to
treatment)
Katz,J.N., Moderate CTS 63 random no Extremities index pos; 79 index neg; 6 0.94|0.8 0.99|0.5 1.97|0.0 POOR STRONG
1990 (A) Quality Positive patients from a threshold katz levels katz levels 3 0 3
classic, symptoms one Studies Studies
probable, or clinical (NCS) and (NCS) and
possible) confirmati Clinical Clinical
(response
to
treatment)
Katz,J.N., Moderate CTS CTS sensory, Subjects index pos; 64 index neg; 14 0.44|0.8 0.93|0.2 1.24|0.2 POOR WEAK
1991 Quality Positive symptomatic motor, and katz; niosh katz; niosh 6 5 7
(Katz Hand subjects at one mixed case case
Diagram; hospital nerve definition definition
classic or cutoffs (Nerve (Nerve
probable) Conduction Conduction
Studies Studies
(NCS)) (NCS))
211
Katz,J.N., Moderate CTS CTS sensory, Subjects index pos; 40 index neg; 38 0.50|0.7 0.67|0.5 1.60|0.5 POOR POOR
1991 Quality Positive symptomatic motor, and katz; niosh katz; niosh 4 8 7
(NIOSH subjects at one mixed case case
Case hospital nerve definition definition
Definition; cutoffs (Nerve (Nerve
symptoms, Conduction Conduction
work Studies Studies
relatedness, (NCS)) (NCS))
objective
evidence)
Kuhlman,K. Moderate CTS 143 clinical referenced Extremities index pos; 121 index neg; 107 0.81|0.5 0.69|0.7 2.58|0.4 WEAK WEAK
A., 1997 Quality Positive CTS suspects sensory wrist ratio wrist ratio 9 3 2
(Wrist and motor (Nerve (Nerve
Ratio) cutoffs Conduction Conduction
Studies Studies
(NCS)) (NCS))
Makanji,H.S Moderate CTS referred CTS DML and index pos; 77 index neg; 11 0.74|0.2 0.88|0.1 1.01|0.9 POOR POOR
., 2014 Quality Positive suspects DSL with CTS 6 lax, CTS 6 lax, 7 3 4
(CTS-6; referenced stringent stringent
Lax; 50+%) normal (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Makanji,H.S Moderate CTS referred CTS DML and index pos; 47 index neg; 41 0.74|0.2 0.54|0.4 1.03|0.9 POOR POOR
., 2014 Quality Positive suspects DSL with CTS 6 lax, CTS 6 lax, 7 8 7
(CTS-6; referenced stringent stringent
Stringent; normal (Nerve (Nerve
80+%) values Conduction Conduction
Studies Studies
(NCS); (NCS);
AANEM AANEM
212
Padua,L., Moderate CTS clinically clinical Extremities index pos; 623 index neg; 500 0.95|0.0 0.55|0.4 0.93|1.1 POOR POOR
1999 Quality Positive suspected and NCS Modified Modified 5 0 1
(Modified idiopathic CTS from Hi-Ob Hi-Ob
Hi-Ob patients AANEM Scale; Pain Scale; Pain
Scale; Pain) considered (Nerve (Nerve
; min of Conduction Conduction
clinical Studies Studies
diagnosis (NCS) and (NCS) and
and clinical clinical
various diagnosis; diagnosis;
severities AANEM AANEM
of NCS referenced) referenced)
testing
results
Stevens,J.C., Moderate CTS 100 CTS motor, Extremities index pos; 175 index neg; 52 0.83|0.7 0.91|0.5 2.07|0.1 WEAK MODERA
1997 (1) Quality Positive diagnosed mixed, HSD; HSQ HSD; HSQ 3 6 6 TE
(Hand patients and 50 sensory (Nerve (Nerve
Symptom with upper nerve Conduction Conduction
Diagram extremity cutoffs Studies Studies
(HSD) and problems other referenced (NCS)) (NCS))
Hand than CTS
Symptom
Questionnai
re (HSQ);
Examiner
1)
Stevens,J.C., Moderate CTS 100 CTS motor, Extremities index pos; 111 index neg; 116 0.86|0.4 0.60|0.7 2.74|0.5 WEAK POOR
1997 (1) Quality Positive diagnosed mixed, HSD; HSQ HSD; HSQ 6 8 1
(HSD); problems other referenced (NCS)) (NCS))
Examiner than CTS
1)
213
Stevens,J.C., Moderate CTS 100 CTS motor, Extremities index pos; 163 index neg; 64 0.83|0.6 0.86|0.6 2.15|0.2 WEAK WEAK
Questionnai extremity cutoffs Studies Studies
re (HSQ); problems other referenced (NCS)) (NCS))
Examiner than CTS
1)
Stevens,J.C., Moderate CTS 100 CTS motor, Extremities index pos; 197 index neg; 30 0.76|0.6 0.94|0.2 1.33|0.2 POOR WEAK
Hand than CTS
Symptom
Questionnai
re (HSQ);
Examiner
2)
Examiner than CTS
2)
Examiner than CTS
2)
214
Hand than CTS
Symptom
Questionnai
re (HSQ);
Examiner
3)
Examiner than CTS
3)
Stevens,J.C., Moderate CTS 100 CTS motor, Extremities index pos; 101 index neg; 126 0.85|0.4 0.54|0.7 2.45|0.5 WEAK POOR
Examiner than CTS
3)
Yagci,I., Moderate CTS DPN PATIENT motor, Extremities index pos; 22 index neg; 72 1.00|0.6 0.50|1.0 10.00|0. STRONG WEAK
2010 Quality Positive POPULATION mixed, katz; katz; 9 0 50
(Katz Hand referred to EDS sensory clinical clinical
Diagram; lab nerve diagnosis diagnosis
classic) cutoffs via lax katz via lax katz
referenced (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
215
Yagci,I., Moderate CTS DPN PATIENT motor, Extremities index pos; 36 index neg; 58 1.00|0.8 0.82|1.0 10.00|0. STRONG MODERA
2010 Quality Positive POPULATION mixed, katz; katz; 6 0 18 TE
classic or cutoffs via lax katz via lax katz
probable) referenced (Nerve (Nerve
Studies Studies
(NCS); (NCS);
AANEM AANEM
Yagci,I., Moderate CTS DPN PATIENT motor, Extremities index pos; 43 index neg; 51 1.00|0.9 0.98|1.0 10.00|0. STRONG STRONG
2010 Quality Positive POPULATION mixed, katz; katz; 8 0 02
classic, cutoffs via lax katz via lax katz
probable, referenced (Nerve (Nerve
and Conduction Conduction
possible) Studies Studies
(NCS); (NCS);
AANEM AANEM
216
TABLE 28: LOW QUALITY STUDIES- PICO 4 (DIAGNOSTIC SCALES VERSUS REFERENCE STANDARD)
Bland,J.D., Low CTS Positive all neurology NCS Subjects index pos; 1430 index neg; 1225 0.78|0.68 0.74|0.73 2.71|0.36 WEAK WEAK
2014 Quality (CTS Web referred graded on Web Web
Questionnaire; patients who Canterbury Questionnaire Questionnaire
40+ score) completed the severity (Nerve (Nerve
web scale Conduction Conduction
questionnaire Studies Studies
(NCS); (NCS);
AANEM AANEM
217
META-ANALYSES
FIGURE 9: GENERAL EDS VERSUS KATZ HAND DIAGRAM (CLASSIC OR PROBABLE)
218
FIGURE 10: EDS AANEM VERSUS KATZ HAND DIAGRAM (CLASSIC OR PROBABLE)
1
.8
.6
Sensitivity
.4
.2
0
1 .8 .6 .4 .2 0
Specificity

region
95% prediction
region
219
RISK FACTOR GUIDELINE RECOMMENDATIONS
INCREASED RISK OF CTS

A. Strong evidence supports that BMI and high hand/wrist repetition rate are
associated with the increased risk of developing carpal tunnel syndrome (CTS).

B. Moderate evidence supports that the following factors are associated with the
increased risk of developing carpal tunnel syndrome (CTS):
Peri-menopausal
Wrist Ratio/Index
Rheumatoid Arthritis
Psychosocial factors
Distal upper extremity tendinopathies
Gardening
ACGIH Hand Activity Level at or above threshold
Assembly line work
Computer work
Vibration
Tendonitis
Workplace forceful grip/exertion

C. Limited evidence supports that the following factors are associated with the
increased risk of developing carpal tunnel syndrome (CTS):
Dialysis
Fibromyalgia
Varicosis
Distal radius fracture
220
Rationale
BMI evaluated as a continuous variable was shown to be associated with development of CTS in four
high quality (Armstrong, 2008; Bonfiglioli, 2013; Evanoff, 2014; Garg, 2012) and three moderate quality
studies (Burt, 2011; Hlebs, 2014; Nordstrom, 1997). Only one moderate quality study (Goodson, 2014)
found an insignificant result for the relationship between BMI and CTS. When evaluated as a categorical
variable, five moderate quality studies (Becker, 2002; Burt, 2011; Burt, 2013; Coggon, 2013; Geoghegan,
2004) found a correlation between increasing BMI and development of CTS, while one high quality study
(Hakim, 2002) and two moderate quality (Mondelli, 2006; Violante, 2007) studies found no significance.
High hand/wrist repetition rate at work was significantly associated to an increased risk of CTS by two
high quality (Armstrong, 2008; Evanoff, 2014) and four moderate quality studies (Chiang, 1990; Coggon,
2013; Goodson, 2014; Silverstein, 1987). In all studies, the hand/wrist repetition involved moderate to
high hand forces. One of the high quality studies (Armstrong, 2008) showed an insignificant association
in two of the categories of repetition, but still showed a significant increase between the high and low
quartile categories.
Peri-menopausal status was shown in one high quality study (Hakim, 2002) to be associated with an
increased risk of CTS development, but no association was found between CTS and post-menopausal
status.
Wrist ratio/index (ratio of wrist depth to width >0.7mm) was significantly associated with an increased
risk of CTS in one high (Armstrong, 2008) and six moderate quality studies (Boz, 2004; Gordon, 1988;
Hlebs, 2014; Moghtaderi, 2005; Sabry, 2009; Shariff-Mollayousefi, 2008).
Rheumatoid arthritis was associated with an increased risk of CTS in one high quality (Garg, 2012) and
one moderate quality study (Burt, 2011). One moderate quality study (Geoghegan, 2004) showed an
association between osteoarthritis and CTS.
Mood (felt down, blue or depressed always/never, compared to seldom) was associated with increased
risk of CTS in one high quality study (Garg, 2012). One moderate quality study (Coggon, 2013) showed
an association with increased risk based on self-rated mental health.
Hand, wrist or elbow tendinopathies (musculoskeletal conditions) were associated with increased risk of
CTS in one high quality (Garg, 2012) and two moderate quality studies (Aktas, 2008; Nordstrom, 1997).
Gardening was associated with an increased risk of developing CTS in one high quality study (Garg,
2012).
The American Conference of Governmental Industrial Hygienists (ACGIH) hand activity level (HAL) is
a standardized method for evaluating jobs that involves expert observation, direct measurement or video
analysis to assess both pinch/grip force and hand/wrist repetition rate. There was one high quality
(Bonfiglioli, 2013) and three moderate quality (Burt, 2011; Burt, 2013; Violante, 2007) studies, showing
significant associations to increased risk of CTS when the ACGIH HAL was at or above the threshold
limit. In addition, there was one high quality study (Garg, 2012) that showed an association with CTS by
hazard ratio but this finding was limited by a wide confidence interval that included a value of 1.0 (HR:
2.01, CI: 0.8-5.0).
221
Assembly line work was associated with increased risk for the development of CTS in one high quality
(Armstrong, 2008) and two low quality studies (Bonfiglioli, 2006; Lecler, 1998).
Computer work was significantly associated with increased risk of CTS by three moderate quality studies
(Ali, 2006; Coggon, 2013; Eleftheriou, 2012). One study found an increased association with an average
of greater than eight hours of computer use per day and more than four years of computer work (Ali,
2006). Another study found an association between an increased risk of CTS and working on a keyboard
or mouse for more than four hours per day (Coggon, 2013). The third study found an association with a
very high number of keystrokes typed per year and a higher risk of CTS (Eletheriou, 2012). There was
one moderate quality study (Ali, 2006) evaluating internet use for leisure, which also found a significant
result for increasing risk of CTS.
The use of vibrating hand-held tools was associated with an increased risk of CTS in one high quality
(Armstrong, 2008) and three moderate quality studies (Coggon, 2013; Dale, 2014; Nordstrom, 1997).
Tendonitis in the shoulder, hand, finger, or wrist was shown to increase risk of CTS by one high quality
(Armstrong, 2008) and one low quality study (Werner, 2005).
Workplace forceful grip/exertion was found to be significantly associated with increased risk of CTS by
one high quality (Armstrong, 2008) and four moderate quality studies (Burt, 2011; Burt, 2013; Dale,
2014; Evanoff, 2012).
Comorbidities including dialysis, fibromyalgia, and varicosis each had one moderate quality study (Shin,
2008; Fahmi, 2013; De Krom, 1990) showing that each has a significantly increased risk of CTS.
Wrist fracture showed an increased risk of CTS in two moderate quality studies (Geoghegan, 2004; Dyer,
2008). One moderate quality study (Morgenstern, 1991) showed an insignificant relationship, but that
study included only female participants and therefore the findings may not be generalizable.

Future Research
Studies should be conducted to identify objective methods for assessing workplace physical factors in
order to improve the precision of risk estimation and improve confidence in thresholds of injury.
Workplace intervention studies should be conducted to confirm that modifications in work activities may
improve symptoms and functional deficits in workers with CTS. Studies of risk should include proper
control for confounding as in a logistic regression analysis with appropriate population sizes and
associated odds ratios.
DECREASED RISK OF CTS

Moderate evidence supports that physical activity/exercise is associated with a
decreased risk of developing carpal tunnel syndrome (CTS).
222
single High quality study for recommending for or against the intervention
Rationale
Vigorous exercise was associated with reduced risk of CTS in one moderate quality study (Goodson,
2014). In the same study, increased risk of CTS was associated with wrist straining exercise (e.g., weight
lifting, mountain biking, racquet sports), but that risk was reduced if there was also vigorous exercise.
Another moderate quality study (Eleftheriou, 2012) found an association between regular physical
activity (e.g., basketball, football, tennis, jogging, and swimming) and reduced risk of CTS.

Future Research
The moderate quality studies finding that found a reduction in risk for CTS with vigorous exercise are
intriguing. There should be additional research to confirm these findings and identify the specific types
and amount of exercise that may be effective. There should be studies to investigate apportionment of risk
between personal and workplace factors.
FACTORS SHOWING NO ASSOCIATED RISK OF CTS

A. Moderate evidence supports that the use of oral contraception and female
hormone replacement therapy (HRT) are not associated with increased or
decreased risk of developing carpal tunnel syndrome (CTS).

B. Limited evidence supports that race/ethnicity and female education level are not
associated with increased or decreased risk of developing carpal tunnel
syndrome (CTS).

Rationale
Oral contraception use among females was shown to have no significant relationship to the development
of CTS in three moderate quality studies (Geoghehan, 2004; Mondelli, 2006; Morgenstern, 1991). Oral
HRT use among females was shown to have no significant relationship to the development of CTS in one
high quality and one moderate quality study (Hakim, 2002; Geoghehan, 2004). Education level among
females showed no significant relationship to the development of CTS in one moderate quality
(Bonfiglioli, 2007) and two low quality studies (Kaplan, 2008; Wright, 2014). Race/ethnicity showed no
significant relationship to the development of CTS in one moderate quality study (Nathan, 2002).
223
Future Research
The moderate quality studies finding that found a reduction in risk for CTS with vigorous exercise are
intriguing. There should be additional research to confirm these findings and identify the specific types
and amount of exercise that may be effective. There should be studies to investigate apportionment of risk
between personal and workplace factors. Studies should be conducted to identify objective methods for
assessing workplace physical factors in order to improve the precision of risk estimation and improve
confidence in thresholds of injury. Workplace intervention studies should be conducted to confirm that
modifications in work activities may improve symptoms and functional deficits in workers with CTS.
More research into the relationship between diabetes and CTS should be done, as the conflicting results
indicate a possible association between these conditions. Studies of risk should include proper control for
confounding as in a logistic regression analysis with appropriate population sizes and associated odds
ratios.
224
FACTORS SHOWING CONFLICTING RISK OF CTS
Limited evidence supports that the following factors have conflicting results
regarding the development of carpal tunnel syndrome (CTS):
Diabetes
Age
Gender/Sex
Genetics
Comorbid drug use
Smoking
Wrist bending
Workplace

Rationale
Diabetes showed a conflicting relationship to CTS development. One high quality study (Armstrong,
2008) did not demonstrate a significant association with CTS. The odds ratio was elevated but there was a
wide confidence interval that included a value of 1.0 (OR 2.45, CI: 0.92-6.53). Three moderate quality
studies (Becker, 2002; Geoghegan, 2004; Plastino, 2011) found significant associations between diabetes
and an increased risk of CTS and one (Coggon, 2013) did not find an association.
Age showed a conflicting relationship to CTS development. Two high quality studies (Armstrong, 2008;
Bonfiglioli, 2013) showed increased risk in older workers on a continuous scale. Two other high quality
studies (Evanoff, 2014; Garg, 2012) measuring age on a continuous scale showed insignificant results but
with slightly increased risk ratios and narrow confidence limits. Two moderate quality studies
(Morgenstern, 1991; Shin, 2008) also found a significantly increased risk of CTS when measuring age
continuously and one moderate quality study (Silverstein, 1987) found an insignificant relationship.
When measured categorically, one high quality study (Hakim, 2002) showed an increasing association at
age >46 and one moderate quality study (Violante, 2007) found an increasing association among all
categories. Two moderate quality studies (Eleftheriou, 2012; Mondelli, 2006) did not find a significant
association between categories of age and CTS development.
Female gender/sex was associated with increased risk of CTS in one high quality (Bonfiglioli, 2013) and
three moderate quality studies (Burt, 2011; Eleftheriou, 2012; Violante, 2007), while two high quality
(Armstrong, 2008; Evanoff, 2014) and two moderate quality studies (Shin, 2008; Silverstein, 1987)
showed no significant association.
Family history/genetics was associated with increased risk of CTS in one high quality (Hakim, 2002) and
two moderate quality studies (Bonfiglioli, 2007; Burt 2011), while two moderate quality studies
(Nordstrom, 1997; Violante, 2007) showed no significant correlation. The studies used varying diagnostic
methods, and two of the studies evaluated female populations, which may have contributed to the
conflicting results.
225
Comorbid drug use showed a conflicting relationship to CTS development. One high quality study
(Hakim, 2002) found no association with thyroxine replacement. One moderate quality study
(Geoghegan, 2004) reported an increasing risk of CTS with insulin, sulphonyl, or thyroxine. Two
moderate quality studies reported no association to CTS when using diuretics (Morgenstern, 1991) or
metformin (Geoghegan, 2004).
Smoking had a conflicting relationship to CTS development. Two moderate quality studies (Eleftheriou,
2012; Violante, 2007) found an association of increasing risk, one moderate quality study (Coggon, 2013)
found an inverse association, and one moderate quality study (Geoghegan, 2004) found no association.
Wrist bending had a conflicting relationship to CTS development. One high (Armstrong, 2008) and one
moderate quality study (De Krom, 1990) showed an increased risk while two moderate quality studies
(Dale, 2014; Evanoff, 2012) displayed an insignificant association. One moderate quality study
(Nordstrom, 1997) showed an insignificant result with a short duration of wrist bending and an increased
risk of CTS with more frequent wrist bending.
Many recent high and moderate quality studies were identified and provide new insights into workplace
factors associated with CTS. However, the studies did not consider the relative contributions of personal
and work-related factors on CTS, so it is difficult to calculate risk attributable to different risk factors
from the data. Some occupational factors and workplace exposures were evaluated by single studies with
weak designs or relatively weak exposure assessment methods. The findings from those studies,
therefore, did not contribute to the conclusions. Workplace categories include: clerical/office work,
industrial, construction, farming, hospital, professional, technical, managerial, sales, skilled trades
(agriculture, fabrication, machining, transporter techs, electricians, plumbers, construction), and other
jobs.

There are no known risks or harms.
Future Research
There should be studies to investigate apportionment of risk between personal and workplace factors.
Studies should be conducted to identify objective methods for assessing workplace physical factors in
order to improve the precision of risk estimation and improve confidence in thresholds of injury.
Workplace intervention studies should be conducted to confirm that modifications in work activities may
improve symptoms and functional deficits in workers with CTS. More research into the relationship
between diabetes and CTS should be done, as the conflicting results indicate a possible association
between these conditions. Studies of risk should include proper control for confounding as in a logistic
regression analysis with appropriate population sizes and associated odds ratios.
226
STUDY QUALITY TABLES FOR RISK FACTOR RECOMMENDATIONS
QUALITY TABLE FOR ASSOCIATED RISK FACTORS FOR CTS
Table 29. Prognostic Quality Evaluations
Reason for Follow Up Prognostic Factor Appropriate Statistical
Study Representative Population
Loss Measured
Outcome Measurement Confounders
Analysis
Inclusion Strength
Akbar,M., 2014 Include Low Quality

Moderate
Aktas,I., 2008 Include
Quality
Moderate
Ali,K.M., 2006 Include
Quality
Armstrong,T., 2008 Include High Quality
Bayrak,I.K., 2008 Include Low Quality
Moderate
Becker,J., 2002 Include
Quality
Bland,J.D., 2005 Include Low Quality
Bonfiglioli,R., 2006 Include Low Quality
Moderate
Bonfiglioli,R., 2007 Include
Quality
Bonfiglioli,R., 2013 Include High Quality
Moderate
Boz,C., 2004 Include
Quality
Moderate
Burt,S., 2011 Include
Quality
Moderate
Burt,S., 2013 Include
Quality
Moderate
Cartwright,M.S., 2012 Include
Quality
Moderate
Cartwright,M.S., 2014 Include
Quality
Moderate
Chiang,H.C., 1990 Include
Quality
227
Loss Measured
Analysis
Inclusion Strength
Moderate
Coggon,D., 2013 Include
Quality
Moderate
Dale,A.M., 2014 Include
Quality
Moderate
de Krom,M.C., 1990 Include
Quality
Dyer,G., 2008 Include Low Quality
Moderate
Eleftheriou,A., 2012 Include
Quality
Estirado de,Cabo E.,
Include Low Quality
2003
Moderate
Evanoff,B., 2012 Include
Quality
Evanoff,B., 2014 Include High Quality
Moderate
Fahmi,D.S., 2013 Include
Quality
Forst,L., 2006 Include Low Quality
Garg,A., 2012 Include High Quality
Gell,N., 2005 Include Low Quality
Moderate
Geoghegan,J.M., 2004 Include
Quality
Goodson,J.T., 2014 Include High Quality
Moderate
Gordon,C., 1988 Include
Quality
Hakim,A.J., 2002 Include High Quality
Moderate
Hlebs,S., 2014 Include
Quality
Jenkins,P.J., 2013 Include Low Quality
Kaplan,Y., 2008 Include Low Quality
228
Loss Measured
Analysis
Inclusion Strength
Keese,G.R., 2006 Include Low Quality

Kopec,J., 2011 Include Low Quality
Leclerc,A., 1998 Include Low Quality
Moderate
Lo,J.K., 2002 Include
Quality
Moderate
Matias,A.C., 1998 Include
Quality
Moderate
Moghtaderi,A., 2005 Include
Quality
Moderate
Mondelli,M., 2006 Include
Quality
Moderate
Morgenstern,H., 1991 Include
Quality
Moderate
Nathan,P.A., 2002 Include
Quality
Moderate
Nathan,P.A., 2005 Include
Quality
Moderate
Nordstrom,D.L., 1997 Include
Quality
Moderate
Petit,A., 2015 Include
Quality
Moderate
Plastino,M., 2011 Include
Quality
Roquelaure,Y., 2001 Include Low Quality
Moderate
Roquelaure,Y., 2008 Include
Quality
Moderate
Sabry,M.M., 2009 Include
Quality
Sharifi-Mollayousefi,A., Moderate
Include
2008 Quality
229
Loss Measured
Analysis
Inclusion Strength
Moderate
Shin,J., 2008 Include
Quality
Moderate
Silverstein,B.A., 1987 Include
Quality
Tang,X., 1999 Include Low Quality
Moderate
Tsai,N.W., 2013 Include
Quality
Moderate
Violante,F.S., 2007 Include
Quality
Vogelsang,L.M., 1994 Include Low Quality
Werner,R.A., 2005 Include Low Quality
Winn,F.J.,Jr., 1989 Include Low Quality
Wolf,J.M., 2009 Include Low Quality
Moderate
Wright,C., 2014 Include
Quality
Yagev,Y., 2001 Include Low Quality
230
RESULTS
TABLE 30: SUMMARY OF FINDINGS- FEMALE GENDER/SEX RELATED RISK FACTORS

Increases Odds
Geoghegan,J.M. 2004
Morgenstern,H. 1991
Decreases Odds
De Krom,M.C. 1990
Mondelli,M. 2006
Not Significant
Hakim,A.J. 2002
Wright, C. 2014
Kaplan,Y. 2008
Female Gender/Sex Related Risk Factors
Normal pre-pregnancy BMI with excessive gestational weight gain
Obese pre-pregnancy with excessive gestational weight gain
Obese pre-pregnancy with normal gestational weight gain
Overweight pre-pregnancy with excessive gestational weight gain
Contraception
HRT use
Hysterectomy
Hysterectomy vs premenopausal
Hysterectomy vs menopause more than 5 years ago
Hysterectomy after controlling for menopause
Number of pregnancies
Number of prenatal care visits
Perimenopause
Post-menopause
Time since menopause
231
TABLE 31: SUMMARY OF FINDINGS- JOB RELATED FACTORS

Increases Odds
Decreases Odds
Nordstrom,D.L. 1997
Roquelaure,Y. 2008
Eleftheriou,A. 2012
Armstrong,T. 2008
Not Significant
Bonfiglioli,R. 2013
Bonfiglioli,R. 2006
Violante,F.S. 2007
Chiang,H.C. 1990
Jenkins,P.J. 2013
Hakim,A.J. 2002
Coggon,D. 2013
Dale, A.M. 2014
Evanoff,B. 2014
Evanoff,B. 2012
Leclerc,A. 1998
Ali,K.M. 2006
Garg,A. 2012
Petit,A. 2015
Burt,S. 2011
Burt,S. 2013
Job Related Risk Factors
ACGIH Hand Activity between action limit and threshold limit value
ACGIH Hand Activity level above threshold limit
ACGIH above threshold limit value (TLV) versus at or below acceptable limit
ACGIH HAL above TLV vs acceptable level or below
Biomechanical load above threshold limit value versus below action limit
Previous exposure to biomechanical overload
Threhold limit ratio
Threshold limit value and above vs below action limit
Assembly Line
Automatic work pace
Chemicals
Contact with solvents 0.08-0.75 hours/day vs none
Contact with solvents 1-11 hours/day vs none
Clerical
Administrative/secretarial jobs vs. Associate professional/technical jobs
Matched all females
Matched all males
Cold Exposure
Computer Work
Construction Work
Dexterity (ONET)
Dexterity derived from factor analysis 4th vs 1st quartile
Dexterity derived from factor analysis 2nd vs 1st quartile
Dexterity derived from factor analysis 3rd vs 1st quartile
Dynamic Strength (ONET)
Exertion
Exerts/min cat 2 versus 1 if BMI<30
Exerts/min cat 2 versus 1 if BMI>=30
Exerts/min cat 3 versus 1 if BMI<30
Exerts/min cat 3 versus 1 if BMI>=30
Peak worker percieved exertion rating (0-10)
Time in forceful exertion between 20 and 60% vs <20%
Time in forceful exertion between greater than 60% vs <20%
Farming
Finger pinch grip
Force
Forceful gripping in most recent job
Peak force match cat 2 versus 1
Peak force match cat 3 versus 1
Peak force, unitary increase (1-7)
Upper extremity force derived from factor analysis 2nd quartile vs 1st quartile
Upper extremity force derived from factor analysis 3rd quartile vs 1st quartile
Forearm Rotation
Grip
Hospital Work vs Clerical
Industrial (blue collar, process, plant, machine, clothing, and shoe industries)
Blue collar, process, plant, machine, clothing, and shoe industries
Job Strain
Strain index above 6.1 vs less than or equal to 6.1
232
TABLE 32: SUMMARY OF FINDINGS- JOB RELATED FACTORS CONTD

Increases Odds
Decreases Odds
* Silverstein,B.A. 1987
Nordstrom,D.L. 1997
* Armstrong,T. 2008
Morgenstern,H. 1991
Cartwright,M.S. 2012
Cartwright,M.S. 2014
Roquelaure,Y. 2008
de Krom,M.C. 1990
Goodson, J.T. 2014

Not Significant
Bonfiglioli,R. 2007
Mondelli,M. 2006
Werner,R.A. 2005
Nathan,P.A. 2005
Chiang,H.C. 1990
Coggon,D. 2013
Matias,A.C. 1998
Jenkins,P.J. 2013
Dale, A.M. 2014
Evanoff,B. 2014
Evanoff,B. 2012
* Yagev,Y. 2001
Wolf,J.M. 2009
Kaplan,Y. 2008
Ali,K.M. 2006
Petit,A. 2015
Forst,L. 2006
Job Related Risk Factors
Lack of Coworker Support
Length of employment
Previously worked at risk jobs
Level of Job Control
IOSH Job control (0=least) 2.8-3.4 vs1-2.7
IOSH Job control (0=least) 4-4.4 vs1-2.7
Job includes targets, bonuses or deadlines
Little job control in work done, in timetables, or breaks
Level of Satisfaction
Lifting
Managerial Jobs
Military Rank
Office Work
Lower-grade white-collar workers vs unemployed
Among men
Among women
Other Jobs
Craftswomen/sales/managerial versus unemployed
Elementary occupations versus technical/professional
Home maker vs employed
Poultry work
System Administrator vs other computer jobs
Piecework Payment
Pressing with the thumb
Professional Jobs
Being a surgeon who uses the Kerrison rongeur tool versus not using the tool
Practicing professionally for greater or equal to 5 years
Professional jobs vs. Associate professional/technical jobs
Professional Jobs vs Unemployed
Repetition
Sales
Service Occupations
Caring, leisure, and other service jobs vs. Associate professional/technical jobs
Full-time cashiers vs office workers
CTS diagnosed with symptoms
CTS diagnosed with symptoms and EDS
Load and lift groceries after checking
Part-time cashiers vs office worker
Unload basket before checking
Use of laser scanner to check items
Skilled Trades
Static Strength (ONET)
Technical Jobs versus Unemployed
Vibration
Work Length
Wrist Bending
Bending wrist frequently
1 hour increase in extension
1 hour increase in flexion
* Significance may conflict among Repitition categories
Significance may conflict among Vibration categories
233
TABLE 33: SUMMARY OF FINDINGS- COMORBID DISEASE RISK FACTORS

Increases Odds
Decreases Odds
Not Significant
Estirado de,Cabo E. 2003

Geoghegan,J.M. 2004
Morgenstern,H. 1991
Vogelsang,L.M. 1994
Nordstrom,D.L. 1997
Roquelaure,Y. 2001
De Krom,M.C. 1990
Armstrong,T. 2008
Winn,F.J.,Jr., 1989
Bonfiglioli,R. 2013
Violante,F.S. 2007
Mondelli,M. 2006
Werner,R.A. 2005
Nathan,P.A. 2002
Plastino,M. 2011
Bayrak,I.K. 2008
Keese,G.R. 2006
Fahmi,D.S. 2013
Hakim,A.J. 2002
Coggon,D. 2013
Akbar,M., 2014
Becker,J. 2002
Kopec,J. 2011
Dyer,G. 2008
Garg,A. 2012
Aktas,I. 2008
Burt,S. 2011
Shin,J. 2008
Comorbidity Risk Factors
Any facillitating comorbidities
Arthritis
Comorbidity Drug Use
Corticosteroid
Current thyroxine replacement therapy
Thyroxine
Diuretics
Diabetes
Diabetes
Insulin use
Metformin use
Sulphonyl use
Female gender/sex and diabetes interaction effect
Dialysis
Endocrine Condition
Fibromyalgia
Fracture
General Comorbidities
1 or more predisposing disease (female floor cleaners)
Bilateral agenesis vs none
High blood pressure vs no
Suspected Medical Risk factors related to cts
Presence of Anti-HCV antibodies
Related Medical Conditions (RMC instrument)
TOS patients with fibrositis vs TOS patients without Fibrositis
TOS women who had miscarraiges versus women with TOS
who did not have a miscarraige
TOS women with fibrositis vs TOS women without Fibrositis
TOS with concomitant neuropathy vs TOS alone
TOS with concomitant scleroderma vs TOS alone
TOS with concomitant Thromboembolic events vs TOS alone
Unilateral agenesis vs none
Mental Health
Feeling down or blue or depressed always vs seldom
Feeling down or blue or depressed never vs seldom
Feeling down or blue or depressed often vs seldom
Intermediate mental health vs good mental health
Poor mental health vs good mental health
Psychological distress measured by General Health
Questionnaire (GHQ-12) greater or equal to 90th percentile
Musculoskeletal Conditions
Paraplegic
Raynaud's Syndrome
Tendonitis
Varicosis
234
TABLE 34: SUMMARY OF FINDINGS- DEMOGRAPHIC RISK FACTORS

Increases Odds
Decreases Odds
Not Significant
Geoghegan,J.M. 2004
Morgenstern,H. 1991
Vogelsang,L.M. 1994
Nordstrom,D.L. 1997
Silverstein,B.A. 1987
* Violante,F.S. 2007
de Krom,M.C. 1990
Eleftheriou,A. 2012
Goodson, J.T. 2014

Armstrong,T. 2008
Winn,F.J.,Jr., 1989
Bonfiglioli,R. 2013
Bonfiglioli,R. 2007
Mondelli,M. 2006
* Hakim,A.J. 2002
Werner,R.A. 2005
Coggon,D. 2013
Nathan,P.A. 2002
* Bland,J.D. 2005
Evanoff,B. 2014
Wright, C. 2014
Kaplan,Y. 2008
Becker,J. 2002
Burt,S. 2011
Hlebs,S. 2014
Ali,K.M. 2006
Garg,A. 2012
Tang,X. 1999
Burt,S. 2013
Gell,N. 2005
Shin,J. 2008
Demographic Risk Factors
Age continuous variable
Age by category
BMI continuous variable
BMI by category
Education
Gender/Sex Female
Female Gender/Sex vs Male
Gender/Sex female vs male at the mean hand activity level (Model 2)
Gender/Sex female vs male at the mean hand activity level (Model 3)
Genetics
CTS family history
CTS diagnosed by symptoms
CTS diagnosed by symptoms and EDS
Hand Activitiy Level among females
Hand Activitiy Level among males
Monozygotic vs dizygotic twins (genetic risk of CTS)
Height/forearm (tall with short forearms)
Hobbies
Gardening
Internet use (leisure)
Hand-knitting/needlework
CTS diagnosed by symptoms
CTS diagnosed by symptoms and EDS
Housework
Continuous duration of kneading or rolling dough per week
Kneading or rolling dough manually more than 2 hours per week
Continuous duration of washing clothes per week
Washing clothes manually more than 2 hours per week
Marital status
Moderate Alcohol Use
Physical activities/exercise involving wrist strain
Physical Activity/Exercise
Vigorous exercise
History of physical sports activity (yes vs no)
Race/Ethnicity (White versus non-white)
SF-36 scores (better scores)
Slimming courses (yes vs. no)
Smoking
Current smoker vs non smoker
Compared to healthy controls
Compared to negative patients
Ever smoked (yes vs no)
Ex-smoker vs non smoker
Symptoms
1 distressing symatic sympt vs none in past week
2 distressing symatic sympts vs none in past week
* Significance may conflict among age categories
Significance may conflict among BMI categories
235
TABLE 35: SUMMARY OF FINDINGS- ANTHROPOMETRIC MEASURE RISK FACTORS

Increases Odds
Sharifi-Mollayousefi,A. 2008
Decreases Odds
Not Significant
Moghtaderi,A. 2005
Armstrong,T. 2008
Violante,F.S. 2007
Werner,R.A. 2005
Sabry,M.M. 2009
Matias,A.C. 1998
Gordon,C. 1988
Tsai,N.W. 2013
Kopec,J. 2011
Hlebs,S. 2014
*Boz,C. 2004
Anthropometric Risk Factors
Arm Length
Cross Sectional Area of Median Nerve
Digit Index
Elbow Posture Rating
Hand Length- Body Height ratio
Hand Shape Index
Location of AV fistula
Overall antrhopometric measures
Shape Index
Trunk Incline
Wrist Circumference
Wrist Deviation
Wrist Extension
Wrist Index
Wrist Ratio
Wrist-Palm-Ratio
*Significant at digit index only for matched females; insignificant for matched male population
236
TABLE 36 RISK FACTOR: ACGIH HAND ACTIVITY
CTS Risk Confounding Stat.

Study Quality Population Diagnostics Factor Adjustment Type Results Significance
Bonfiglioli,R. High N= 2492 ; part of CTS symptoms ACGIH between sex, age, BMI personal incident rate 2.43 (1.77, having rating
2013 Observational at 3 years acceptable level history of diseases ratio from 3.33) between
Prospective Unified and threshold predisposing to CTS Poisson acceptable and
Study (OCTOPUS), limit value versus (diabetes mellitus, regression threshold levels
enrolled workers in at or below amyloidosis, gout, is associated
large and small acceptable limit progressive systemic with higher risk
domestic appliance, sclerosis, rheumatoid of symptoms
underwear, ceramic tile arthritis, systemic lupus
and shoe factories erythematosus, thyroid
disorders, tendonitis of the
finger flexors, and chronic
renal failure)
Bonfiglioli,R. High N= 2492 ; part of CTS symptoms ACGIH above sex, age, BMI personal incident rate 3.32 (2.34, having rating
2013 Observational at 3 years threshold limit history of diseases ratio from 4.72) above threshold
Prospective Unified value versus at or predisposing to CTS Poisson level is
Study (OCTOPUS), below acceptable (diabetes mellitus, regression associated with
enrolled workers in limit amyloidosis, gout, higher risk of
large and small progressive systemic symptoms
domestic appliance, sclerosis, rheumatoid
renal failure)
237
Bonfiglioli,R. High N= 2299 ; part of CTS symptoms ACGIH between sex, age, BMI personal incident rate 1.95 (1.21, having rating
2013 Observational and NCS test at acceptable level history of diseases ratio from 3.16) between
Prospective Unified 3 years and threshold predisposing to CTS Poisson acceptable and
Study (OCTOPUS), limit value versus (diabetes mellitus, regression threshold levels
enrolled workers in at or below amyloidosis, gout, is associated
large and small acceptable limit progressive systemic with higher risk
domestic appliance, sclerosis, rheumatoid of CTS
renal failure)
Bonfiglioli,R. High N= 2299 ; part of CTS symptoms ACGIH above sex, age, BMI personal incident rate 2.70 (1.48, having rating
2013 Observational and NCS test at threshold limit history of diseases ratio from 4.91) above threshold
Prospective Unified 3 years value versus at or predisposing to CTS Poisson level is
Study (OCTOPUS), below acceptable (diabetes mellitus, regression associated with
enrolled workers in limit amyloidosis, gout, higher risk of
large and small progressive systemic CTS
renal failure)
238
Garg,A. 2012 High N= 536 ; workers from symptoms ACGIH HAL Model1: ACGIH Hand cox 1.44 (0.55 NS
a wide range of (tingling and/or between AL and Activity Level (HAL) ,age, proportional 3.76)
manufacturing facilities numbness) in at TLV vs BMI (continuous), number hazard ratio
in the Midwest least 2 median acceptable level of other distal upper
nerve served or below extremity musculoskeletal
digits, symptoms disorders, gardening, feeling
at least 25% of down, blue or depressed,
days in previous rheumatoid arthritis
month,
symptoms for at
least 2 or more
consecutive
monthly follow
ups, abnormal
NCS at 6 years
Garg,A. 2012 High N= 536 ; workers from symptoms ACGIH HAL Model1: ACGIH Hand cox 2.01 (0.80 NS
a wide range of (tingling and/or above TLV vs Activity Level (HAL) ,age, proportional 5.04)
manufacturing facilities numbness) in at acceptable level BMI (continuous), number hazard ratio
in the Midwest least 2 median or below of other distal upper
nerve served extremity musculoskeletal
digits, symptoms disorders, gardening, feeling
at least 25% of down, blue or depressed,
days in previous rheumatoid arthritis
month,
symptoms for at
least 2 or more
consecutive
monthly follow
ups, abnormal
NCS at 6 years
239
Burt,S. 2011 Moderate N= 455 ; healthcare and electrodiagnostic Between the Model 3: peak worker logistic 2.28 (0.58- NS
manufacturing workers tests, hand action limit and perceived exertion rating (0- regression 8.88)
diagram and the TLV vs below 10), BMI, Hand Activity odds ratio
symptoms action limit Level among females, Hand
Activity Level among
males, Gender/Sex female
vs male at the mean hand
activity level
Burt,S. 2011 Moderate N= 455 ; healthcare and electrodiagnostic Threshold limit Model 3: peak worker logistic 2.96 (1.51- having a hand
manufacturing workers tests, hand value and above perceived exertion rating (0- regression 5.80) action level
diagram and vs below action 10), BMI, Hand Activity odds ratio above the TLV
symptoms limit Level among females, Hand increases CTS
Activity Level among odds
activity level
Burt,S. 2013 Moderate N= 347 ; workers from electrodiagnostic Threshold limit model 2: threshold limit hazard ratios 1.4 (1.11, higher amount
hospital, school bus test, symptoms, ratio value, BMI, Job strain 1.78) of time in spent
manufacturing plant, hand diagram at threshold limit
and engine assembly 2 years value is
plant associated with
higher risk of
CTS
240
Violante,F.S. Moderate Blue-collar workers of occurrence Biomechanical sex, age, biomechanical Logistic 1.5 (0.9 2.5) NS
2007 several factories within last load between load, BMI*wrist interaction Regression
(producing large and month of action limit and effect, height*forearm OR
small domestic classic/ threshold limit interaction effect, family
appliances, underwear, probable or value versus history of CTS, pathologies
ceramic tiles, and shoes possible below action limit facilitating CTS
and workers employed symptoms of onset(diabetes mellitus,
in all municipal nursery CTS amyloidosis, gout,
schools. progressive systemic
sclerosis, rheumatoid
arthritis, systemic lupus
erythematosus, thyroid
renal failure) alcohol
consumption, smoking
status, previous exposure to
biomechanical overload
Violante,F.S. Moderate Blue-collar workers of occurrence Biomechanical sex, age, biomechanical Logistic 3.0 (2.0 4.5) Biomechanical
2007 several factories within last load above load, BMI*wrist interaction Regression loads above the
(producing large and month of threshold limit effect, height*forearm OR threshold limit
small domestic classic/ value versus interaction effect, family value increases
appliances, underwear, probable or below action limit history of CTS, pathologies odds of CTS
ceramic tiles, and shoes possible facilitating CTS compared to
and workers employed symptoms of onset(diabetes mellitus, biomechanical
in all municipal nursery CTS amyloidosis, gout, loads under the
schools. progressive systemic action limit
241
Violante,F.S. Moderate Blue-collar workers of occurrence Previous sex, age, biomechanical Logistic 1.4(.9-2.1) NS
2007 several factories within last exposure to load, BMI*wrist interaction Regression
(producing large and month of biomechanical effect, height*forearm OR
small domestic classic/ overload interaction effect, family
appliances, underwear, probable or history of CTS, pathologies
ceramic tiles, and shoes possible facilitating CTS
and workers employed symptoms of onset(diabetes mellitus,
in all municipal nursery CTS amyloidosis, gout,
242
TABLE 37 RISK FACTOR: AGE
Risk Confounding Stat.

Study Quality Population CTS Diagnostics Factor Adjustment Type Results Significance
Armstrong,T. High N= 1071; following median neuropathy Age per 10 year model 2 best fitting model: logistic 1.58 (1.32, 1.89) older have
2008 worker populations: cases increase age, Gender/Sex, body regression significantly
carpenters, floor mass index, wrist index, OR higher odds of
layers, sheet metal history of diabetes, and median
workers, engineers, history of shoulder neuropathy
laboratory workers, tendonitis, lifting more than
computer workers, and 2lbs/day, assembly line
hospital support staff. work, hospital vs clerical
work, construction vs
clerical work
Bonfiglioli,R. High N= 2492 ; part of CTS symptoms at 3 Age sex, age, BMI personal incident rate 1.03 (1.02, 1.04) older age
2013 Observational years history of diseases ratio from increases CTS
Prospective Unified predisposing to CTS Poisson symptom risk
Study (OCTOPUS), (diabetes mellitus, regression
enrolled workers in amyloidosis, gout,
large and small progressive systemic
underwear, ceramic arthritis, systemic lupus
tile and shoe factories erythematosus, thyroid
renal failure)
243
Bonfiglioli,R. High N= 2299 ; part of CTS symptoms and Age sex, age, BMI personal incident rate 1.06 (1.05, 1.08) older age
2013 Observational NCS test at 3 years history of diseases ratio from increases CTS
Prospective Unified predisposing to CTS Poisson risk
Study (OCTOPUS), (diabetes mellitus, regression
enrolled workers in amyloidosis, gout,
large and small progressive systemic
underwear, ceramic arthritis, systemic lupus
tile and shoe factories erythematosus, thyroid
renal failure)
Evanoff,B. High 711 clerical, service, Presence of Age adjusted for age, Multivariable 1.03 (1.00-1.05) NS
2014 and construction specific nerve Gender/Sex, and BMI; past mixed logistic
workers from eight symptoms in diagnosis of CTS or other regression
participating survey and median upper extremity peripheral models OR
employers and three neuropathy by NCS neuropathy, had a
construction trade (DML, MUDS, pacemaker or internal
unions between July DSL) at 3 years defibrillator, or were
2004and October 2006 pregnant at the time of
into the PrediCTS enrollment excluded
study
Garg,A. 2012 High N= 536 ; workers from symptoms (tingling Age Model1: ACGIH Hand cox 1.077 (.99,1.17) NS
a wide range of and/or numbness) Activity Level (HAL) ,age, proportional
manufacturing in at least 2 median BMI (continuous), number hazard ratio
facilities in the nerve served digits, of other distal upper
Midwest symptoms at least extremity musculoskeletal
25% of days in disorders, gardening,
previous month, feeling down, blue or
symptoms for at depressed, rheumatoid
least 2 or more arthritis
consecutive
monthly follow
ups, abnormal NCS
at 6 years
244
Garg,A. 2012 High N= 536 ; workers from symptoms (tingling Age Model 2: strain index ,age, cox 1.076 (0.991.17) NS
a wide range of and/or numbness) BMI (continuous), number proportional
manufacturing in at least 2 median of other distal upper hazard ratio
facilities in the nerve served digits, extremity musculoskeletal
Midwest symptoms at least disorders, gardening,
25% of days in feeling down, blue or
previous month, depressed, rheumatoid
symptoms for at arthritis
least 2 or more
consecutive
monthly follow
ups, abnormal NCS
at 6 years
Hakim,A.J. High N= 3674 ; twins from hand diagram: Age 4650 vs matched by: pairs of twins ; logit 2.01 (1.442.81) age 46 to 50
2002 the UK Adult Twin classic or probable Age 45 or below covariates: age, BMI, home regression has higher
Registry CTS activity level, leisure odds ratio odds of CTS
activity level, clerical vs with than 45 or
not clerical occupation, adjustment younger
menopausal status, for pair
hysterectomy, use of codependency
hormone replacement
therapy, current use of
thyroxine replacement
therapy
Hakim,A.J. High N= 3674 ; twins from hand diagram: Age 5155 vs matched by: pairs of twins ; logit 1.3 (0.921.83) NS
2002 the UK Adult Twin classic or probable Age 45 or below covariates: age, BMI, home regression
Registry CTS activity level, leisure odds ratio
activity level, clerical vs with
not clerical occupation, adjustment
hormone replacement
therapy
245
Hakim,A.J. High N= 3674 ; twins from hand diagram: Age 5659 vs matched by: pairs of twins ; logit 1.33 (0.921.92) NS
2002 the UK Adult Twin classic or probable Age 45 or below covariates: age, BMI, home regression
hormone replacement
therapy
Hakim,A.J. High N= 3674 ; twins from hand diagram: Age 60 vs 45 matched by: pairs of twins ; logit 1.28 (0.941.75) NS
2002 the UK Adult Twin classic or probable covariates: age, BMI, home regression
hormone replacement
therapy
Bland,J.D. Low N= 4155 ; all patients NCS confirmed In age quintile 2 Gender/Sex, smoking, age, logistic 1.52 (0.53,4.39) NS
2005 referred to the CTS vs 1st BMI*age interaction regression
neurophysiology OR
service at hospital for
suspicion of CTS
Bland,J.D. Low N= 4155 ; all patients NCS confirmed In age quintile 3 Gender/Sex, smoking, age, logistic 5.29 (1.79,15.66) older age is
2005 referred to the CTS vs 1st BMI*age interaction regression associated
neurophysiology OR with higher
service at hospital for odds of CTS
suspicion of CTS
246
Bland,J.D. Low N= 4155 ; all patients NCS confirmed In age quintile 4 Gender/Sex, smoking, age, logistic 7.42 (2.34,23.5) older age is
suspicion of CTS
Bland,J.D. Low N= 4155 ; all patients NCS confirmed In age quintile 5 Gender/Sex, smoking, age, logistic 38.33(12.11,121.29) older age is
suspicion of CTS
Wright, C. Low (3155 w/o CTS clinically Age <30 versus age, race/ethnicity, Logistical 0.99 (0.59-1.69) NS
2014 diagnosis and 91 with diagnosed with older education, smoking, parity, Regression
CTS diagnosis); EMR ICD 9 diagnosis hypertension, diabetes, OR
of a cohort of pregnant code for CTS maternal weight category
women receiving (constructed variable
prenatal care at a large including information
obstetrics unit; about maternal BMI and
representative of those GWG), and number
served by the urban prenatal care visits
academic center, with
a large proportion of
black patients
Eleftheriou,A. Moderate N= 441 ; 548 workers personal history of Age at least 45 Keyboard strokes, age, logistic 1.16 (0.53 to 2.55) NS
2012 of a Governmental CTS physical activity, smoking regression
data entry & OR
processing unit
Eleftheriou,A. Moderate N= 441 ; 548 workers personal history of Age at least 45 Keyboard strokes, sex, logistic 1.48 (0.90 to 2.43) NS
2012 of a Governmental CTS or newly physical activity, age regression
data entry & diagnosed CTS OR
processing unit with CTS-7
algorithm score of
12 or more
247
Mondelli,M. Moderate N= 145 ; female diagnosed Age 2nd vs 1st Age, BMI, duration of logistic 1.32 (0.44-4.00) NS
2006 hospital floor cleaners according to AAN quartile occupational exposure to regression
in Italy criteria: population current job, occupational OR
of hospital floor exposure to the same job
cleaners for previous employers,
manual hobbies (including
motorcycle use, diseases
known to be associated
with CTS (diabetes
connective tissue diseases,
hypothyroidism, and
wrist/hand trauma),
hospital (to adjust for
center effects)
Mondelli,M. Moderate N= 145 ; female diagnosed Age 3rd vs 1st Age, BMI, duration of logistic 1.50 (0.45-4.96) NS
with CTS (diabetes
hypothyroidism, and
wrist/hand trauma),
center effects)
248
Mondelli,M. Moderate N= 145 ; female diagnosed Age 4th vs 1st Age, BMI, duration of logistic 1.69 (0.50-5.75) NS
with CTS (diabetes
hypothyroidism, and
wrist/hand trauma),
center effects)
Morgenstern,H. Moderate N= 1058 ; grocery symptoms of CTS Age matched by: all members logistic 1.07(P=.002) odds of CTS
1991 store checkers indicated in were members of union regression are greater in
belonging to local questionnaire food and commercial odds ratio older patients
California union workers union ; covariates:
age, hours per work week,
years worked, age*years
worked interaction, use of
laser scanner to check
items, unload basket before
checking, load and lift
grocery bags after
checking, currently
pregnant, contraceptive
use, use of exogenous
estrogen, use of diuretics,
history of broken wrist
Shin,J. 2008 Moderate N= 123 ; All were pain or pain in Age age, sex, predialysis plasma logistic 1.43(1.09,1.89) age is
hemodialysis patients median nerve BMG level in 1990, regression positively
distribution and duration of dialysis OR associated
Tinel's sign with CTS odds
249
Silverstein,B.A. Moderate N= 652 ; workers form based on phalen Age Gender/Sex, age, years on logistic 1.05(0.99,1.11) NS
1987 seven different and tinel's signs job, work repetition, level regression
industrial sites and symptoms of force involved in job, OR
mentioned in dummy variables
interview controlling for job center
effects
Violante,F.S. Moderate Blue-collar workers of occurrence within Age 31 to 35 sex, age, biomechanical Logistic 1.1 (0.6 2.1) NS
2007 several factories last month of versus 30 or load, BMI*wrist interaction Regression
(producing large and classic/ probable younger effect, height*forearm OR
small domestic or possible interaction effect, family
appliances, underwear, symptoms of CTS history of CTS, pathologies
ceramic tiles, and facilitating CTS
shoes and workers onset(diabetes mellitus,
employed in all amyloidosis, gout,
municipal nursery progressive systemic
schools. sclerosis, rheumatoid
250
Violante,F.S. Moderate Blue-collar workers of occurrence within Age 36 to 40 sex, age, biomechanical Logistic 1.4 (0.8 2.6) NS
Violante,F.S. Moderate Blue-collar workers of occurrence within Age 41 to 45 sex, age, biomechanical Logistic 2.2 (1.2 4.1) 41 to 45 year
2007 several factories last month of versus 30 or load, BMI*wrist interaction Regression olds had
(producing large and classic/ probable younger effect, height*forearm OR greater odds of
small domestic or possible interaction effect, family CTS than
appliances, underwear, symptoms of CTS history of CTS, pathologies people at age
ceramic tiles, and facilitating CTS 30 or younger
251
Violante,F.S. Moderate Blue-collar workers of occurrence within Age 46 to 50 sex, age, biomechanical Logistic 1.3 (0.72.5) NS
Violante,F.S. Moderate Blue-collar workers of occurrence within Age 50 or older sex, age, biomechanical Logistic 1.7 (0.9 3.3) NS
252
TABLE 38 RISK FACTOR: ANTHROPOMETRIC MEASURES

Armstrong,T. High N= 1071; following median Wrist index >= model 2 best fitting model: logistic 2.54 (1.69, wrist index is
2008 worker populations: neuropathy cases 7(depth/width of age, Gender/Sex, body regression OR 3.82) significantly
carpenters, workers, wrist in cm) mass index, wrist index, correlated with
engineers, laboratory history of diabetes, and median
workers, computer history of shoulder neuropathy
workers, and hospital tendonitis, lifting more
support staff. than 2lbs/day, assembly
line work, hospital vs
clerical work, construction
vs clerical work
Kopec,J. 2011 Low N= 386 ; all patients signs and location of AV location of AV fistula none none NS
were on hemodialysis symptoms verified fistula
by nerve
conduction studies
Tsai,N.W. 2013 Low N= 120 (80 non-DM clinically and Cross sectional Gender/Sex, BMI, body Stepwise 1.21 (1.07- In DM patients,
and 40 DM patients); electromyography- area of the weight, CSA outlet, CSA logistic 1.38) increased CSA
Patients with confirmed CTS median nerve at W; clinical and regression OR W increases
clinically suspicious the wrist crease electrophysiologic odds of CTS
CTS at the out-patient (CSA W) diagnosis of diabetic
clinics of the polyneuropathy, prior
Department of surgery for CTS, and those
Neurology of with gout, rheumatoid
Kaohsiung Chang arthritis, or abnormal
Gung Memorial thyroid function related to
Hospital were peripheral neuropathy
evaluated.
253
Werner,R.A. Low N= 189 ; all were hand diagram Elbow posture Gender/Sex, wrist/hand logistic 8.08(1.48 higher elbow
2005 automobile assembly symptoms, and rating (110 tendonitis, diabetes, regression 44.22) posture rating
line workers median sensory scale) coworker support, median odds ratio was associated
evoked response ulnar peak latency on with higher
that .5 msec longer dominant side, elbow odds of CTS
than ipsilateral posture rating
ulnar sensory
response at 1 year
Boz,C. 2004 Moderate N= 304 ; cases were clinical and wrist index matched by: age matched logistic 1.157(1.099- higher wrist
selected and controls electrodiagnostic females ; covariates: BMI, regression 1.219) index is
were relatives or tests wrist index, shape index, odds ratio associated with
people accompanying digit index, hand higher CTS
CTS patients length/body height ratio odds
Boz,C. 2004 Moderate N= 304 ; cases were clinical and Shape index matched by: age matched logistic 1.362(1.207- higher hand
selected and controls electrodiagnostic [hand females ; covariates: BMI, regression 1.537) shape index is
were relatives or tests width(mm)/hand wrist index, shape index, odds ratio correlated with
people accompanying length (mm) digit index, hand higher CTS
CTS patients 100] length/body height ratio odds
Boz,C. 2004 Moderate N= 304 ; cases were clinical and digit index [third matched by: age matched logistic 1.375(1.164- higher digit
selected and controls electrodiagnostic finger length females ; covariates: BMI, regression 1.624) index shape
were relatives or tests (mm)/hand length wrist index, shape index, odds ratio index is
people accompanying (mm) 100] digit index, hand correlated with
CTS patients length/body height ratio higher CTS
odds
Boz,C. 2004 Moderate N= 304 ; cases were clinical and Hand length/body matched by: age matched logistic 1.246(0.650- NS
selected and controls electrodiagnostic height ratio females ; covariates: BMI, regression 2.287)
were relatives or tests wrist index, shape index, odds ratio
people accompanying digit index, hand
CTS patients length/body height ratio
Boz,C. 2004 Moderate N= 304 ; cases were clinical and wrist index matched by: aged matched logistic 1.047(0.966- NS
selected and controls electrodiagnostic males ; covariates: BMI, regression 1.135)
254
Boz,C. 2004 Moderate N= 304 ; cases were clinical and Shape index matched by: aged matched logistic 1.041(0.878- NS
selected and controls electrodiagnostic [hand males ; covariates: BMI, regression 1.233)
were relatives or tests width(mm)/hand wrist index, shape index, odds ratio
people accompanying length (mm) digit index, hand
CTS patients 100] length/body height ratio
Boz,C. 2004 Moderate N= 304 ; cases were clinical and digit index [third matched by: aged matched logistic 1.177(0.880- NS
selected and controls electrodiagnostic finger length males ; covariates: BMI, regression 1.574)
were relatives or tests (mm)/hand length wrist index, shape index, odds ratio
people accompanying (mm) 100] digit index, hand
Boz,C. 2004 Moderate N= 304 ; cases were clinical and Hand length/body matched by: aged matched logistic 1.069(0.381- NS
selected and controls electrodiagnostic height ratio males ; covariates: BMI, regression 2.998)
Gordon,C. 1988 Moderate N= 80 ; Midwestern median motor and Wrist ratio age, sex regression p 0.001 wrist ratio
car manufacturing sensory latencies value predicted
workers at 3 years median motor
latency
Hlebs,S. 2014 Moderate convenience and clinically and Mean wrist index diabetes mellitus, Multiple 42.89 (9.22, Wrist ratio is
random sampling of electromyography >0.695 rheumatoid arthritis, logistic 199.60) associated with
N= 100 (50 with CTS (EMG) confirmed thyroid disease, regression OR increased odds
and 50 healthy CTS; controls had neuropathy, infections, of CTS
controls); subjects no signs or thoracic outlet syndrome,
performed various symptoms of CTS neck pain or paresthesia
occupations, but the (tingling) in upper limbs,
groups were balanced pregnancy, past injury or
regarding Gender/Sex surgery of the wrist or the
and age neck, BMI, ratio of hand
length to body height,
mean wrist index >0.695,
mean hand shape index,
mean digit index
255
Hlebs,S. 2014 Moderate convenience and clinically and mean ratio of diabetes mellitus, Multiple 0.18 (0.04, Hand length-
random sampling of electromyography hand length to rheumatoid arthritis, logistic 0.92) body height
N= 100 (50 with CTS (EMG) confirmed body height thyroid disease, regression OR ratio decreased
and 50 healthy CTS; controls had neuropathy, infections, odds of CTS
mean digit index
Hlebs,S. 2014 Moderate convenience and clinically and Mean digit index diabetes mellitus, Multiple 1.12 (0.64, NS
random sampling of electromyography rheumatoid arthritis, logistic 1.96)
N= 100 (50 with CTS (EMG) confirmed thyroid disease, regression OR
and 50 healthy CTS; controls had neuropathy, infections,
mean digit index
256
Hlebs,S. 2014 Moderate convenience and clinically and Mean hand shape diabetes mellitus, Multiple 1.22 (0.93, NS
random sampling of electromyography index rheumatoid arthritis, logistic 1.61)
N= 100 (50 with CTS (EMG) confirmed thyroid disease, regression OR
and 50 healthy CTS; controls had neuropathy, infections,
mean digit index
Matias,A.C. Moderate N= 100 ; video "medically Trunk incline work day duration logistic .898(p=.03) trunk incline is
1998 display terminal diagnosed" CTS regression negatively
operators at odds ratio associated with
Midwestern CTS
university
Matias,A.C. Moderate N= 100 ; video "medically Wrist extension work day duration logistic 1.057(p=.09) NS
1998 display terminal diagnosed" CTS regression
operators at odds ratio
Midwestern
university
Matias,A.C. Moderate N= 100 ; video "medically Wrist deviation work day duration logistic 1.098(p=.009) wrist deviation
1998 display terminal diagnosed" CTS regression is positively
operators at odds ratio associated with
Midwestern CTS
university
257
Matias,A.C. Moderate N= 100 ; video "medically overall work day duration logistic 1.406(P=.07) Overall
1998 display terminal diagnosed" CTS anthropometric regression anthropometric
operators at measure factor odds ratio measures are
Midwestern consisting of associated with
university measures of wrist higher CTS
circumference, odds
wrist diameter,
upper arm length,
forearm length,
and hand length
Moghtaderi,A. Moderate N= 237 ; cases and clinical and Wrist ratio matched by: age ; logistic 1.12(1.03, higher wrist
2005 controls recruited electrodiagnostic covariates: sex, BMI, wrist regression 1.21) ratio is
from same urban area tests ratio, wrist circumference odds ratio positively
associated with
CTS
Moghtaderi,A. Moderate N= 237 ; cases and clinical and Wrist matched by: age ; logistic .82(.76, .88) higher wrist
2005 controls recruited electrodiagnostic circumference covariates: sex, BMI, wrist regression circumference
from same urban area tests ratio, wrist circumference odds ratio is negatively
associated with
CTS
Sabry,M.M. Moderate N= 78 ; cases wrist ratio CTS symptoms none mean 0.02(0, 0.04) wrist ratio is
2009 presented to with mild nerve difference higher in CTS
neurophysiological conduction patients with
laboratory unclear abnormality vs mild
which population health controls conduction
controls were abnormality
recruited from
Sabry,M.M. Moderate N= 69 ; cases wrist ratio CTS symptoms none mean 0.03(0.01, wrist ratio is
2009 presented to with moderate difference 0.05) higher in CTS
neurophysiological nerve conduction patients with
laboratory unclear abnormality vs moderate
recruited from
258
Sabry,M.M. Moderate N= 68 ; cases wrist ratio CTS symptoms none mean 0.04(0.02, wrist ratio is
2009 presented to with severe nerve difference 0.06) higher in CTS
neurophysiological conduction patients with
laboratory unclear abnormality vs severe
recruited from
Sabry,M.M. Moderate N= 78 ; cases wrist palm ratio CTS symptoms none mean 0.01(0, 0.02) wrist palm ratio
2009 presented to with mild nerve difference is higher in
neurophysiological conduction CTS patients
laboratory unclear abnormality vs with mild
recruited from
Sabry,M.M. Moderate N= 69 ; cases wrist palm ratio CTS symptoms none mean 0.02(0, 0.04) wrist palm ratio
2009 presented to with moderate difference is higher in
neurophysiological nerve conduction CTS patients
laboratory unclear abnormality vs with moderate
recruited from
Sabry,M.M. Moderate N= 68 ; cases wrist palm ratio CTS symptoms none mean 0.03(0.01, wrist palm ratio
2009 presented to with severe nerve difference 0.05) is higher in
neurophysiological conduction CTS patients
laboratory unclear abnormality vs with severe
recruited from
Sharifi- Moderate N= 262 ; cases were clinical and Digit index [third matched by: age ; logistic 1 NS
Mollayousefi,A. from same urban area, electrodiagnostic finger length covariates: digit index, regression
2008 and controls were tests (mm)/hand length shape index, wrist ratio, odds ratio
their relatives (mm) 100] hand length/hand height
ratio, BMI
259
Sharifi- Moderate N= 262 ; cases were clinical and Shape index matched by: age ; logistic 1.058 odds of CTS
Mollayousefi,A. from same urban area, electrodiagnostic [hand covariates: digit index, regression increases as
2008 and controls were tests width(mm)/hand shape index, wrist ratio, odds ratio shape index
their relatives length (mm) hand length/hand height increases
100] ratio, BMI
Sharifi- Moderate N= 262 ; cases were clinical and Wrist ratio[wrist matched by: age ; logistic 1.351 odds of CTS
Mollayousefi,A. from same urban area, electrodiagnostic depth(mm)/wrist covariates: digit index, regression increases as
2008 and controls were tests width (mm)] shape index, wrist ratio, odds ratio wrist ratio
their relatives hand length/hand height index increases
ratio, BMI
Sharifi- Moderate N= 262 ; cases were clinical and Hand matched by: age ; logistic 1.002 odds of CTS
Mollayousefi,A. from same urban area, electrodiagnostic length/height covariates: digit index, regression increases as
2008 and controls were tests ratio[hand length shape index, wrist ratio, odds ratio hand
their relatives (cm)/height(m)] hand length/hand height length/height
ratio, BMI ratio index
increases
Violante,F.S. Moderate Blue-collar workers occurrence within BMI under 25 sex, age, biomechanical Logistic 1.1 (0.71.7) NS
2007 of several factories last month of with a robust load, BMI*wrist Regression
(producing large and classic/ probable wrist versus BMI interaction effect, OR
small domestic or possible under 25 with a height*forearm interaction
appliances, symptoms of CTS slim wrist effect, family history of
underwear, ceramic CTS, pathologies
tiles, and shoes and facilitating CTS
workers employed in onset(diabetes mellitus,
all municipal nursery amyloidosis, gout,
status, previous exposure
to biomechanical overload
260
Violante,F.S. Moderate Blue-collar workers occurrence within short height with sex, age, biomechanical Logistic 0.7 (0.4 1.1) NS
2007 of several factories last month of long forearm load, BMI*wrist Regression
(producing large and classic/ probable length versus interaction effect, OR
small domestic or possible short height and height*forearm interaction
appliances, symptoms of CTS short forearm effect, family history of
underwear, ceramic length CTS, pathologies
tiles, and shoes and (tall/long=50th facilitating CTS
workers employed in percentile or onset(diabetes mellitus,
all municipal nursery higher) amyloidosis, gout,
status, previous exposure
to biomechanical overload
261
TABLE 39 RISK FACTOR: ANY FACILITATING COMORBIDITIES
Bonfiglioli,R. High N= 2492 ; part of CTS symptoms 1 or more gender/sex, age, BMI incident rate 1.60 (1.31, having
2013 Observational at 3 years predisposing personal history of ratio from 1.94) predisposing
Prospective Unified disease (diabetes, diseases predisposing to Poisson diseases
Study amyloidosis, CTS (diabetes mellitus, regression increase risk of
(OCTOPUS), gout, thyroid amyloidosis, gout, symptoms
enrolled workers in disorders, progressive systemic
large and small scleroderma, sclerosis, rheumatoid
domestic appliance, rheumatoid arthritis, systemic lupus
underwear, ceramic arthritis, systemic erythematosus, thyroid
tile and shoe lupus disorders, tendonitis of
factories erythematosus, the finger flexors, and
and digital flexor chronic renal failure)
tendonitis)
Bonfiglioli,R. High N= 2299 ; part of CTS symptoms 1 or more gender/sex, age, BMI incident rate 1.91 (1.26, predisposing
2013 Observational and NCS test at predisposing personal history of ratio from 2.91) conditions
Prospective Unified 3 years disease (diabetes, diseases predisposing to Poisson increase CTS
Study amyloidosis, CTS (diabetes mellitus, regression risk
(OCTOPUS), gout, thyroid amyloidosis, gout,
enrolled workers in disorders, progressive systemic
large and small scleroderma, sclerosis, rheumatoid
domestic appliance, rheumatoid arthritis, systemic lupus
underwear, ceramic arthritis, systemic erythematosus, thyroid
tile and shoe lupus disorders, tendonitis of
factories erythematosus, the finger flexors, and
and digital flexor chronic renal failure)
tendonitis)
262
Violante,F.S. Moderate Blue-collar workers occurrence Presence of sex, age, biomechanical Logistic 2.3 (1.53.6) presence
2007 of several factories within last pathologies load, BMI*wrist Regression pathologies
(producing large month of facilitating CTS interaction effect, OR facilitating CTS
and small domestic classic/ onset(diabetes height*forearm onset increases
appliances, probable or mellitus, interaction effect, family odds of CTS
underwear, ceramic possible amyloidosis, history of CTS,
tiles, and shoes and symptoms of gout, progressive pathologies facilitating
workers employed CTS systemic CTS onset(diabetes
in all municipal sclerosis, mellitus, amyloidosis,
nursery schools. rheumatoid gout, progressive systemic
arthritis, systemic sclerosis, rheumatoid
lupus arthritis, systemic lupus
erythematosus, erythematosus, thyroid
thyroid disorders, disorders, tendonitis of
tendonitis of the the finger flexors, and
finger flexors, chronic renal failure)
and chronic renal alcohol consumption,
failure) smoking status, previous
exposure to
263
TABLE 40 RISK FACTOR: ARTHRITIS

Garg,A. 2012 High N= 536 ; workers symptoms (tingling Rheumatoid Model1: ACGIH Hand cox 4.07 (1.43 RA is a risk
from a wide and/or numbness) in at Arthritis Activity Level (HAL) ,age, proportional 11.58) factor for CTS
range of least 2 median nerve BMI (continuous), number hazard ratio
manufacturing served digits, symptoms of other distal upper
facilities in the at least 25% of days in extremity musculoskeletal
Midwest previous month, disorders, gardening,
symptoms for at least 2 or feeling down, blue or
more consecutive depressed, rheumatoid
monthly follow ups, arthritis
abnormal NCS at 6 years
Garg,A. 2012 High N= 536 ; workers symptoms (tingling Rheumatoid Model 2: strain index ,age, cox 4.14 (1.48 RA is a risk
from a wide and/or numbness) in at Arthritis BMI (continuous), number proportional 11.59) factor for CTS
range of least 2 median nerve of other distal upper hazard ratio
manufacturing served digits, symptoms extremity musculoskeletal
facilities in the at least 25% of days in disorders, gardening,
Midwest previous month, feeling down, blue or
symptoms for at least 2 or depressed, rheumatoid
more consecutive arthritis
monthly follow ups,
Burt,S. 2011 Moderate N= 455 ; electrodiagnostic tests, arthritis yes Model 3: peak worker logistic 2.03 (1.02- arthritis
healthcare and hand diagram and versus no perceived exertion rating regression 4.04) increases CTS
manufacturing symptoms (0-10), BMI, Hand Activity odds ratio odds
workers Level among females,
Hand Activity Level among
activity level
264
Coggon,D. Moderate N= 855; cases neurophysiologically other arthritis matched by: sex, age ; logistic 0.7 (0.5-1.0) NS
2013 were selected positive patients vs present covariates: ethnicity, BMI, regression
from the negatively tested patients smoking habits, diabetes, OR
neurophysiology other arthritis present,
department and number of moderately
controls for the distressing somatic
accident and symptoms per week, use of
emergency keyboard 4 or more hours
services at per day, use of vibrating
Southampton tools, job includes
general hospital. bonuses/targets/deadlines
All were aged 20-
64
Geoghegan,J.M. Moderate N= 134 ; patients diagnosed CTS rheumatoid matched by: age, sex, and logistic 2.23 (1.57 odds are
2004 from the UK arthritis general practice ; regression 3.17) greater in
General Practice covariates: consulting rate, OR patients with
Research BMI, smoking, diabetes, RA
Database insulin use, metformin use,
sulphonyl use, hormone
replacement therapy,
corticosteroid use,
combined oral
contraceptive pill use,
Thyroxine use, Rheumatoid
arthritis, wrist fracture,
arthritis, also adjusted for
missing data on smoking
and BMI
265
Geoghegan,J.M. Moderate N= 1233 ; diagnosed CTS Arthritis matched by: age, sex, and logistic 1.89 (1.65 arthritis
2004 patients from the general practice ; regression 2.17) patients have
UK General covariates: consulting rate, OR greater odds
Practice Research BMI, smoking, diabetes, of CTS
Database insulin use, metformin use,
corticosteroid use,
combined oral
and BMI
266
TABLE 41 RISK FACTOR: ASSEMBLY LINE

Armstrong,T. High N= 1071; following median working on model 1:age, Gender/Sex, body logistic 2.86 (1.64, working on
2008 worker populations: neuropathy assembly line mass index, wrist index, history regression OR 5.01) assembly line is
carpenters, workers, cases of diabetes, and history of associated with
engineers, laboratory shoulder tendonitis, lifting more higher odds of
workers, computer than 2lbs/day, using vibrating median
workers, and hospital tools, assembly line work, neuropathy
support staff. twisting forearm work, bending
wrist work, using forceful hand
grip, using fingers/thumb as
pressing tool, using fingers in a
pinch grip
Armstrong,T. High N= 1071; following median working on model 2 best fitting model: age, logistic 2.57 (1.46, working on
2008 worker populations: neuropathy assembly line Gender/Sex, body mass index, regression OR 4.54) assembly line is
carpenters, workers, cases wrist index, history of diabetes, associated with
engineers, laboratory and history of shoulder higher odds of
workers, computer tendonitis, lifting more than median
workers, and hospital 2lbs/day, assembly line work, neuropathy
support staff. hospital vs clerical work,
construction vs clerical work
Bonfiglioli,R. Low N= 212 ; electric-power abnormal NCS assembly line matched by: all employed at odds ratio 7.22(2.858, odds of
2006 tool plant workers test and workers versus company that manufactures 18.237) abnormal NCS
symptoms non-assembly line electric-powered tools ; and symptoms
workers covariates: assembly line vs. is higher in
non-assembly line work assembly line
workers than in
non-assembly
line workers
267
Leclerc,A. 1998 Low N= 816 ; assembly line Tinel or phalen assembly line matched by: all were of similar logistic 4.54 (2.27 to odds of CTS are
workers and non- test positive or work vs non education level ; covariates: sex, regression 9.09) significantly
repetitive nerve condition repetitive work age, psychological problems, odds ratio higher in
workers(cleaning, velocity had (cleaning, BMI assembly line
maintenance or catering been maintenance and workers
jobs) established catering)
before medical
examination
268
TABLE 42 RISK FACTOR: AUTOMATIC WORK PACE

Petit,A. 2015 Moderate French salaried CTS symptoms work pace Gender/Sex, age, Logistical 1.9 (0.9-4.1) NS
workers working in on the day of dependent on use of vibrating Regression
manufacturing medical exam automatic rate hand tools, OR
industry and (or for at least 4 exposure to cold
services sector as days during the temperature,
skilled and preceding 7 holding objects in
unskilled blue days) pinch grip, extreme
collar workers wrist bending
posture, pressing
with palm base,
force, and work
organization factors
269
TABLE 43 RISK FACTOR: BMI

Armstrong,T. High N= 1071; following median neuropathy BMI per 5 model 2 best fitting model: logistic 1.28 (1.12, BMI is
2008 worker populations: cases point age, Gender/Sex, body mass regression 1.49) significantly
carpenters, workers, increase index, wrist index, history of OR correlated
engineers, laboratory diabetes, and history of with greater
workers, computer shoulder tendonitis, lifting odds of
workers, and hospital more than 2lbs/day, assembly median
support staff. line work, hospital vs clerical neuropathy
work, construction vs clerical
work
Bonfiglioli,R. High N= 2492 ; part of CTS symptoms at 3 BMI sex, age, BMI personal incident rate 1.03 (1.00, NS
2013 Observational years history of diseases ratio from 1.06)
Prospective Unified predisposing to CTS (diabetes Poisson
Study (OCTOPUS), mellitus, amyloidosis, gout, regression
enrolled workers in progressive systemic
large and small sclerosis, rheumatoid arthritis,
domestic appliance, systemic lupus
underwear, ceramic erythematosus, thyroid
tile and shoe factories disorders, tendonitis of the
renal failure)
Bonfiglioli,R. High N= 2299 ; part of CTS symptoms and BMI sex, age, BMI personal incident rate 1.09 (1.04, BMI increases
2013 Observational NCS test at 3 years history of diseases ratio from 1.14) CTS risk
Prospective Unified predisposing to CTS (diabetes Poisson
Study (OCTOPUS), mellitus, amyloidosis, gout, regression
large and small sclerosis, rheumatoid arthritis,
domestic appliance, systemic lupus
underwear, ceramic erythematosus, thyroid
tile and shoe factories disorders, tendonitis of the
renal failure)
270
Evanoff,B. High 711 clerical, service, Presence of specific BMI adjusted for age, Gender/Sex, Multivariable 1.07(1.01- Higher BMI
2014 and construction nerve symptoms in and BMI; past diagnosis of mixed logistic 1.12) significantly
workers from eight survey and median CTS or other upper extremity regression increases odds
participating neuropathy by NCS peripheral neuropathy, had a models OR of CTS
employers and three (DML, MUDS, pacemaker or internal
construction trade DSL) at 3 years defibrillator, or were pregnant
unions between July at the time of enrollment
2004and October 2006 excluded
into the PrediCTS
study
Garg,A. 2012 High N= 536 ; workers from symptoms (tingling BMI Model1: ACGIH Hand cox 1.070 (1.02 BMI is
a wide range of and/or numbness) in continuous Activity Level (HAL) ,age, proportional 1.12) significantly
manufacturing at least 2 median BMI (continuous), number of hazard ratio associated
facilities in the nerve served digits, other distal upper extremity with CTS risk
Midwest symptoms at least musculoskeletal disorders,
25% of days in gardening, feeling down, blue
previous month, or depressed, rheumatoid
symptoms for at arthritis
least 2 or more
consecutive monthly
follow ups,
abnormal NCS at 6
years
Garg,A. 2012 High N= 536 ; workers from symptoms (tingling BMI Model 2: strain index ,age, cox 1.063 1.02 BMI is
a wide range of and/or numbness) in (continuous) BMI (continuous), number of proportional 1.11 0.005) significantly
manufacturing at least 2 median other distal upper extremity hazard ratio associated
facilities in the nerve served digits, musculoskeletal disorders, with CTS risk
Midwest symptoms at least gardening, feeling down, blue
25% of days in or depressed, rheumatoid
previous month, arthritis
symptoms for at
least 2 or more
consecutive monthly
follow ups,
abnormal NCS at 6
years
271
Hakim,A.J. High N= 3674 ; twins from hand diagram: BMI 21.1 matched by: pairs of twins ; logit 0.91(0.69 NS
2002 the UK Adult Twin classic or probable 23.0 vs 21 covariates: age, BMI, home regression 1.22)
Registry CTS activity level, leisure activity odds ratio
level, clerical vs not clerical with
occupation, menopausal adjustment
status, hysterectomy, use of for pair
hormone replacement codependency
therapy
therapy
therapy
272
Hakim,A.J. High N= 3674 ; twins from hand diagram: BMI matched by: pairs of twins ; logit 0.84(0.57 NS
2002 the UK Adult Twin classic or probable Greater than covariates: age, BMI, home regression 1.23)
Registry CTS 28.1 vs 21 activity level, leisure activity odds ratio
therapy
Bland,J.D. 2005 Low N= 4155 ; all patients NCS confirmed CTS BMI in age Gender/Sex, smoking, age, logistic 1.09(1.06,1.12) Higher BMI is
referred to the quintile 1 BMI*age interaction regression a significant
neurophysiology OR risk factor in
service at hospital for the first age
suspicion of CTS quintile
service at hospital for the second
suspicion of CTS age quintile
service at hospital for the third age
suspicion of CTS quintile
service at hospital for the first fourth
suspicion of CTS age quintile
273
Bland,J.D. 2005 Low N= 4155 ; all patients NCS confirmed CTS BMI in age Gender/Sex, smoking, age, logistic 1.01(0.98,1.04) NS in fifth
referred to the quintile 5 BMI*age interaction regression age quintile
neurophysiology OR
suspicion of CTS
Becker,J. 2002 Moderate N= 1772; cases and nerve conduction BMI BMI over 30, Gender/Sex, logistic 1.25(1.07,1.46) although the
controls consisted of and Gender/Sex age between 41 and 60, regression overall effect
patients referred for electromyography interaction diabetes, BMI*Gender/Sex odds ratio of BMI
nerve conduction effect interaction effect, remained
studies and Gender/Sex*diabetes significant in
electromyography. interaction effect the model(for
both
Gender/Sex)
the effect of
BMI was
significantly
greater in
males than in
females
Burt,S. 2011 Moderate N= 448 ; healthcare electrodiagnostic BMI>=30 Model 1 Peak force match cat logistic 0.77 (0.24- NS
and manufacturing tests, hand diagram versus <30 2 versus 1, Peak force match regression 2.48)
workers and symptoms if cat 3 versus 1, Exerts/min cat odds ratio
exerts/min 2 versus 1 if BMI<30,
cat1 Exerts/min cat 3 versus 1 if
BMI<30, Exerts/min cat 2
versus 1 if BMI>=30,
Exerts/min cat 3 versus 1 if
BMI>=30, BMI>=30 versus
<30 if exerts/min cat1,
BMI>=30 versus <30 if
exerts/min cat2 1.60,
exerts/min cat3
274
Burt,S. 2011 Moderate N= 448 ; healthcare electrodiagnostic BMI>=30 Model 1 Peak force match cat logistic 1.60 (0.52- NS
and manufacturing tests, hand diagram versus <30 2 versus 1, Peak force match regression 5.00)
workers and symptoms if cat 3 versus 1, Exerts/min cat odds ratio
exerts/min 2 versus 1 if BMI<30,
cat2 1.60 Exerts/min cat 3 versus 1 if
exerts/min cat3
Burt,S. 2011 Moderate N= 448 ; healthcare electrodiagnostic BMI>=30 Model 1 Peak force match cat logistic 2.26 (1.01- obesity
and manufacturing tests, hand diagram versus <30 2 versus 1, Peak force match regression 5.10) increases the
workers and symptoms if cat 3 versus 1, Exerts/min cat odds ratio odds of CTS
exerts/min 2 versus 1 if BMI<30, among
cat3 Exerts/min cat 3 versus 1 if patients with
BMI<30, Exerts/min cat 2 highest
versus 1 if BMI>=30, category of
Exerts/min cat 3 versus 1 if exertions per
BMI>=30, BMI>=30 versus minute
<30 if exerts/min cat1, (>=15/minute)
exerts/min cat3
Burt,S. 2011 Moderate N= 456 ; healthcare electrodiagnostic BMI Model 2: peak worker logistic 1.07 (1.03- BMI increases
and manufacturing tests, hand diagram perceived exertion rating (0- regression 1.11) CTS odds
workers and symptoms 10), BMI, Hand Activity odds ratio
Level among females, Hand
Activity Level among males,
Gender/Sex
275
Burt,S. 2013 Moderate N= 347 ; workers electrodiagnostic BMI of at model1: time in forceful hazard ratios 3.19(1.28,7.98) having a BMI
from hospital, school test, symptoms, hand least 30 vs exertion, BMI>=30, threshold of 30 or
bus manufacturing diagram at 2 years less than 30 limit value, job strain greater is
plant, and engine associated
assembly plant with higher
risk of CTS
Coggon,D. Moderate N= 1230; cases were neurophysiologically BMI matched by: sex, age ; logistic 1.6 (1.1-2.1) odds higher in
2013 selected from the positive patients vs between 25 covariates: ethnicity, BMI, regression high BMI
neurophysiology healthy controls and 29.9 vs smoking, mental health, OR group
department and <25 repeated movements,
controls for the vibrating tools, job control,
accident and level of supervisor/colleague
emergency services at support
Southampton general
hospital. All were aged
20-64
Coggon,D. Moderate N= 1230; cases were neurophysiologically BMI of 30 matched by: sex, age ; logistic 2.1 (1.6-2.9) odds higher in
2013 selected from the positive patients vs or above vs covariates: ethnicity, BMI, regression high BMI
neurophysiology healthy controls <25 smoking, mental health, OR group
department and repeated movements,
controls for the vibrating tools, job control,
accident and level of supervisor/colleague
emergency services at support
Southampton general
20-64
276
Coggon,D. Moderate N= 855; cases were neurophysiologically BMI matched by: sex, age ; logistic 1.3 (0.9-1.9) NS
2013 selected from the positive patients vs between 25 covariates: ethnicity, BMI, regression
neurophysiology negatively tested and 29.9 vs smoking habits, diabetes, OR
department and patients <25 other arthritis present, number
controls for the of moderately distressing
accident and somatic symptoms per week,
emergency services at use of keyboard 4 or more
Southampton general hours per day, use of
hospital. All were aged vibrating tools, job includes
20-64 bonuses/targets/deadlines
Coggon,D. Moderate N= 855; cases were neurophysiologically BMI of 30 matched by: sex, age ; logistic 2.7 (1.9-3.9) BMI is
2013 selected from the positive patients vs or above vs covariates: ethnicity, BMI, regression associated
neurophysiology negatively tested <25 smoking habits, diabetes, OR with greater
department and patients other arthritis present, number risk of median
controls for the of moderately distressing neuropathy
accident and somatic symptoms per week,
emergency services at use of keyboard 4 or more
Southampton general hours per day, use of
hospital. All were aged vibrating tools, job includes
Geoghegan,J.M. Moderate N= 171 ; patients from diagnosed CTS BMI <18.5 matched by: age, sex, and logistic 0.64 (0.40 NS
2004 the UK General vs BMI general practice ; covariates: regression 1.01)
Practice Research 18.525 consulting rate, BMI, OR
Database smoking, diabetes, insulin
use, metformin use, sulphonyl
use, hormone replacement
therapy, corticosteroid use,
combined oral contraceptive
pill use, Thyroxine use,
Rheumatoid arthritis, wrist
fracture, arthritis, also
adjusted for missing data on
smoking and BMI
277
Geoghegan,J.M. Moderate N= 3127 ; patients diagnosed CTS BMI 25.1 matched by: age, sex, and logistic 1.63 (1.45 odds of CTS
2004 from the UK General 30 vs BMI general practice ; covariates: regression 1.84) are greater in
Practice Research 18.525 consulting rate, BMI, OR higher BMI
Database smoking, diabetes, insulin group
smoking and BMI
Geoghegan,J.M. Moderate N= 1422 ; patients diagnosed CTS BMI 3040 matched by: age, sex, and logistic 2.06 (1.79 odds of CTS
2004 from the UK General vs BMI general practice ; covariates: regression 2.38) are greater in
Practice Research 18.525 consulting rate, BMI, OR higher BMI
smoking and BMI
278
Geoghegan,J.M. Moderate N= 140 ; patients from diagnosed CTS BMI >40 vs matched by: age, sex, and logistic 2.22 (1.53 odds of CTS
2004 the UK General BMI 18.5 general practice ; covariates: regression 3.21) are greater in
Practice Research 25 consulting rate, BMI, OR higher BMI
smoking and BMI
Goodson, J.T. Moderate 87 CTS and 74 sex- (1)Electrodiagnostic BMI excluded confounding Logistical 1.09(0.99,1.19) NS
2014 matched general (EDX) testing conditions; sex, age, Regression
orthopedic patients results suggestive of education levels, ethnicity, OR
from an outpatient abnormal slowing of and EDX testing results
orthopedic clinic in the the median nerve,
Western US. (2) the presence of
clinical symptoms of
CTS, and (3) no
confounding
syndromes/disorders
Hlebs,S. 2014 Moderate convenience and clinically and BMI diabetes mellitus, rheumatoid Multiple 1.43 (1.16, high BMI is
random sampling of electromyography arthritis, thyroid disease, logistic 1.76) associated
N= 100 (50 with CTS (EMG) confirmed neuropathy, infections, regression with increased
and 50 healthy CTS; controls had thoracic outlet syndrome, OR odds of CTS
controls); subjects no signs or neck pain or paresthesia
performed various symptoms of CTS (tingling) in upper limbs,
occupations, but the pregnancy, past injury or
groups were balanced surgery of the wrist or the
regarding Gender/Sex neck, BMI, ratio of hand
and age length to body height, mean
wrist index >0.695, mean
hand shape index, mean digit
index
279
Mondelli,M. Moderate N= 145 ; female diagnosed according BMI over Age, BMI, duration of logistic 1.73 (0.68- NS
2006 hospital floor cleaners to AAN criteria: 25 vs 25 or occupational exposure to regression 4.44)
in Italy population of less current job, occupational OR
hospital floor exposure to the same job for
cleaners previous employers, manual
hobbies (including
known to be associated with
CTS (diabetes connective
tissue diseases,
hypothyroidism, and
wrist/hand trauma), hospital
(to adjust for center effects)
Nordstrom,D.L. Moderate N= 417 ; only incident Diagnosed by Body mass matched by: age ; covariates: logistic 1.08 (1.03, higher BMI
1997 cases diagnosed physician, or had index musculoskeletal condition, regression 1.14) increases odds
between 1994 and explicit treatment for (kg/m2) BMI, Parent/sibling/child has OR of CTS
1995 were eligible as CTS and hand CTS, power tool use, hours
cases in Marshfield symptoms within bending or twisting wrists,
Wisconsin, and one month of date of hours contacted with solvents
controls were a diagnosis. per day, IOSH job control
random sample from measure, cumulative hours
this area worked since 1993
280
Violante,F.S. Moderate Blue-collar workers of occurrence within Overweight sex, age, biomechanical load, Logistic 1.5 (0.73.4) NS
2007 several factories last month of BMI over BMI*wrist interaction effect, Regression
(producing large and classic/ probable 24.9 with a height*forearm interaction OR
small domestic or possible slim wrist effect, family history of CTS,
appliances, underwear, symptoms of CTS versus BMI pathologies facilitating CTS
ceramic tiles, and under 25 onset(diabetes mellitus,
shoes and workers with a slim amyloidosis, gout,
employed in all wrist progressive systemic
municipal nursery sclerosis, rheumatoid arthritis,
schools. systemic lupus
consumption, smoking status,
previous exposure to
de Krom,M.C. Moderate N= 629; 28 cases and clinical history and slimming matched by: age and sex logistic 1.57(0.92, NS
1990 all controls were neurophysiologic courses yes stratified random sample ; regression 2.66)
identified through testing vs no covariates: height, odds ratio
random sample of weight(kg), slimming
patients in the courses(yes/no), Hours/week
Netherlands. An in flexion activities,
additional 128 cases hours/week for extension
were added from a activities, Varicosis (for men
single hospital in the only), for women: years since
area menopause onset vs pre-
menopausal, hysterectomy vs
premenopausal
281
TABLE 44 RISK FACTOR: BENDING

Armstrong,T. High N= 1071; following median bending wrist model 1:age, Gender/Sex, logistic 1.72 (1.07, bending wrist
2008 worker populations: neuropathy cases frequently body mass index, wrist regression OR 2.76) frequently is
carpenters, workers, index, history of diabetes, associated with
engineers, laboratory and history of shoulder higher odds of
workers, computer tendonitis, lifting more than median
workers, and hospital 2lbs/day, using vibrating neuropathy
support staff. tools, assembly line work,
twisting forearm work,
bending wrist work, using
forceful hand grip, using
fingers/thumb as pressing
tool, using fingers in a
pinch grip
Dale, A.M. Moderate 710 clerical, service, Presence of peak exposure to age, BMI, Gender/Sex, med Logistical 0.98 (0.46, NS
2014 and construction specific nerve Wrist bending history, pregnancy, history Regression 2.10)
workers from eight symptoms in of CTS or peripheral OR
participating survey and neuropathy, or other
employers and three median contraindication to
construction trade neuropathy by receiving nerve conduction
unions between July NCS (DML, studies (NCS), lifting
2004and October 2006 MUDS, DSL) at objects, vibrating tools,
into the PrediCTS 3 years forearm rotation, wrist
study bending, forceful gripping,
thumb pressing, finger
pinching
282
Dale, A.M. Moderate 710 clerical, service, Presence of Wrist bending in age, BMI, Gender/Sex, med Logistical 1.48 (0.71, NS
2014 and construction specific nerve most recent job history, pregnancy, history Regression 3.12)
participating survey and neuropathy, or other
employers and three median contraindication to
construction trade neuropathy by receiving nerve conduction
unions between July NCS (DML, studies (NCS), lifting
2004and October 2006 MUDS, DSL) at objects, vibrating tools,
into the PrediCTS 3 years forearm rotation, wrist
study bending, forceful gripping,
thumb pressing, finger
pinching
Evanoff,B. Moderate N= 745 ; newly symptoms and hand wrist age, Gender/Sex, lifting at NR NR NS
2012 employed workers NCS at 3 years bending least 1kg, forceful grip,
finger/thumb pressing,
using vibrating tools, pinch
grip, forearm rotation,
hand/wrist bending
Nordstrom,D.L. Moderate N= 417 ; only incident Diagnosed by Bending/twisting matched by: age ; logistic 2.42 (0.88, NS
1997 cases diagnosed physician, or had hand 0.25-1.75 covariates: musculoskeletal regression OR 6.62)
between 1994 and explicit hours/day vs condition, BMI,
1995 were eligible as treatment for none Parent/sibling/child has
cases in Marshfield CTS and hand CTS, power tool use, hours
Wisconsin, and symptoms within bending or twisting wrists,
controls were a one month of hours contacted with
random sample from date of solvents per day, IOSH job
this area diagnosis. control measure, cumulative
hours worked since 1993
283
1997 cases diagnosed physician, or had hand 2-3 covariates: musculoskeletal regression OR 3.26)
1995 were eligible as treatment for none hours/day Parent/sibling/child has
cases in Marshfield CTS and hand vs none CTS, power tool use, hours
Nordstrom,D.L. Moderate N= 417 ; only incident Diagnosed by Bending/twisting matched by: age ; logistic 2.65 (1.83, higher in
1997 cases diagnosed physician, or had hand 3.5-6 covariates: musculoskeletal regression OR 5.92) workers who
between 1994 and explicit hours/day vs condition, BMI, bend/twist hand
1995 were eligible as treatment for none Parent/sibling/child has 3.5-6 hours/day
1997 cases diagnosed physician, or had hand -16 covariates: musculoskeletal regression OR 4.52)
1995 were eligible as treatment for none Parent/sibling/child has
284
de Krom,M.C. Moderate N= 629; 28 cases and clinical history increased CTS matched by: age and sex logistic 1.05(1.02, working longer
1990 all controls were and odds for 1 hour stratified random sample ; regression 1.08) hours in
identified through neurophysiologic increase in covariates: height, odds ratio activities
random sample of testing flexion weight(kg), slimming requiring wrist
patients in the courses(yes/no), flexion is
Netherlands. An Hours/week in flexion associated with
additional 128 cases activities, hours/week for higher CTS
were added from a extension activities, odds
single hospital in the Varicosis (for men only),
area for women: years since
menopause onset vs pre-
menopausal, hysterectomy
vs premenopausal
de Krom,M.C. Moderate N= 629; 28 cases and clinical history increased CTS matched by: age and sex logistic 1.04(1, 1.09) working longer
1990 all controls were and odds for 1 hour stratified random sample ; regression hours in
identified through neurophysiologic increase in covariates: height, odds ratio activities
random sample of testing extension weight(kg), slimming requiring wrist
patients in the courses(yes/no), extension is
Netherlands. An Hours/week in flexion associated with
additional 128 cases activities, hours/week for higher CTS
were added from a extension activities, odds
single hospital in the Varicosis (for men only),
area for women: years since
menopause onset vs pre-
menopausal, hysterectomy
vs premenopausal
285
TABLE 45 RISK FACTOR: CHEMICALS

Nordstrom,D.L. Moderate N= 417 ; only Diagnosed by Contact with matched by: age ; logistic 0.44 (0.21, odds lower in
1997 incident cases physician, or solvents 0.08- covariates: regression OR 0.90) workers with
diagnosed between had explicit 0.75 hours/day vs musculoskeletal .08 to .75 hours
1994 and 1995 treatment for none condition, BMI, of contact with
were eligible as CTS and hand Parent/sibling/child solvents
cases in Marshfield symptoms has CTS, power
Wisconsin, and within one tool use, hours
controls were a month of date bending or twisting
random sample of diagnosis. wrists, hours
from this area contacted with
solvents per day,
IOSH job control
measure,
cumulative hours
worked since 1993
Nordstrom,D.L. Moderate N= 417 ; only Diagnosed by Contact with matched by: age ; logistic 0.80 (0.36, NS
1997 incident cases physician, or solvents 1-11 covariates: regression OR 1.79)
diagnosed between had explicit hours/day vs none musculoskeletal
1994 and 1995 treatment for condition, BMI,
were eligible as CTS and hand Parent/sibling/child
cases in Marshfield symptoms has CTS, power
Wisconsin, and within one tool use, hours
controls were a month of date bending or twisting
random sample of diagnosis. wrists, hours
from this area contacted with
solvents per day,
IOSH job control
measure,
cumulative hours
worked since 1993
286
TABLE 46 RISK FACTOR: CLERICAL

Hakim,A.J. High N= 3674 ; twins hand diagram: Occupation matched by: pairs of twins ; logit 1.13(0.90 NS
2002 from the UK Adult classic or probable (clerical vs. non- covariates: age, BMI, home regression 1.43)
Twin Registry CTS clerical) activity level, leisure activity odds ratio
occupation, menopausal status, adjustment for
hysterectomy, use of hormone pair
replacement therapy, current codependency
use of thyroxine replacement
therapy
Jenkins,P.J. Low N= unclear ; symptoms and Administrative matched by: all males ; univariate 2.21 (1.00 NS
2013 prospective audit phalen and tinel's and secretarial covariates: Administrative and odds ratios 4.73)
database of General sign at 66 months occupations vs. secretarial occupations vs.
Registrar Office for Associate Associate professional and
Scotland professional and technical occupations
technical
occupations
Jenkins,P.J. Low N= unclear ; symptoms and Administrative matched by: all females ; univariate 1.76 (1.14 odds are higher
2013 prospective audit phalen and tinel's and secretarial covariates: Administrative and odds ratios 2.81) than in
database of General sign at 66 months occupations vs. secretarial occupations vs. associate
Registrar Office for Associate Associate professional and professional
Scotland professional and technical occupations and technical
technical occupations
occupations
287
TABLE 47 RISK FACTOR: COLD EXPOSURE

Chiang,H.C. Moderate N= 269 ; workers neurological work exposure to Age, sex, length of logistic 1.85 (1.10, exposure to
1990 at frozen food examinations and cold vs no employment, regression 3.13) cold is a
plants electrophysiological exposure to cold exposure to odds ratio significant
tests cold(frozen food predictor of
packers), repetitive CTS
movement (frozen
and non-frozen
food packers), and
cold*repetitious
movement
interaction
288
TABLE 48 RISK FACTOR: COMORBIDITY DRUG USE

Hakim,A.J. High N= 3674 ; twins hand diagram: Current thyroxine matched by: pairs of twins ; logit 1.13(0.72 NS
2002 from the UK Adult classic or replacement covariates: age, BMI, home regression 1.78)
Twin Registry probable CTS therapy activity level, leisure odds ratio
activity level, clerical vs not with
clerical occupation, adjustment for
menopausal status, pair
hormone replacement
therapy
Geoghegan,J.M. Moderate N= 766 ; patients diagnosed CTS Corticosteroid matched by: age, sex, and logistic 1.07 (0.90 NS
2004 from the UK general practice ; covariates: regression OR 1.27)
General Practice consulting rate, BMI,
Research Database smoking, diabetes, insulin
use, metformin use,
corticosteroid use, combined
oral contraceptive pill use,
and BMI
289
Geoghegan,J.M. Moderate N= 415 ; patients diagnosed CTS Thyroxine matched by: age, sex, and logistic 1.36 (1.08 odds are greater
2004 from the UK general practice ; covariates: regression OR 1.70) in patients who
General Practice consulting rate, BMI, use Thyroxine
Research Database smoking, diabetes, insulin
use, metformin use,
and BMI
Morgenstern,H. Moderate N= 1049 ; grocery symptoms of use of diuretics matched by: all members logistic 2.66 ( 1.00, NS
1991 store checkers CTS indicated were members of union regression 7.04)
belonging to local in questionnaire food and commercial odds ratio
California union workers union ; covariates:
age, hours per work week,
years worked, age*years
worked interaction, use of
laser scanner to check items,
unload basket before
checking, load and lift
grocery bags after checking,
currently pregnant,
contraceptive use, use of
exogenous estrogen, use of
diuretics, history of broken
wrist
290
TABLE 49 RISK FACTOR: COMPUTER WORK

Ali,K.M. 2006 Moderate N= 648 ; Phalen's and Tinel's 4-8 years of age, Gender/Sex, smoking, logistic 2.1(1.3,3.6) Years of
computer test computer work alcohol use, BMI, years of regression computer use
professionals vs <4 years computer work, hours of odds ratio is associated
from 21 computer work per day, system with greater
companies administrator job vs other job CTS odds
functions, and internet use in
leisure time
Ali,K.M. 2006 Moderate N= 648 ; Phalens and Tinel's 8 or more years age, Gender/Sex, smoking, logistic 2.7(1.3,5.8) Years of
computer test of computer alcohol use, BMI, years of regression computer use
professionals work vs <4 computer work, hours of odds ratio is associated
from 21 years computer work per day, system with greater
companies administrator job vs other job CTS odds
leisure time
Ali,K.M. 2006 Moderate N= 648 ; Phalens and Tinel's computer used 8 age, Gender/Sex, smoking, logistic 3.6(1.3,10.3) using a
computer test to 12 hours vs alcohol use, BMI, years of regression computer
professionals less than 8 hours computer work, hours of odds ratio more hours
from 21 computer work per day, system per day is
companies administrator job vs other job associated
functions, and internet use in with greater
leisure time CTS odds
Ali,K.M. 2006 Moderate N= 648 ; Phalens and Tinel's computer used age, Gender/Sex, smoking, logistic 4.4(1.3, using a
computer test more than 12 alcohol use, BMI, years of regression 14.9) computer
professionals hours vs less computer work, hours of odds ratio more hours
from 21 than 8 hours computer work per day, system per day is
companies administrator job vs other job associated
functions, and internet use in with greater
leisure time CTS odds
291
Ali,K.M. 2006 Moderate N= 648 ; Phalens and Tinel's system age, Gender/Sex, smoking, logistic 2.4(1.2, 4.8) being a system
computer test administrator vs alcohol use, BMI, years of regression administrator
professionals other job computer work, hours of odds ratio increases odds
from 21 functions computer work per day, system of CTS
companies administrator job vs other job compared to
functions, and internet use in other job
leisure time functions
Coggon,D. Moderate N= 855; cases neurophysiologically use of keyboard matched by: gender/sex, age ; logistic 0.6 (0.4-0.8) patients
2013 were selected positive patients vs >4 hours per day covariates: ethnicity, BMI, regression testing
from the negatively tested smoking habits, diabetes, other OR positive were
neurophysiology patients arthritis present, number of less likely to
department and moderately distressing somatic use keyboard
controls for the symptoms per week, use of or mouse
accident and keyboard 4 or more hours per more than 4
emergency day, use of vibrating tools, job hours per day
services at includes
Southampton bonuses/targets/deadlines
general hospital.
All were aged 20-
64
Eleftheriou,A. Moderate N= 441 ; 548 personal history of at least Keyboard strokes, age, physical logistic 2.23 (1.09 to higher key
2012 workers of a CTS 240,500,000 vs activity, smoking regression 4.52) strokes
Governmental <240,500,000 OR associated
data entry & keyboard with higher
processing unit strokes CTS odds
Eleftheriou,A. Moderate N= 441 ; 548 personal history of at least Keyboard strokes, gender/sex, logistic 2.41 (1.36 to higher key
2012 workers of a CTS or newly 240,500,000 vs physical activity, age regression 4.25) strokes
Governmental diagnosed CTS with <240,500,000 OR associated
data entry & CTS-7 algorithm with higher
processing unit score of 12 or more CTS odds
292
TABLE 50 RISK FACTOR: CONSTRUCTION WORK

Armstrong,T. High N= 1071; following median construction vs model 2 best fitting logistic 7.01 (2.65, construction
2008 worker populations: neuropathy clerical work model: age, regression OR 18.54) workers are at
carpenters, cases Gender/Sex, body significantly
workers, engineers, mass index, wrist higher odds of
laboratory workers, index, history of median
computer workers, diabetes, and neuropathy
and hospital history of shoulder
support staff. tendonitis, lifting
more than 2lbs/day,
assembly line work,
hospital vs clerical
work, construction
vs clerical work
293
TABLE 51 RISK FACTOR: DEXTERITY

Armstrong,T. High N= 1071; following median dexterity derived Model 3 with O*NET factor logistic 1.48 (0.80, NS
2008 worker populations: neuropathy from factor variables: age, Gender/Sex, regression OR 2.74)
carpenters, cases analysis (O*NET body mass index, wrist index,
workers, engineers, subscales: manual history of diabetes, and history
laboratory workers, and finger of shoulder tendonitis, lifting
computer workers, dexterity, wrist more than 2lbs/day, assembly
and hospital finger speed, and line work, hospital vs clerical
support staff. time spent work, construction vs clerical
handling work
objects)2nd vs 1st
quartile
Armstrong,T. High N= 1071; follow median dexterity derived Model 3 with O*NET factor logistic 1.11 (0.61, NS
2008 worker populations: neuropathy from factor variables: age, Gender/Sex, regression OR 2.00)
carpenters, cases analysis (O*NET body mass index, wrist index,
workers, engineers, subscales: manual history of diabetes, and history
laboratory workers, and finger of shoulder tendonitis, lifting
computer workers, dexterity, wrist more than 2lbs/day, assembly
and hospital finger speed, and line work, hospital vs clerical
support staff. time spent work, construction vs clerical
handling work
objects)3rd vs 1st
quartile
Armstrong,T. High N= 1071; follow median dexterity derived Model 3 with O*NET factor logistic 1.79 (1.01, Workers in the
2008 worker populations: neuropathy from factor variables: age, Gender/Sex, regression OR 3.18) highest quartile
carpenters, cases analysis (O*NET body mass index, wrist index, are at
workers, engineers, subscales: manual history of diabetes, and history significantly
laboratory workers, and finger of shoulder tendonitis, lifting higher odds of
computer workers, dexterity, wrist more than 2lbs/day, assembly median
and hospital finger speed, and line work, hospital vs clerical neuropathy than
support staff. time spent work, construction vs clerical workers in the
handling objects) work lowest quartile
4th vs 1st
quartile
294
TABLE 52 RISK FACTOR: DIABETES

Armstrong,T. High N= 1071; following median neuropathy diabetes model 2 best fitting model: age, logistic 2.45 (0.92, NS
2008 worker populations: cases history Gender/Sex, body mass index, regression 6.53)
carpenters, workers, wrist index, history of diabetes, OR
engineers, laboratory and history of shoulder tendonitis,
workers, computer lifting more than 2lbs/day,
workers, and hospital assembly line work, hospital vs
support staff. clerical work, construction vs
clerical work
Becker,J. 2002 Moderate N= 1772; cases and nerve conduction female BMI over 30, Gender/Sex, age logistic 1.15(0.84,1.57) no significant
controls consisted of and Gender/Sex between 41 and 60, diabetes, regression interaction
patients referred for electromyography and diabetes BMI*Gender/Sex interaction odds ratio between
nerve conduction interaction effect, Gender/Sex*diabetes diabetes and
studies and effect interaction effect Gender/Sex
electromyography.
Becker,J. 2002 Moderate N= 1772; cases and nerve conduction Diabetes BMI over 30, Gender/Sex, age logistic 1.49(1.09,2.04) Diabetes
controls consisted of and between 41 and 60, diabetes, regression increases
patients referred for electromyography BMI*Gender/Sex interaction odds ratio odds of CTS
nerve conduction effect, Gender/Sex*diabetes
studies and interaction effect
electromyography.
Coggon,D. Moderate N= 855; cases were neurophysiologically diabetes vs no matched by: gender/sex, age ; logistic 1.6 (0.9-3.1) NS
2013 selected from the positive patients vs diabetes covariates: ethnicity, BMI, regression
neurophysiology negatively tested smoking habits, diabetes, other OR
department and patients arthritis present, number of
controls for the moderately distressing somatic
emergency services at keyboard 4 or more hours per day,
Southampton general use of vibrating tools, job includes
hospital. All were aged bonuses/targets/deadlines
20-64
295
Geoghegan,J.M. Moderate N= 494 ; patients from diagnosed CTS Diabetes matched by: age, gender/sex, and logistic 1.51 (1.24 odds are
2004 the UK General general practice ; covariates: regression 1.84) greater in
Practice Research consulting rate, BMI, smoking, OR diabetic
Database diabetes, insulin use, metformin patients
use, sulphonyl use, hormone
corticosteroid use, combined oral
contraceptive pill use, Thyroxine
use, Rheumatoid arthritis, wrist
fracture, arthritis, also adjusted for
missing data on smoking and BMI
Geoghegan,J.M. Moderate N= 137 ; patients from diagnosed CTS Insulin use matched by: age, gender/sex, and logistic 1.52 (1.06 odds are
Practice Research consulting rate, BMI, smoking, OR patients who
Database diabetes, insulin use, metformin use insulin
Geoghegan,J.M. Moderate N= 149 ; patients from diagnosed CTS Metformin matched by: age, gender/sex, and logistic 1.2 (0.841.72) NS
2004 the UK General use general practice ; covariates: regression
Practice Research consulting rate, BMI, smoking, OR
Database diabetes, insulin use, metformin
296
Geoghegan,J.M. Moderate N= 197 ; patients from diagnosed CTS Sulphonyl use matched by: age, gender/sex, and logistic 1.45 (1.07 odds are
Practice Research consulting rate, BMI, smoking, OR patients who
Database diabetes, insulin use, metformin use sulphonyl
Plastino,M. Moderate N= 245 ; CTS patients confirmed by abnormal weight circumference, BMI, age p value 0.001 odds are
2011 from a single hospital, electrodiagnostic glucose higher in
and controls from exam metabolism patients with
patients friends or abnormalities glucose
non-blood relatives by 2h_OGTT metabolism
abnormalities
297
TABLE 53 RISK FACTOR: DIALYSIS

Kopec,J. 2011 Low N= 386 ; all signs and number of years hemodialysis p value from <.00001 CTS patients
patients were on symptoms on hemodialysis chi squared have been on
hemodialysis verified by test hemodialysis
nerve significantly
conduction longer than
studies non-CTS
hemodialysis
patients
Shin,J. 2008 Moderate N= 123 ; All were pain or pain in duration of age, gender/sex, logistic 1.06(1.01,1.11) Duration of
hemodialysis median nerve dialysis predialysis plasma regression OR Dialysis is
patients distribution and BMG level in 1990, associated with
Tinel's sign duration of dialysis increased CTS
odds
Shin,J. 2008 Moderate N= 123 ; All were pain or pain in predialysis age, gender/sex, logistic 1.65(1.13,2.41) higher BMG
hemodialysis median nerve plasma BMG predialysis plasma regression OR levels were
patients distribution and level in 1990 BMG level in 1990, associated with
Tinel's sign duration of dialysis higher CTS
odds
298
TABLE 54 RISK FACTOR: DYNAMIC STRENGTH

Evanoff,B. High 711 clerical, Presence of Dynamic strength adjusted for age, Multivariable 2.14(.56-8.22) NS
2014 service, and specific nerve importance in Gender/Sex, and mixed logistic
construction symptoms in current job BMI; past regression
workers from eight survey and diagnosis of CTS or models OR
participating median other upper
employers and neuropathy by extremity
three construction NCS (DML, peripheral
trade unions MUDS, DSL) neuropathy, had a
between July at 3 years pacemaker or
2004and October internal
2006 into the defibrillator, or
PrediCTS study were pregnant at
the time of
enrollment
excluded
299
TABLE 55 RISK FACTOR: EDUCATION

Kaplan,Y. 2008 Low N= 221 ; all were NCS education matched by: age matched p-value >.05 NS
postmenopausal women females ; covariates: education
level
Wright, C. 2014 Low (3155 w/o CTS diagnosis and clinically Maternal age, race/ethnicity, education, Logistical 1.58 (0.4- NS
91 with CTS diagnosis); EMR diagnosed with Education smoking, parity, hypertension, Regression 9.94)
of a cohort of pregnant women ICD 9 diagnosis (finished high diabetes, maternal weight OR
receiving prenatal care at a code for CTS school) versus category (constructed variable
large obstetrics unit; some high school including information about
representative of those served maternal BMI and GWG), and
by the urban academic center, number prenatal care visits
with a large proportion of
black patients
Wright, C. 2014 Low (3155 w/o CTS diagnosis and clinically Maternal age, race/ethnicity, education, Logistical 10.4 (1-148) NS
91 with CTS diagnosis); EMR diagnosed with Education smoking, parity, hypertension, Regression
of a cohort of pregnant women ICD 9 diagnosis (college or above) diabetes, maternal weight OR
receiving prenatal care at a code for CTS versus some high category (constructed variable
large obstetrics unit; school including information about
representative of those served maternal BMI and GWG), and
by the urban academic center, number prenatal care visits
with a large proportion of
black patients
Bonfiglioli,R. Moderate N= 269 ; cashiers and office CTS symptoms Education >8 work(cashiers vs office logistic 1.48(0.77 NS
2007 workers from 4 big years workers), BMI, age, previous regression 2.86)
supermarket stores at risk jobs, CTS family odds ratio
history, presence of children,
do hand-knitting/needle work,
over 8 years of education,
300
Bonfiglioli,R. Moderate N= 269 ; cashiers and office CTS diagnosis Education >8 work(cashiers vs office logistic 2.15(0.75 NS
2007 workers from 4 big with clinical and years workers), BMI, age, previous regression 6.17)
supermarket stores electrodiagnostic at risk jobs, CTS family odds ratio
examinations history, presence of children,
do hand-knitting/needle work,
over 8 years of education,
301
TABLE 56 RISK FACTOR: ENDOCRINE

Nathan,P.A. Moderate N= 256; workers at electrodiagnostic endocrine repetitious logistic .23 (.041.24) NS
2002 4 industrial sites (a test and condition movement, heavy regression
steel mill, symptoms at 11 lifting, keyboard odds ratio
meat/food years use, vibration tools,
packaging, force, cigarette use,
electronics, and Gender/Sex, age,
plastics). BMI, avocational
activities, hormone
use, race/ethnicity,
endocrine
condition, years on
job
302
TABLE 57 RISK FACTOR: EXERTION

Burt,S. 2011 Moderate N= 448 ; electrodiagnostic Exerts/min cat 2 Model 1 Peak force match cat 2 logistic 1.40 (0.45-4.34) NS
healthcare and tests, hand versus 1 if versus 1, Peak force match cat 3 regression
manufacturing diagram and BMI<30 versus 1, Exerts/min cat 2 versus 1 if odds ratio
workers symptoms BMI<30, Exerts/min cat 3 versus 1
if BMI<30, Exerts/min cat 2 versus
1 if BMI>=30, Exerts/min cat 3
versus 1 if BMI>=30, BMI>=30
versus <30 if exerts/min cat1,
BMI>=30 versus <30 if exerts/min
cat2 1.60, BMI>=30 versus <30 if
exerts/min cat3
manufacturing diagram and BMI<30 versus 1, Exerts/min cat 2 versus 1 if odds ratio
exerts/min cat3
manufacturing diagram and BMI>=30 versus 1, Exerts/min cat 2 versus 1 if odds ratio
exerts/min cat3
303
Burt,S. 2011 Moderate N= 448 ; electrodiagnostic Exerts/min cat 3 Model 1 Peak force match cat 2 logistic 3.35 (1.14-9.87) the highest
healthcare and tests, hand versus 1 if versus 1, Peak force match cat 3 regression frequency of
manufacturing diagram and BMI>=30 versus 1, Exerts/min cat 2 versus 1 if odds ratio exertions per
workers symptoms BMI<30, Exerts/min cat 3 versus 1 minute(>= 15)
if BMI<30, Exerts/min cat 2 versus increases the
1 if BMI>=30, Exerts/min cat 3 odds of CTS
versus 1 if BMI>=30, BMI>=30 among obese
versus <30 if exerts/min cat1, workers
exerts/min cat3
Burt,S. 2011 Moderate N= 456 ; electrodiagnostic peak worker Model 2: peak worker perceived logistic 1.14 (1.01-1.29) worker
healthcare and tests, hand perceived exertion rating (0-10), BMI, Hand regression perceived
manufacturing diagram and exertion rating Activity Level among females, Hand odds ratio exertion rating
workers symptoms (0-10) Activity Level among males, increases odds
Gender/Sex of CTS
Burt,S. 2013 Moderate N= 347 ; workers electrodiagnostic time in forceful model1: time in forceful exertion, hazard ratios 2.83(1.18,6.79) Having
from hospital, test, symptoms, exertion between BMI>=30, threshold limit value, job between 20%
school bus hand diagram at 20 and 60% vs strain and 60% of
manufacturing 2 years <20% work time
plant, and engine involve
assembly plant forceful
exertion is
associated with
higher risk of
CTS than
workers with
<20% forceful
exertion time
304
Burt,S. 2013 Moderate N= 347 ; workers electrodiagnostic time in forceful model1: time in forceful exertion, hazard ratios 19.57(5.96,64.24) Having greater
from hospital, test, symptoms, exertion between BMI>=30, threshold limit value, job than 60% of
school bus hand diagram at greater than 60% strain work time
manufacturing 2 years vs <20% involve
plant, and engine forceful
assembly plant exertion is
associated with
higher risk of
CTS than
workers with
<20% forceful
exertion time
305
TABLE 58 RISK FACTOR: FARMING

Roquelaure,Y. Moderate N= 193802 ; clinical and Farmers vs matched by: among relative risk 1.3 [0.8-2.3] NS
2008 French electrodiagnostic unemployed men ; covariates: ratio
prospectively CTS tests at 3 years controlled for age,
surveillance system stratified by
gender/sex
Roquelaure,Y. Moderate N= 194276 ; clinical and Farmers vs matched by: among relative risk 1.2 [0.8-2.0] NS
2008 French electrodiagnostic unemployed women ; ratio
prospectively CTS tests at 3 years covariates:
surveillance system controlled for age,
stratified by
gender/sex
306
TABLE 59 RISK FACTOR: FEMALE RISK FACTORS

Hakim,A.J. High N= 3674 ; twins hand diagram: Perimenopause vs matched by: pairs of twins ; logit 1.53(1.01 perimenopausal
2002 from the UK Adult classic or premenopausal covariates: age, BMI, home regression 2.32) at higher odds
Twin Registry probable CTS activity level, leisure activity odds ratio of CTS than
level, clerical vs not clerical with premenopausal
replacement therapy, current use codependency
of thyroxine replacement therapy
Hakim,A.J. High N= 3674 ; twins hand diagram: Postmenopausal matched by: pairs of twins ; logit 1.43(0.89 NS
2002 from the UK Adult classic or vs premenopausal covariates: age, BMI, home regression 2.29)
Twin Registry probable CTS activity level, leisure activity odds ratio
Hakim,A.J. High N= 3674 ; twins hand diagram: Hysterectomy matched by: pairs of twins ; logit 1.2(0.89 NS
2002 from the UK Adult classic or After controlling covariates: age, BMI, home regression 1.63)
Twin Registry probable CTS for menopause activity level, leisure activity odds ratio
Hakim,A.J. High N= 3674 ; twins hand diagram: Current use of matched by: pairs of twins ; logit 0.85(0.62 NS
2002 from the UK Adult classic or HRT covariates: age, BMI, home regression 1.16)
Twin Registry probable CTS activity level, leisure activity odds ratio
307
Kaplan,Y. 2008 Low N= 221 ; all were NCS number of matched by: age matched females mean 1.07(0.67, number of
postmenopausal pregnancies ; covariates: number of difference 1.47) pregnancies
women pregnancies was higher in
postmenopausal
CTS women
than
postmenopausal
healthy controls
Wright, C. 2014 Low (3155 w/o CTS clinically Second or Third age, race/ethnicity, education, Logistical 1.22 (1.05- NS
diagnosis and 91 diagnosed with live birth versus smoking, parity, hypertension, Regression 1.75)
with CTS ICD 9 diagnosis first live birth diabetes, maternal weight OR
diagnosis); EMR of code for CTS category (constructed variable
a cohort of including information about
pregnant women maternal BMI and GWG), and
receiving prenatal number prenatal care visits
care at a large
obstetrics unit;
representative of
those served by the
urban academic
center, with a large
proportion of black
patients
308
Wright, C. 2014 Low (3155 w/o CTS clinically 10+ prenatal care age, race/ethnicity, education, Logistical 2.95 (1.88- NS
diagnosis and 91 diagnosed with visits versus <10 smoking, parity, hypertension, Regression 4.62)
with CTS ICD 9 diagnosis prenatal care diabetes, maternal weight OR
diagnosis); EMR of code for CTS visits category (constructed variable
a cohort of including information about
care at a large
obstetrics unit;
representative of
those served by the
urban academic
proportion of black
patients
Wright, C. 2014 Low (3155 w/o CTS clinically Normal BMI age, race/ethnicity, education, Logistical 1.33 (0.41- NS
diagnosis and 91 diagnosed with 18.5+ kg/m sq smoking, parity, hypertension, Regression 3.86)
with CTS ICD 9 diagnosis (excessive diabetes, maternal weight OR
diagnosis); EMR of code for CTS Gestational category (constructed variable
a cohort of Weight Gain) including information about
pregnant women versus Normal maternal BMI and GWG), and
receiving prenatal BMI 18.5+ kg/m number prenatal care visits
care at a large sq (adequate
obstetrics unit; Gestational
representative of Weight Gain)
those served by the
urban academic
proportion of black
patients
309
Wright, C. 2014 Low (3155 w/o CTS clinically Overweight BMI age, race/ethnicity, education, Logistical 1.75 (0.38- NS
diagnosis and 91 diagnosed with 25+ to 29.9 kg/m smoking, parity, hypertension, Regression 12.48)
with CTS ICD 9 diagnosis sq (excessive diabetes, maternal weight OR
pregnant women versus Normal maternal BMI and GWG), and
receiving prenatal BMI 18.5+ kg/m number prenatal care visits
care at a large sq (adequate
obstetrics unit; Gestational
representative of Weight Gain)
those served by the
urban academic
proportion of black
patients
Wright, C. 2014 Low (3155 w/o CTS clinically Obese BMI 30+ age, race/ethnicity, education, Logistical 2.99 (1.81- BMI of 30 or
diagnosis and 91 diagnosed with kg/m sq (normal smoking, parity, hypertension, Regression 16.79) more increases
with CTS ICD 9 diagnosis Gestational diabetes, maternal weight OR odds of CTS
diagnosis); EMR of code for CTS Weight Gain) category (constructed variable even with
a cohort of versus Normal including information about normal
pregnant women BMI 18.5+ kg/m maternal BMI and GWG), and gestational
receiving prenatal sq (adequate number prenatal care visits weight gain
care at a large Gestational
obstetrics unit; Weight Gain)
representative of
those served by the
urban academic
proportion of black
patients
310
Wright, C. 2014 Low (3155 w/o CTS clinically Obese BMI 30+ age, race/ethnicity, education, Logistical 1.27 (0.11- NS
diagnosis and 91 diagnosed with kg/m sq smoking, parity, hypertension, Regression 12.74)
with CTS ICD 9 diagnosis (excessive diabetes, maternal weight OR
care at a large
obstetrics unit;
representative of
those served by the
urban academic
proportion of black
patients
Geoghegan,J.M. Moderate N= 2355 ; patients diagnosed CTS hormone matched by: age, gender/sex, and logistic 0.95 (0.84 NS
2004 from the UK replacement general practice ; covariates: regression OR 1.08)
General Practice therapy use consulting rate, BMI, smoking,
Research Database diabetes, insulin use, metformin
fracture, arthritis, also adjusted
for missing data on smoking and
BMI
311
Geoghegan,J.M. Moderate N= 1932 ; patients diagnosed CTS combined oral matched by: age, gender/sex, and logistic 0.82 (0.71 NS
2004 from the UK contraceptive pill general practice ; covariates: regression OR 0.95)
General Practice use consulting rate, BMI, smoking,
Research Database diabetes, insulin use, metformin
fracture, arthritis, also adjusted
for missing data on smoking and
BMI
Mondelli,M. Moderate N= 145 ; female diagnosed Oral Age, BMI, duration of logistic 1.52 (0.58- NS
2006 hospital floor according to contraceptive yes occupational exposure to current regression OR 4.04)
cleaners in Italy AAN criteria: vs no job, occupational exposure to the
population of same job for previous employers,
hospital floor manual hobbies (including
cleaners motorcycle use, diseases known
to be associated with CTS
(diabetes connective tissue
diseases, hypothyroidism, and
wrist/hand trauma), hospital (to
adjust for center effects)
Morgenstern,H. Moderate N= 1049 ; grocery symptoms of Use of oral matched by: all members were logistic 0.84 (0.46, NS
1991 store checkers CTS indicated in contraceptives members of union food and regression 1.56)
belonging to local questionnaire commercial workers union ; odds ratio
California union covariates: age, hours per work
week, years worked, age*years
worked interaction, use of laser
scanner to check items, unload
basket before checking, load and
lift grocery bags after checking,
currently pregnant, contraceptive
use, use of exogenous estrogen,
use of diuretics, history of broken
wrist
312
de Krom,M.C. Moderate N= 629; 28 cases clinical history menopause in last matched by: age and gender/sex logistic 2.32(0.79, NS
1990 and all controls and year vs stratified random sample ; regression 6.81)
were identified neurophysiologic premenopausal covariates: height, weight(kg), odds ratio
through random testing slimming courses(yes/no),
sample of patients Hours/week in flexion activities,
in the Netherlands. hours/week for extension
An additional 128 activities, Varicosis (for men
cases were added only), for women: years since
from a single menopause onset vs pre-
hospital in the area menopausal, hysterectomy vs
premenopausal
de Krom,M.C. Moderate N= 629; 28 cases clinical history menopause 2 to 5 matched by: age and gender/sex logistic 0.87(0.26, NS
1990 and all controls and years ago vs stratified random sample ; regression 2.93)
were identified neurophysiologic premenopausal covariates: height, weight(kg), odds ratio
premenopausal
de Krom,M.C. Moderate N= 629; 28 cases clinical history menopause more matched by: age and gender/sex logistic 0.49(0.17, NS
1990 and all controls and than 5 years ago stratified random sample ; regression 1.39)
were identified neurophysiologic vs premenopausal covariates: height, weight(kg), odds ratio
premenopausal
313
de Krom,M.C. Moderate N= 629; 28 cases clinical history hysterectomy vs matched by: age and gender/sex logistic 1.8(0.87, NS
1990 and all controls and premenopausal stratified random sample ; regression 3.73)
were identified neurophysiologic covariates: height, weight(kg), odds ratio
premenopausal
de Krom,M.C. Moderate N= 629; 28 cases clinical history hysterectomy vs matched by: age and gender/sex logistic women who
1990 and all controls and menopause more stratified random sample ; regression have had a
were identified neurophysiologic than 5 years ago covariates: height, weight(kg), odds ratio hysterectomy
through random testing slimming courses(yes/no), are significantly
sample of patients Hours/week in flexion activities, more likely to
in the Netherlands. hours/week for extension get CTS than
An additional 128 activities, Varicosis (for men greater than 5
cases were added only), for women: years since year post-
from a single menopause onset vs premenopausal
hospital in the area menopausal, hysterectomy vs women
premenopausal
TABLE 60 RISK FACTOR: FIBROMYALGIA

Fahmi,D.S. Moderate N= 100 ; all are electrophysiologically fibromyalgia fibromyalgia risk ratio 6.65(2.33, odds higher in
2013 housewives with diagnosed 19.027) fibromyalgia
moderate socio- patients
economic standing
314
TABLE 61 RISK FACTOR: FORCE

Armstrong,T. High N= 1071; following median upper extremity Model 3 with O*NET factor logistic 2.15 (1.10, Workers who
2008 worker populations: neuropathy force derived from variables: age, Gender/Sex, regression OR 4.18) use more upper
carpenters, workers, cases factor body mass index, wrist index, extremity force
engineers, laboratory analysis(includes history of diabetes, and are at higher
workers, computer Occupational history of shoulder tendonitis, odds of median
workers, and hospital Information lifting more than 2lbs/day, neuropathy
support staff. Network(O*NET): assembly line work, hospital
general physical vs clerical work, construction
activity, static vs clerical work
strength, explosive
strength on ) 2nd
quartile vs 1st
quartile
strength, explosive
strength on ) 2nd
quartile vs 1st
quartile
315
strength, explosive
strength on ) 3rd
quartile vs 1st
quartile
Bonfiglioli,R. High N= 2299 ; part of CTS symptoms peak force, unitary Gender/sex, age, BMI 1.09(.97, NS
2013 Observational and NCS test at increase (1-7) personal history of diseases 1.22)
Prospective Unified 3 years predisposing to CTS (diabetes
Study (OCTOPUS), mellitus, amyloidosis, gout,
enrolled workers in large progressive systemic
and small domestic sclerosis, rheumatoid arthritis,
appliance, underwear, systemic lupus
ceramic tile and shoe erythematosus, thyroid
factories disorders, tendonitis of the
renal failure)
316
Burt,S. 2011 Moderate N= 448 ; healthcare and electrodiagnostic Peak force match Model 1 Peak force match cat logistic 1.33 (0.58- NS
manufacturing workers tests, hand cat 2 versus 1 2 versus 1, Peak force match regression 3.04)
diagram and cat 3 versus 1, Exerts/min cat odds ratio
symptoms 2 versus 1 if BMI<30,
exerts/min cat3
Burt,S. 2011 Moderate N= 448 ; healthcare and electrodiagnostic Peak force match Model 1 Peak force match cat logistic 2.74 (1.32- highest level of
manufacturing workers tests, hand cat 3 versus 1 2 versus 1, Peak force match regression 5.68) peak force
diagram and cat 3 versus 1, Exerts/min cat odds ratio increases the
symptoms 2 versus 1 if BMI<30, odds of CTS
Exerts/min cat 3 versus 1 if versus the
BMI<30, Exerts/min cat 2 lowest level of
versus 1 if BMI>=30, peak force
exerts/min cat3
317
Dale, A.M. Moderate 710 clerical, service, and Presence of Forceful gripping age, BMI, Gender/Sex, med Logistical 2.70 (1.26, increased odds
2014 construction workers specific nerve in most recent job history, pregnancy, history of Regression 5.78) of CTS for
from eight participating symptoms in CTS or peripheral OR those
employers and three survey and neuropathy, or other conducting
construction trade unions median contraindication to receiving forceful
between July 2004and neuropathy by nerve conduction studies activities
October 2006 into the NCS (DML, (NCS), lifting objects, (lifting and
PrediCTS study MUDS, DSL) at vibrating tools, forearm gripping)
3 years rotation, wrist bending,
forceful gripping, thumb
pressing, finger pinching
318
TABLE 62 RISK FACTOR: FRACTURE

Dyer,G. 2008 Low N= 100 ; all had progressive fracture matched by: age and logistic .26 p=.02 percent distal
fractures associated numbness in the translation Gender/Sex ; covariates: all regression radius fracture
with the distal median nerve percentage bivariate associations with P odds ratio and translation
radius distribution values over .08 were excluded p value increases the
with or without from multivariate model odds of CTS
weakness of
palmar
abduction
Geoghegan,J.M. Moderate N= 190 ; patients diagnosed CTS Wrist fracture matched by: age, gender/sex, logistic 2.29 (1.67 wrist fracture
2004 from the UK and general practice ; regression OR 3.12) patients at
General Practice covariates: consulting rate, higher odds of
Research Database BMI, smoking, diabetes, CTS
insulin use, metformin use,
missing data on smoking and
BMI
319
Morgenstern,H. Moderate N= 1049 ; grocery symptoms of history of broken matched by: all members were logistic 1.13 (0.54, NS
1991 store checkers CTS indicated wrist members of union food and regression 2.37)
belonging to local in questionnaire commercial workers union ; odds ratio
California union covariates: age, hours per
work week, years worked,
age*years worked interaction,
use of laser scanner to check
items, unload basket before
checking, load and lift grocery
bags after checking, currently
pregnant, contraceptive use,
use of exogenous estrogen, use
of diuretics, history of broken
wrist
320
TABLE 63 RISK FACTOR: GENDER/SEX (F)

Armstrong,T. High N= 1071; median Gender/Sex: model 2 best fitting model: logistic 1.13(.64-2.02) NS
2008 following worker neuropathy male vs female age, Gender/Sex, body mass regression
populations: cases index, wrist index, history of OR
carpenters, diabetes, and history of
workers, engineers, shoulder tendonitis, lifting
laboratory workers, more than 2lbs/day,
computer workers, assembly line work, hospital
and hospital vs clerical work, construction
support staff. vs clerical work
Bonfiglioli,R. High N= 2492 ; part of CTS symptoms being female vs Gender/sex, age, BMI incident rate 2.37 (1.83, 3.06) females are at
2013 Observational at 3 years male personal history of diseases ratio from higher risk of
Prospective predisposing to CTS Poisson CTS symptoms
Unified Study (diabetes mellitus, regression
(OCTOPUS), amyloidosis, gout,
large and small sclerosis, rheumatoid
domestic arthritis, systemic lupus
appliance, erythematosus, thyroid
underwear, ceramic disorders, tendonitis of the
tile and shoe finger flexors, and chronic
factories renal failure)
Bonfiglioli,R. High N= 2299 ; part of CTS symptoms being female vs Gender/sex, age, BMI incident rate 2.85 (1.51, 5.37) being female
2013 Observational and NCS test at male personal history of diseases ratio from increases risk
Prospective 3 years predisposing to CTS Poisson of CTS
Unified Study (diabetes mellitus, regression
(OCTOPUS), amyloidosis, gout,
large and small sclerosis, rheumatoid
domestic arthritis, systemic lupus
appliance, erythematosus, thyroid
underwear, ceramic disorders, tendonitis of the
tile and shoe finger flexors, and chronic
factories renal failure)
321
Evanoff,B. High 711 clerical, Presence of Female adjusted for age, Gender/Sex, Multivariable 1.09 (0.49,2.43) NS
2014 service, and specific nerve Gender/Sex and BMI; past diagnosis of mixed logistic
construction symptoms in CTS or other upper extremity regression
workers from eight survey and peripheral neuropathy, had a models OR
participating median pacemaker or internal
employers and neuropathy by defibrillator, or were
three construction NCS (DML, pregnant at the time of
trade unions MUDS, DSL) at enrollment excluded
between July 3 years
2004and October
2006 into the
PrediCTS study
Bland,J.D. Low N= 4155 ; all NCS confirmed Gender/Sex: Gender/Sex, smoking, age, logistic 1.11(0.96,1.27) NS
2005 patients referred to CTS female vs male BMI*age interaction regression
the OR
neurophysiology
service at hospital
for suspicion of
CTS
Burt,S. 2011 Moderate N= 456 ; electrodiagnostic Gender/Sex Model 2: peak worker logistic 2.21 (1.17-4.15) females are at
healthcare and tests, hand female vs male at perceived exertion rating (0- regression higher CTS
manufacturing diagram and the mean hand 10), BMI, Hand Activity odds ratio odds
workers symptoms activity level Level among females, Hand
Gender/Sex
Burt,S. 2011 Moderate N= 455 ; electrodiagnostic Gender/Sex Model 3: peak worker logistic 1.77 (0.99-3.17) NS
healthcare and tests, hand female vs male at perceived exertion rating (0- regression
manufacturing diagram and the mean hand 10), BMI, Hand Activity odds ratio
workers symptoms activity level Level among females, Hand
Gender/Sex female vs male
at the mean hand activity
level
322
Eleftheriou,A. Moderate N= 441 ; 548 personal history Gender/sex Keyboard strokes, logistic 4.08 (1.51 to females have
2012 workers of a of CTS or newly (female vs male) gender/sex, physical activity, regression 11.04) greater odds of
Governmental data diagnosed CTS age OR CTS
entry & processing with CTS-7
unit algorithm score
of 12 or more
Shin,J. 2008 Moderate N= 123 ; All were pain or pain in Gender/Sex age, gender/sex, predialysis logistic 0.89(0.05,15.51) NS
hemodialysis median nerve plasma BMG level in 1990, regression
patients distribution and duration of dialysis OR
Tinel's sign
Silverstein,B.A. Moderate N= 652 ; workers based on phalen Gender/Sex Gender/Sex, age, years on logistic 1.17(0.29,4.69) NS
1987 form seven and tinel's signs job, work repetition, level of regression
different industrial and symptoms force involved in job, OR
sites mentioned in dummy variables controlling
interview for job center effects
Violante,F.S. Moderate Blue-collar occurrence Female gender/sex, age, Logistic 4.0 (2.3 6.7) Odds of CTS
2007 workers of several within last Gender/Sex biomechanical load, Regression were
factories month of BMI*wrist interaction effect, OR significantly
(producing large classic/ height*forearm interaction greater in
and small domestic probable or effect, family history of CTS, Females
appliances, possible pathologies facilitating CTS
underwear, ceramic symptoms of onset(diabetes mellitus,
tiles, and shoes and CTS amyloidosis, gout,
workers employed progressive systemic
in all municipal sclerosis, rheumatoid
nursery schools. arthritis, systemic lupus
323
TABLE 64 RISK FACTOR: GENERAL COMORBIDITIES

Estirado de, Low N= 727 ; all patients some were previously Toxic Oil Model1 (all logistic 3.32(1.47- TOS patients
Cabo E. 2003 had toxic oil syndrome diagnosed by Syndrome (TOS) patients):TOS with regression 7.5) with Neuropathy
physician, others were with Neuropathy, TOS with odds ratio were at higher
diagnosed with concomitant Thromboembolic odds of CTS than
electrodiagnostic tests neuropathy vs events, TOS with TOS patients
and Tinel's and/or toxic oil scleroderma, smoking without
Phalens sign at 9 syndrome alone neuropathy
years
Estirado de, Low N= 727 ; all patients some were previously Toxic Oil Model1 (all logistic 2.85(1.14- TOS patients
Cabo E. 2003 had toxic oil syndrome diagnosed by Syndrome (TOS) patients):TOS with regression 7.13) with
physician, others were with Neuropathy, TOS with odds ratio thromboembolic
diagnosed with concomitant Thromboembolic events were at
electrodiagnostic tests Thromboembolic events, TOS with higher odds of
and Tinel's and/or events vs toxic scleroderma, smoking CTS than TOS
Phalens sign at 9 oil syndrome patients without
years alone thromboembolitic
events
Estirado de, Low N= 727 ; all patients some were previously Toxic Oil Model1 (all logistic .43(.24-.8) TOS patients
Cabo E. 2003 had toxic oil syndrome diagnosed by Syndrome (TOS) patients):TOS with regression with scleroderma
physician, others were with Neuropathy, TOS with odds ratio were at lower
diagnosed with concomitant Thromboembolitic odds of CTS than
electrodiagnostic tests scleroderma vs events, TOS with TOS patients
and Tinel's and/or toxic oil scleroderma, smoking without
Phalens sign at 9 syndrome alone scleroderma
years
Estirado de, Low N= 727 ; all patients some were previously TOS patients Model1 (all logistic NR NS
Cabo E. 2003 had toxic oil syndrome diagnosed by with fibrositis vs patients):TOS with regression
physician, others were TOS patients Neuropathy, TOS with odds ratio
diagnosed with without Thromboembolitic
electrodiagnostic tests Fibrositis events, TOS with
and Tinel's and/or scleroderma, smoking
Phalens sign at 9
years
324
Estirado de, Low N= 495 ; all female some were previously TOS women Model 2: female logistic 2.53(1.06- women with
Cabo E. 2003 patients had toxic oil diagnosed by with fibrositis vs patients (with fibrosis regression 3.2) fibrositis and
syndrome physician, others were TOS women as covariate)TOS with odds ratio TOS are at higher
diagnosed with without Neuropathy, TOS with odds of CTS than
electrodiagnostic tests Fibrositis Thromboembolitic TOS women
and Tinel's and/or events, TOS with patients without
Phalens sign at 9 scleroderma, smoking, fibrositis
years fibrosis
Estirado de, Low N= 495 ; all female some were previously TOS women Model 3: female TOS logistic 1.84(1.04- women who had
Cabo E. 2003 patients had toxic oil diagnosed by who had (with miscarriages as a regression 3.2) miscarriages and
syndrome physician, others were miscarriages covariate) with odds ratio have TOS are at
diagnosed with versus women Neuropathy, TOS with higher odds of
electrodiagnostic tests with TOS who Thromboembolitic CTS than TOS
and Tinel's and/or did not have a events, TOS with women who did
Phalens sign at 9 miscarriage scleroderma, smoking, not have a
years miscarriages miscarriage
Keese,G.R. Low N= 72 ; CTS cases and symptoms and bilateral agenesis matched by: age, odds ratio 0.23(0.024, ns
2006 control patients neurodiagnostic test at vs none Gender/Sex, industrial 2.167)
selected from one clinic 6 months exposures, diabetes,
thyroid disease,
alcohol abuse and
rheumatoid arthritis ;
covariates: bilateral
agenesis vs none
Keese,G.R. Low N= 72 ; CTS cases and symptoms and unilateral matched by: age, odds ratio .099(.005, odds are higher
2006 control patients neurodiagnostic test at agenesis vs none Gender/Sex, industrial 1.909) in patients with
selected from one clinic 6 months exposures, diabetes, unilateral
thyroid disease, agenesis
alcohol abuse and
rheumatoid arthritis ;
covariates: unilateral
agenesis vs none
325
Kopec,J. 2011 Low N= 386 ; all patients signs and symptoms presence of Anti- presence of Anti-HCV p value from <.00001 presence of anti-
were on hemodialysis verified by nerve HCV antibodies antibodies chi squared hcv antibodies
conduction studies test increased the
odds of CTS
Vogelsang,L.M. Low N= 100 ; all were diagnosed by RMC, Related social readjustment p value <.05 patients with
1994 worked in what were orthopaedist Medical scale, self-control logistic CTS were more
considered high risk Conditions schedule, life style regression likely to have
occupations(automotive approaches scale, self- related medical
parts or assembly control questionnaire, conditions
workers, keyboard perceived stress scales,
operators, electronics Cohen-Hoberman
industry workers, and Inventory of Physical
garment industry Symptoms, related
workers from East medical condition,
Tennessee, and sign suspected medical
language interpreters). risk, related
Each case was matched musculoskeletal
by age, Gender/Sex, problems
race/ethnicity, height,
weight, body type,
length of time, job
duties
326
Vogelsang,L.M. Low N= 100 ; all were diagnosed by MR, Suspected social readjustment p value >.05 NS
1994 worked in what were orthopaedist Medical Risk scale, self-control logistic
considered high risk factors related to schedule, life style regression
occupations(automotive CTS approaches scale, self-
parts or assembly control questionnaire,
workers, keyboard perceived stress scales,
operators, electronics Cohen-Hoberman
industry workers, and Inventory of Physical
garment industry Symptoms, related
workers from East medical condition,
Tennessee, and sign suspected medical
language interpreters). risk, related
Each case was matched musculoskeletal
by age, Gender/Sex, problems
weight, body type,
length of time, job
duties
Burt,S. 2011 Moderate N= 455 ; healthcare electrodiagnostic tests, High blood Model 3: peak worker logistic 1.89 (1.01- High blood
and manufacturing hand diagram and pressure vs no perceived exertion regression 3.53) pressure
workers symptoms rating (0-10), BMI, odds ratio increases CTS
Hand Activity Level odds
among females, Hand
Activity Level among
males, Gender/Sex
female vs male at the
mean hand activity
level
327
Mondelli,M. Moderate N= 145 ; female diagnosed according to other Age, BMI, duration of logistic 1.47 (0.45- NS
2006 hospital floor cleaners AAN criteria: diseases(diabetes occupational exposure regression 4.79)
in Italy population of hospital connective tissue to current job, OR
floor cleaners diseases, occupational exposure
hypothyroidism, to the same job for
and wrist/hand previous employers,
trauma) vs none manual hobbies
(including motorcycle
use, diseases known to
be associated with
CTS (diabetes
connective tissue
diseases,
hypothyroidism, and
wrist/hand trauma),
center effects)
328
TABLE 65 RISK FACTOR: GENETICS/FAMILY HISTORY

Hakim,A.J. High N= 3674 ; twins hand diagram: monozygotic vs matched by: pairs of twins ; heritability .47(.34, .59) 47 percent of
2002 from the UK Adult classic or dizygotic covariates: age, height, weight, statistic the variation in
Twin Registry probable CTS twins(supposed to menopausal status, and physical CTS diagnoses
be a measure of activity was attributable
genetic risk of to whether the
CTS) twins in this
population
were
monozygotic as
opposed to
dizygotic
Bland,J.D. 2005 Low N= 4155 ; all NCS confirmed Family history Gender/Sex, smoking, age, logistic 1.11(0.91,1.34) NS
patients referred to CTS BMI*age interaction regression OR
the
neurophysiology
service at hospital
for suspicion of
CTS
Bonfiglioli,R. Moderate N= 269 ; cashiers CTS symptoms CTS familiar work(cashiers vs office workers), logistic 1.68(0.74 NS
2007 and office workers history BMI, age, previous at risk jobs, CTS regression 3.82)
from 4 big family history, presence of children, odds ratio
supermarket stores do hand-knitting/needle work, over
8 years of education,
Bonfiglioli,R. Moderate N= 269 ; cashiers CTS diagnosis CTS familiar work(cashiers vs office workers), logistic 3.6(1.20 CTS family
2007 and office workers with clinical and history BMI, age, previous at risk jobs, CTS regression 10.75) history
from 4 big electrodiagnostic family history, presence of children, odds ratio increases risk
supermarket stores examinations do hand-knitting/needle work, over
8 years of education,
329
Burt,S. 2011 Moderate N= 456 ; healthcare electrodiagnostic Hand Activity Model 2: peak worker perceived logistic 1.03 (0.83- NS
and manufacturing tests, hand Level among exertion rating (0-10), BMI, Hand regression 1.28)
workers diagram and females Activity Level among females, odds ratio
symptoms Hand Activity Level among males,
Gender/Sex
Burt,S. 2011 Moderate N= 456 ; healthcare electrodiagnostic Hand Activity Model 2: peak worker perceived logistic 1.38 (1.05- Higher hand
and manufacturing tests, hand Level among exertion rating (0-10), BMI, Hand regression 1.81) activity level
workers diagram and males Activity Level among females, odds ratio increases the
symptoms Hand Activity Level among males, odds of CTS
Gender/Sex
Nordstrom,D.L. Moderate N= 417 ; only Diagnosed by Parent, child, or matched by: age ; covariates: logistic 1.87 (0.97, NS
1997 incident cases physician, or sibling had CTS musculoskeletal condition, BMI, regression OR 3.60)
diagnosed between had explicit Parent/sibling/child has CTS, power
1994 and 1995 treatment for tool use, hours bending or twisting
were eligible as CTS and hand wrists, hours contacted with
cases in Marshfield symptoms solvents per day, IOSH job control
Wisconsin, and within one measure, cumulative hours worked
controls were a month of date of since 1993
random sample diagnosis.
from this area
Violante,F.S. Moderate Blue-collar occurrence family history gender/sex, age, biomechanical Logistic 1.2 (0.72.0) NS
2007 workers of several within last (yes versus no) load, BMI*wrist interaction effect, Regression
factories month of height*forearm interaction effect, OR
(producing large classic/ family history of CTS, pathologies
and small domestic probable or facilitating CTS onset(diabetes
appliances, possible mellitus, amyloidosis, gout,
underwear, ceramic symptoms of progressive systemic sclerosis,
tiles, and shoes and CTS rheumatoid arthritis, systemic lupus
workers employed erythematosus, thyroid disorders,
in all municipal tendonitis of the finger flexors, and
nursery schools. chronic renal failure) alcohol
previous exposure to biomechanical
overload
330
TABLE 66 RISK FACTOR: GRIP

Armstrong,T. High N= 1071; following median using forceful model 1:age, Gender/Sex, body logistic 1.68 (1.12, using forceful
2008 worker populations: neuropathy hand grip mass index, wrist index, history regression OR 2.53) hand grip is
carpenters, cases of diabetes, and history of associated with
workers, engineers, shoulder tendonitis, lifting more higher odds of
laboratory workers, than 2lbs/day, using vibrating median
computer workers, tools, assembly line work, neuropathy
and hospital twisting forearm work, bending
support staff. wrist work, using forceful hand
pinch grip
Armstrong,T. High N= 1071; following median using fingers in model 1:age, Gender/Sex, body logistic 1.24 (0.82, NS
2008 worker populations: neuropathy pinch grip mass index, wrist index, history regression OR 1.86)
carpenters, cases of diabetes, and history of
workers, engineers, shoulder tendonitis, lifting more
laboratory workers, than 2lbs/day, using vibrating
computer workers, tools, assembly line work,
pinch grip
331
Dale, A.M. Moderate 710 clerical, Presence of peak exposure to age, BMI, Gender/Sex, med Logistical 2.21 (1.03, increased risk
2014 service, and specific nerve Forceful gripping history, pregnancy, history of Regression 4.73) of CTS for
construction symptoms in CTS or peripheral neuropathy, or OR those
workers from eight survey and other contraindication to conducting
participating median receiving nerve conduction forceful
employers and neuropathy by studies (NCS), lifting objects, activities
three construction NCS (DML, vibrating tools, forearm rotation, (lifting and
trade unions MUDS, DSL) wrist bending, forceful gripping, gripping)
between July at 3 years thumb pressing, finger pinching
2004and October
2006 into the
PrediCTS study
Evanoff,B. Moderate N= 745 ; newly symptoms and pinch grip age, Gender/Sex, lifting at least NR NR NS
2012 employed workers NCS at 3 years 1kg, forceful grip, finger/thumb
pressing, using vibrating tools,
pinch grip, forearm rotation,
hand/wrist bending
Evanoff,B. Moderate N= 745 ; newly symptoms and forceful gripping age, Gender/Sex, lifting at least logistic 2.59(1.12- forceful
2012 employed workers NCS at 3 years 1kg, forceful grip, finger/thumb regression 5.99) gripping
pressing, using vibrating tools, odds ratio increases CTS
pinch grip, forearm rotation, odds
hand/wrist bending
332
TABLE 67 RISK FACTOR: HEIGHT

Violante,F.S. Moderate Blue-collar workers occurrence tall height with gender/sex, age, biomechanical Logistic 0.5 (0.3 0.9) being tall with a
2007 of several factories within last short forearm load, BMI*wrist interaction Regression short forearm
(producing large month of length versus effect, height*forearm OR significantly
and small domestic classic/ short height and interaction effect, family decreases odds
appliances, probable or short forearm history of CTS, pathologies of CTS
underwear, ceramic possible length facilitating CTS onset(diabetes compared to
tiles, and shoes and symptoms of (tall/long=50th mellitus, amyloidosis, gout, short stature
workers employed CTS percentile or progressive systemic sclerosis, with short
in all municipal higher) rheumatoid arthritis, systemic forearm
nursery schools. lupus erythematosus, thyroid
finger flexors, and chronic renal
failure) alcohol consumption,
smoking status, previous
exposure to biomechanical
overload
333
TABLE 68 RISK FACTOR: HOBBIES

Garg,A. 2012 High N= 536 ; workers symptoms (tingling and/or Gardening Model1: ACGIH Hand Activity cox 3.02 (1.287.15) gardening is
from a wide numbness) in at least 2 Level (HAL) ,age, BMI proportional a risk factor
range of median nerve served digits, (continuous), number of other hazard ratio for CTS
manufacturing symptoms at least 25% of distal upper extremity
facilities in the days in previous month, musculoskeletal disorders,
Midwest symptoms for at least 2 or gardening, feeling down, blue
more consecutive monthly or depressed, rheumatoid
follow ups, abnormal NCS arthritis
at 6 years
Garg,A. 2012 High N= 536 ; workers symptoms (tingling and/or Gardening Model 2: strain index ,age, BMI cox 3.17 (1.347.46) gardening is
from a wide numbness) in at least 2 (continuous), number of other proportional a risk factor
range of median nerve served digits, distal upper extremity hazard ratio for CTS
manufacturing symptoms at least 25% of musculoskeletal disorders,
facilities in the days in previous month, gardening, feeling down, blue
Midwest symptoms for at least 2 or or depressed, rheumatoid
more consecutive monthly arthritis
follow ups, abnormal NCS
at 6 years
Hakim,A.J. High N= 3674 ; twins hand diagram: classic or Leisure activity matched by: pairs of twins ; logit 1(0.801.26) NS
2002 from the UK probable CTS (low vs. high level) covariates: age, BMI, home regression
Adult Twin activity level, leisure activity odds ratio
Registry level, clerical vs not clerical with
occupation, menopausal status, adjustment
hysterectomy, use of hormone for pair
replacement therapy, current codependency
use of thyroxine replacement
therapy
334
Tang,X. 1999 Low N= 122 ; female CTS signs and symptoms duration knitting matched by: age and diabetes ; odds ratio 1 NS
cases and with selective hours per week covariates: duration knitting
controls recruited abnormalities of the MN hours per week
from one hospital conduction distal to the
neurology wrist that showed slowing
department compared to a separately
cited average values from
another population
Tang,X. 1999 Low N= 122 ; female CTS signs and symptoms knitting more than matched by: age and diabetes ; odds ratio 1.13(.57,2.22) NS
cases and with selective 2 hours per week covariates: knitting more than 2
controls recruited abnormalities of the MN hours per week
from one hospital conduction distal to the
neurology wrist that showed slowing
department compared to a separately
cited average values from
another population
Ali,K.M. Moderate N= 648 ; Phalens and Tinel's test internet use age, Gender/Sex, smoking, logistic 1.7(1.2,2.7) internet use
2006 computer alcohol use, BMI, years of regression increases
professionals computer work, hours of odds ratio odds of CTS
from 21 computer work per day, system
companies administrator job vs other job
leisure time
Bonfiglioli,R. Moderate N= 269 ; cashiers CTS symptoms Hand- work(cashiers vs office logistic 2.21(1.094.47) people who
2007 and office knitting/needlework workers), BMI, age, previous at regression hand-knit/do
workers from 4 risk jobs, CTS family history, odds ratio needle work
big supermarket presence of children, do hand- are at higher
stores knitting/needle work, over 8 odds for
years of education, CTS
symptoms
335
Bonfiglioli,R. Moderate N= 269 ; cashiers CTS diagnosis with clinical Hand- work(cashiers vs office logistic 2(0.685.87) NS
2007 and office and electrodiagnostic knitting/needlework workers), BMI, age, previous at regression
workers from 4 examinations risk jobs, CTS family history, odds ratio
big supermarket presence of children, do hand-
stores knitting/needle work, over 8
years of education,
Eleftheriou,A. Moderate N= 441 ; 548 personal history of CTS history of physical Keyboard strokes, age, physical logistic 0.38 (0.16 to 0.87) history of
2012 workers of a sports activity (yes activity, smoking regression physical
Governmental vs no) OR activity is
data entry & associated
processing unit with lower
risk of CTS
Eleftheriou,A. Moderate N= 441 ; 548 personal history of CTS or history of physical Keyboard strokes, gender/sex, logistic 0.72 (0.44 to 1.20) NS
2012 workers of a newly diagnosed CTS with sports activity (yes physical activity, age regression
Governmental CTS-7 algorithm score of vs no) OR
data entry & 12 or more
processing unit
Goodson, J.T. Moderate 87 CTS and 74 (1)Electrodiagnostic (EDX) vigorous exercise excluded confounding Logistical 0.997(0.995,0.999) Vigorous
2014 sex-matched testing results suggestive of conditions; gender/sex, age, Regression exercise
general abnormal slowing of the education levels, ethnicity, and OR decreases
orthopedic median nerve, (2) the EDX testing results odds
patients from an presence of clinical
outpatient symptoms of CTS, and (3)
orthopedic clinic no confounding
in the Western syndromes/disorders
US.
Goodson, J.T. Moderate 87 CTS and 74 (1)Electrodiagnostic (EDX) physical activities excluded confounding Logistical 1.002(1,1.004) physical
2014 sex-matched testing results suggestive of with wrist strain conditions; gender/sex, age, Regression activity that
general abnormal slowing of the education levels, ethnicity, and OR involves
orthopedic median nerve, (2) the EDX testing results wrist strain
patients from an presence of clinical increases
outpatient symptoms of CTS, and (3) odds of CTS
orthopedic clinic no confounding
in the Western syndromes/disorders
US.
336
Mondelli,M. Moderate N= 145 ; female diagnosed according to hobbies (including Age, BMI, duration of logistic 1.73 (0.75-3.98) NS
2006 hospital floor AAN criteria: population of motorcycle riding) occupational exposure to regression
cleaners in Italy hospital floor cleaners vs none current job, occupational OR
exposure to the same job for
previous employers, manual
hobbies (including motorcycle
use, diseases known to be
associated with CTS (diabetes
hypothyroidism, and wrist/hand
trauma), hospital (to adjust for
center effects)
337
TABLE 69 RISK FACTOR: HOSPITAL WORK

Armstrong,T. High N= 1071; following median hospital vs model 2 best fitting model: logistic 2.42 (0.96, NS
2008 worker populations: neuropathy clerical work age, Gender/Sex, body mass regression OR 6.09)
carpenters, cases index, wrist index, history
workers, engineers, of diabetes, and history of
laboratory workers, shoulder tendonitis, lifting
computer workers, more than 2lbs/day,
and hospital assembly line work, hospital
support staff. vs clerical work,
construction vs clerical
work
338
TABLE 70 RISK FACTOR: HOUSEWORK

Hakim,A.J. High N= 3674 ; twins hand diagram: Home activity matched by: pairs of twins ; logit 1.21(0.95 NS
2002 from the UK Adult classic or (low vs. high covariates: age, BMI, home regression 1.55)
Twin Registry probable CTS level) activity level, leisure activity odds ratio
Tang,X. 1999 Low N= 122 ; female CTS signs and washing clothes matched by: age and diabetes ; odds ratio 3.86(1.79,8.33) washing clothes
cases and controls symptoms with manually more covariates: washing clothes manually more
recruited from one selective than 2 hours per manually more than 2 hours per than 2 hours
hospital neurology abnormalities of week week per week
department the MN increase odds
conduction of CTS
distal to the
wrist that
showed slowing
compared to a
separately cited
average values
from another
population
339
Tang,X. 1999 Low N= 122 ; female CTS signs and continuous matched by: age and diabetes ; odds ratio 2.33(.63-8.64) NS
cases and controls symptoms with duration of covariates: continuous duration of
recruited from one selective washing clothes washing clothes per week
hospital neurology abnormalities of per week
department the MN
conduction
distal to the
wrist that
showed slowing
compared to a
separately cited
average values
from another
population
Tang,X. 1999 Low N= 122 ; female CTS signs and kneading or matched by: age and diabetes ; odds ratio 6.25(2.5,15.63) kneading or
cases and controls symptoms with rolling dough covariates: kneading or rolling rolling dough
recruited from one selective manually more dough manually more than 2 more than 2
hospital neurology abnormalities of than 2 hours per hours per week hours per week
department the MN week increases odds
conduction of CTS
distal to the
wrist that
showed slowing
compared to a
separately cited
average values
from another
population
340
Tang,X. 1999 Low N= 122 ; female CTS signs and continuous matched by: age and diabetes ; odds ratio 1.88(.81,4.38) NS
cases and controls symptoms with duration of covariates: continuous duration of
recruited from one selective kneading or kneading or rolling dough per
hospital neurology abnormalities of rolling dough per week
department the MN week
conduction
distal to the
wrist that
showed slowing
compared to a
separately cited
average values
from another
population
Bonfiglioli,R. Moderate N= 269 ; cashiers CTS symptoms Children work(cashiers vs office workers), logistic 1.61(0.83 NS
2007 and office workers BMI, age, previous at risk jobs, regression 3.13)
from 4 big CTS family history, presence of odds ratio
supermarket stores children, do hand-knitting/needle
work, over 8 years of education,
Bonfiglioli,R. Moderate N= 269 ; cashiers CTS diagnosis Children work(cashiers vs office workers), logistic 2.16(0.67 the presence of
2007 and office workers with clinical and BMI, age, previous at risk jobs, regression 6.95) children
from 4 big electrodiagnostic CTS family history, presence of odds ratio increases odds
supermarket stores examinations children, do hand-knitting/needle of CTS
work, over 8 years of education,
341
TABLE 71 RISK FACTOR: INDUSTRIAL

Jenkins,P.J. Low N= unclear ; symptoms and Process, plant, matched by: all males ; univariate 2.69 (1.58 odds are higher
2013 prospective audit phalen and and machine covariates: Process, plant, odds ratios 4.76) than in
database of General tinel's sign at 66 operatives vs. and machine operatives vs. associate
Registrar Office for months Associate Associate professional and professional
occupations
Jenkins,P.J. Low N= unclear ; symptoms and Process, plant, matched by: all females ; univariate 1.99 (1.12 odds are higher
2013 prospective audit phalen and and machine covariates: Process, plant, odds ratios 3.51) than in
database of General tinel's sign at 66 operatives vs. and machine operatives vs. associate
Registrar Office for months Associate Associate professional and professional
occupations
Leclerc,A. 1998 Low N= 601 ; clothing Tinel or phalen clothing and shoe matched by: all were of logistic 4.12 (1.95 to odds of CTS
and shoe (non test positive or industry (non- similar education level ; regression 8.71) are significantly
packaging) workers nerve condition packaging) vs covariates: gender/sex, age, odds ratio higher in
and non-repetitive velocity had non repetitive psychological problems, clothing and
workers(cleaning, been established work (cleaning, BMI shoe industry
maintenance or before medical maintenance and workers
catering jobs) examination catering)
Leclerc,A. 1998 Low N= 644 ; food Tinel or phalen food industry matched by: all were of logistic 3.14 (1.38 to odds of CTS
industry (non- test positive or workers (non- similar education level ; regression 7.15) are significantly
packaging) workers nerve condition packaging) vs covariates: gender/sex, age, odds ratio higher in food
and non-repetitive velocity had non repetitive psychological problems, (non-
workers( or been established work (cleaning, BMI packaging)
catering jobs) before medical maintenance and workers
examination catering)
342
Leclerc,A. 1998 Low N= 497 ; packaging Tinel or phalen packaging matched by: all were of logistic 6.55 (3.02 to odds of CTS
workers and non- test positive or workers vs non similar education level ; regression 14.2) are significantly
repetitive workers( nerve condition repetitive work covariates: gender/sex, age, odds ratio higher in
or catering jobs) velocity had (cleaning, psychological problems, packaging
been established maintenance and BMI workers
before medical catering)
examination
Roquelaure,Y. Moderate N= 194276 ; clinical and Blue-collar matched by: among women relative risk 3.0 [2.5-3.6] risk
2008 French electrodiagnostic workers vs ; covariates: controlled for ratio significantly
prospectively CTS tests at 3 years unemployed age, stratified by gender/sex higher than in
surveillance system the unemployed
Roquelaure,Y. Moderate N= 193802 ; clinical and Blue-collar matched by: among men ; relative risk 4.2 [3.3-5.5] risk
2008 French electrodiagnostic workers vs covariates: controlled for ratio significantly
prospectively CTS tests at 3 years unemployed age, stratified by gender/sex higher than in
surveillance system the unemployed
343
TABLE 72 RISK FACTOR: JOB CONTROL

Coggon,D. Moderate N= 1230; cases were neurophysiologically little job control matched by: gender/sex, age ; logistic 1.4 (1.1-2.0) odds higher in
2013 selected from the positive patients vs in work done, in covariates: ethnicity, BMI, regression patients with
neurophysiology healthy controls timetables, or smoking, mental health, repeated OR little job
department and breaks movements, vibrating tools, job control
controls for the control, level of
accident and supervisor/colleague support
emergency services at
Southampton general
20-64
Coggon,D. Moderate N= 855; cases were neurophysiologically job includes matched by: gender/sex, age ; logistic 1.2 (0.9-1.7) NS
2013 selected from the positive patients vs targets, bonuses covariates: ethnicity, BMI, regression
neurophysiology negatively tested or deadlines smoking habits, diabetes, other OR
department and patients arthritis present, number of
emergency services at keyboard 4 or more hours per
Southampton general day, use of vibrating tools, job
hospital. All were aged includes
Nordstrom,D.L. Moderate N= 417 ; only incident Diagnosed by IOSH Job matched by: age ; covariates: logistic 1.05 (0.48, NS
1997 cases diagnosed physician, or had control (0=least) musculoskeletal condition, BMI, regression 2.27)
between 1994 and explicit treatment for 2.8-3.4 vs1-2.7 Parent/sibling/child has CTS, OR
1995 were eligible as CTS and hand power tool use, hours bending or
cases in Marshfield symptoms within twisting wrists, hours contacted
Wisconsin, and one month of date of with solvents per day, IOSH job
controls were a random diagnosis. control measure, cumulative
sample from this area hours worked since 1993
344
Nordstrom,D.L. Moderate N= 417 ; only incident Diagnosed by IOSH Job matched by: age ; covariates: logistic 0.34 (0.14, higher job
1997 cases diagnosed physician, or had control (0=least) musculoskeletal condition, BMI, regression 0.82) control
between 1994 and explicit treatment for 3.6-3.8 vs1-2.7 Parent/sibling/child has CTS, OR associated
1995 were eligible as CTS and hand power tool use, hours bending or with lower
cases in Marshfield symptoms within twisting wrists, hours contacted CTS odds
Nordstrom,D.L. Moderate N= 417 ; only incident Diagnosed by IOSH Job matched by: age ; covariates: logistic 0.64 (0.29, NS
1997 cases diagnosed physician, or had control (0=least) musculoskeletal condition, BMI, regression 1.42)
between 1994 and explicit treatment for 4-4.4 vs1-2.7 Parent/sibling/child has CTS, OR
Nordstrom,D.L. Moderate N= 417 ; only incident Diagnosed by IOSH Job matched by: age ; covariates: logistic 0.35 (0.14, higher job
1997 cases diagnosed physician, or had control (0=least) musculoskeletal condition, BMI, regression 0.91) control
between 1994 and explicit treatment for 4.6-4.8 vs1-2.7 Parent/sibling/child has CTS, OR associated
1995 were eligible as CTS and hand power tool use, hours bending or with lower
cases in Marshfield symptoms within twisting wrists, hours contacted CTS odds
345
TABLE 73 RISK FACTOR: LACK OF COWORKER SUPPORT

Werner,R.A. Low N= 189 ; all were hand diagram coworker support Gender/Sex, wrist/hand logistic .69(.48,.99) higher levels of
2005 automobile assembly line symptoms, and level tendonitis, diabetes, regression coworker
workers median sensory coworker support, odds ratio support was
evoked response that median ulnar peak associated with
.5 msec longer than latency on dominant side, lower odds of
ipsilateral ulnar elbow posture rating CTS
sensory response at
1 year
Coggon,D. Moderate N= 1230; cases were neurophysiologically little level of matched by: gender/sex, logistic 1.6 (1.1-2.3) odds higher in
2013 selected from the positive patients vs support from age ; covariates: regression patients with
neurophysiology healthy controls supervisors or ethnicity, BMI, smoking, OR little level of
department and controls colleagues mental health, repeated support
for the accident and movements, vibrating
emergency services at tools, job control, level of
Southampton general supervisor/colleague
hospital. All were aged support
20-64
346
TABLE 74 RISK FACTOR: LENGTH OF EMPLOYMENT

Bonfiglioli,R. Moderate N= 269 ; cashiers CTS symptoms Previous at-risk work(cashiers vs office logistic 1.01(0.94 NS
2007 and office workers jobs workers), BMI, age, regression 1.09)
from 4 big previous at risk jobs, CTS odds ratio
supermarket stores family history, presence of
children, do hand-
knitting/needle work, over 8
years of education,
Bonfiglioli,R. Moderate N= 269 ; cashiers CTS diagnosis Previous at-risk work(cashiers vs office logistic 0.95(0.84 NS
2007 and office workers with clinical and jobs workers), BMI, age, regression 1.07)
from 4 big electrodiagnostic previous at risk jobs, CTS odds ratio
supermarket stores examinations family history, presence of
children, do hand-
knitting/needle work, over 8
years of education,
Mondelli,M. Moderate N= 145 ; female diagnosed same job with Age, BMI, duration of logistic 12.15 (2.96- patients who
2006 hospital floor according to previous occupational exposure to regression OR 49.93) had same floor
cleaners in Italy AAN criteria: employers yes vs current job, occupational cleaner job with
population of no exposure to the same job for a previous
hospital floor previous employers, manual employer had
cleaners hobbies (including greater odds of
motorcycle use, diseases CTS than those
known to be associated with who did not
CTS (diabetes connective have same job
tissue diseases, at previous
hypothyroidism, and employer
wrist/hand trauma), hospital
(to adjust for center effects)
347
Nordstrom,D.L. Moderate N= 417 ; only Diagnosed by Worked 4880- matched by: age ; logistic 0.29 (0.12, more hours
1997 incident cases physician, or 5383 vs 2954 covariates: musculoskeletal regression OR 0.72) worked since
diagnosed between had explicit hours condition, BMI, 1993 was
1994 and 1995 treatment for Parent/sibling/child has associated with
were eligible as CTS and hand CTS, power tool use, hours lower odds of
cases in Marshfield symptoms bending or twisting wrists, CTS
Wisconsin, and within one hours contacted with
controls were a month of date of solvents per day, IOSH job
random sample diagnosis. control measure, cumulative
from this area hours worked since 1993
Nordstrom,D.L. Moderate N= 417 ; only Diagnosed by Worked 6647- matched by: age ; logistic 0.29 (0.10, more hours
1997 incident cases physician, or 15510 vs 2954 covariates: musculoskeletal regression OR 0.78) worked since
diagnosed between had explicit hours condition, BMI, 1993 was
1994 and 1995 treatment for Parent/sibling/child has associated with
were eligible as CTS and hand CTS, power tool use, hours lower odds of
cases in Marshfield symptoms bending or twisting wrists, CTS
Wisconsin, and within one hours contacted with
controls were a month of date of solvents per day, IOSH job
random sample diagnosis. control measure, cumulative
from this area hours worked since 1993
348
TABLE 75 RISK FACTOR: LEVEL OF SATISFACTION

Goodson, J.T. Moderate 87 CTS and 74 (1)Electrodiagnostic Job Satisfaction excluded confounding Logistical 0.66(0.5,0.88) Job satisfaction
2014 gender/sex- (EDX) testing conditions; gender/sex, Regression decreases odds
matched general results suggestive of age, education levels, OR of CTS
orthopedic patients abnormal slowing of ethnicity, and EDX testing
from an outpatient the median nerve, results
orthopedic clinic in (2) the presence of
the Western US. clinical symptoms
of CTS, and (3) no
confounding
syndromes/disorders
349
TABLE 76 RISK FACTOR: LIFTING

Armstrong,T. High N= 1071; following median lifting 2 or more model 1:age, Gender/Sex, body logistic 3.31(1.54, lifting 2 or
2008 worker neuropathy pounds/day mass index, wrist index, history regression OR 7.12) more
populations: cases of diabetes, and history of pounds/day
carpenters, shoulder tendonitis, lifting significantly
workers, engineers, more than 2lbs/day, using increases CTS
laboratory workers, vibrating tools, assembly line odds
computer workers, work, twisting forearm work,
and hospital bending wrist work, using
support staff. forceful hand grip, using
fingers/thumb as pressing tool,
using fingers in a pinch grip
Armstrong,T. High N= 1071; following median lifting 2 or more model 2 best fitting model: age, logistic 2.67 (1.21, lifting 2 or
2008 worker neuropathy pounds/day Gender/Sex, body mass index, regression OR 5.88) more
populations: cases wrist index, history of diabetes, pounds/day is
carpenters, and history of shoulder associated with
workers, engineers, tendonitis, lifting more than higher odds of
laboratory workers, 2lbs/day, assembly line work, median
computer workers, hospital vs clerical work, neuropathy
and hospital construction vs clerical work
support staff.
Dale, A.M. Moderate 710 clerical, Presence of peak exposure to age, BMI, Gender/Sex, med Logistical 3.61 (1.41, Peak exposure
2014 service, and specific nerve Lifting objects history, pregnancy, history of Regression 9.24) to lifting
construction symptoms in CTS or peripheral neuropathy, OR increases odds
workers from eight survey and or other contraindication to of CTS
participating median receiving nerve conduction
employers and neuropathy by studies (NCS), lifting objects,
three construction NCS (DML, vibrating tools, forearm
trade unions MUDS, DSL) at rotation, wrist bending, forceful
between July 3 years gripping, thumb pressing,
2004and October finger pinching
2006 into the
PrediCTS study
350
Dale, A.M. Moderate 710 clerical, Presence of Lifting objects in age, BMI, Gender/Sex, med Logistical 2.98 (1.41, Lifting
2014 service, and specific nerve most recent job history, pregnancy, history of Regression 6.31) increases odds
construction symptoms in CTS or peripheral neuropathy, OR
workers from eight survey and or other contraindication to
three construction NCS (DML, vibrating tools, forearm
trade unions MUDS, DSL) at rotation, wrist bending, forceful
between July 3 years gripping, thumb pressing,
2004and October finger pinching
2006 into the
PrediCTS study
Evanoff,B. Moderate N= 745 ; newly symptoms and lifting more than age, Gender/Sex, lifting at least logistic 3.27(1.27, lifting at least 1
2012 employed workers NCS at 3 years 1 kg/day 1kg, forceful grip, finger/thumb regression 8.44) kg increases
pressing, using vibrating tools, odds ratio CTS odds
hand/wrist bending
Nathan,P.A. Moderate N= 148 ; industrial clinical and heavy lifting repetitious movement, heavy logistic 1.31 (p- NS
2005 workers in Portland electrodiagnostic lifting, keyboard use, vibration regression value=.63)
Oregon area tests at 15-16 tools, force, cigarette use, odds ratio
years Gender/Sex, age, BMI
351
TABLE 77 RISK FACTOR: MANAGERIAL JOBS

Jenkins,P.J. Low N= unclear ; symptoms and Managers, matched by: all males ; univariate 0.88 (0.43 NS
2013 prospective audit phalen and directors, and covariates: Managers, odds ratios 1.77)
database of General tinel's sign at 66 senior officials directors, and senior
Registrar Office for months vs. Associate officials vs. Associate
Scotland professional and professional and technical
occupations
Jenkins,P.J. Low N= unclear ; symptoms and Managers, matched by: all females ; univariate 1.69 (0.99 NS
2013 prospective audit phalen and directors, and covariates: Managers, odds ratios 2.91)
database of General tinel's sign at 66 senior officials directors, and senior
Registrar Office for months vs. Associate officials vs. Associate
Scotland professional and professional and technical
occupations
352
TABLE 78 RISK FACTOR: MARITAL STATUS

Kaplan,Y. 2008 Low N= 221 ; all were NCS marital status- matched by: age p-value >.05 NS
postmenopausal married versus matched females ;
women other covariates: marital
status
353
TABLE 79 RISK FACTOR: MENTAL

Garg,A. 2012 High N= 536 ; workers symptoms (tingling and/or feeling down or Model1: ACGIH Hand cox 0.08 (.01 depression/feeling
from a wide range numbness) in at least 2 blue or Activity Level (HAL) ,age, proportional 0.62) down is
of manufacturing median nerve served depressed never BMI (continuous), number of hazard ratio associated with
facilities in the digits, symptoms at least vs seldom other distal upper extremity CTS
mid-west 25% of days in previous musculoskeletal disorders,
month, symptoms for at gardening, feeling down, blue
least 2 or more consecutive or depressed, rheumatoid
Garg,A. 2012 High N= 536 ; workers symptoms (tingling and/or feeling down or Model1: ACGIH Hand cox 0.99 0.44 NS
from a wide range numbness) in at least 2 blue or Activity Level (HAL) ,age, proportional 2.24)
of manufacturing median nerve served depressed often BMI (continuous), number of hazard ratio
facilities in the digits, symptoms at least vs seldom other distal upper extremity
Midwest 25% of days in previous musculoskeletal disorders,
Garg,A. 2012 High N= 536 ; workers symptoms (tingling and/or feeling down or Model1: ACGIH Hand cox 8.19 1.69 depression/feeling
from a wide range numbness) in at least 2 blue or Activity Level (HAL) ,age, proportional 39.72) down is
of manufacturing median nerve served depressed BMI (continuous), number of hazard ratio associated with
facilities in the digits, symptoms at least always vs other distal upper extremity CTS
Midwest 25% of days in previous seldom musculoskeletal disorders,
354
Garg,A. 2012 High N= 536 ; workers symptoms (tingling and/or feeling down or Model 2: strain index ,age, cox 0.10 (0.01 depression/feeling
from a wide range numbness) in at least 2 blue or BMI (continuous), number of proportional 0.71) down is
of manufacturing median nerve served depressed never other distal upper extremity hazard ratio associated with
facilities in the digits, symptoms at least vs seldom musculoskeletal disorders, CTS
Midwest 25% of days in previous gardening, feeling down, blue
month, symptoms for at or depressed, rheumatoid
least 2 or more consecutive arthritis
monthly follow ups,
Garg,A. 2012 High N= 536 ; workers symptoms (tingling and/or feeling down or Model 2: strain index ,age, cox 0.94 (0.42 NS
from a wide range numbness) in at least 2 blue or BMI (continuous), number of proportional 2.12)
of manufacturing median nerve served depressed often other distal upper extremity hazard ratio
facilities in the digits, symptoms at least vs seldom musculoskeletal disorders,
Midwest 25% of days in previous gardening, feeling down, blue
monthly follow ups,
Garg,A. 2012 High N= 536 ; workers symptoms (tingling and/or feeling down or Model 2: strain index ,age, cox 8.44 1.73 depression/feeling
from a wide range numbness) in at least 2 blue or BMI (continuous), number of proportional 41.16) down is
of manufacturing median nerve served depressed other distal upper extremity hazard ratio associated with
facilities in the digits, symptoms at least always vs musculoskeletal disorders, CTS
Midwest 25% of days in previous seldom gardening, feeling down, blue
monthly follow ups,
355
Roquelaure,Y. Low N= 162 ; footwear psychological distressed psychological BMI over 30,GHQ-12 score, logistic 4.3 (1.0- having high levels
2001 factory workers measured by G at 2 year distress rapid trigger movements, regression 18.6) of psychological
measured by work strongly controlled by odds ratio distress on the
General Health superiors GHQ-12 (90th
Questionnaire percentile) was
(GHQ-12) associated with
greater or equal greater odds of
to 90th CTS
percentile
Coggon,D. Moderate N= 1230; cases neurophysiologically intermediate matched by: gender/sex, age ; logistic 1.3 (0.9-1.7) NS
2013 were selected positive patients vs healthy mental health vs covariates: ethnicity, BMI, regression
from the controls good mental smoking, mental health, OR
neurophysiology health repeated movements,
department and vibrating tools, job control,
controls for the level of supervisor/colleague
accident and support
emergency
services at
Southampton
general hospital.
All were aged 20-
64
Coggon,D. Moderate N= 1230; cases neurophysiologically poor mental matched by: gender/sex, age ; logistic 1.4 (1.0-1.9) odds higher in
2013 were selected positive patients vs healthy health vs good covariates: ethnicity, BMI, regression patients with poor
from the controls mental health smoking, mental health, OR mental health
neurophysiology repeated movements,
department and vibrating tools, job control,
controls for the level of supervisor/colleague
accident and support
emergency
services at
Southampton
general hospital.
All were aged 20-
64
356
TABLE 80 RISK FACTOR: MODERATE ALCOHOL USE
Violante,F.S. Moderate Blue-collar workers of occurrence Moderate alcohol gender/sex, age, Logistic 0.2 (0.11.0) Moderate
2007 several factories within last consumption biomechanical load, Regression alcohol
(producing large and small month of (defined as 2 to 4 BMI*wrist interaction effect, OR consumption
domestic appliances, classic/ drinks per week) height*forearm interaction decreases odds
underwear, ceramic tiles, probable or effect, family history of CTS, of CTS. Greater
and shoes and workers possible pathologies facilitating CTS alcohol
employed in all municipal symptoms of onset(diabetes mellitus, consumption
nursery schools. CTS amyloidosis, gout, did not
progressive systemic significantly
sclerosis, rheumatoid arthritis, affect odds of
systemic lupus CTS
previous exposure to
357
TABLE 81 RISK FACTOR: MUSCULOSKELETAL

Garg,A. 2012 High N= 536 ; workers from a symptoms (tingling 1 to 2 distal Model1: ACGIH Hand cox 2.45 (1.21 more distal
wide range of manufacturing and/or numbness) in upper extremity Activity Level (HAL) ,age, proportional 5.08) upper extremity
facilities in the Midwest at least 2 median musculoskeletal BMI (continuous), number of hazard ratio musculoskeletal
nerve served digits, disorders vs other distal upper extremity disorders is
symptoms at least zero disorders musculoskeletal disorders, associated with
25% of days in gardening, feeling down, blue higher CTS risk
symptoms for at least arthritis
2 or more consecutive
monthly follow ups,
abnormal NCS at 6
years
Garg,A. 2012 High N= 536 ; workers from a symptoms (tingling 3 or more distal Model1: ACGIH Hand cox 3.85 (1.08 more distal
wide range of manufacturing and/or numbness) in upper extremity Activity Level (HAL) ,age, proportional 13.8) upper extremity
facilities in the Midwest at least 2 median musculoskeletal BMI (continuous), number of hazard ratio musculoskeletal
nerve served digits, disorders vs other distal upper extremity disorders is
symptoms at least zero disorders musculoskeletal disorders, associated with
25% of days in gardening, feeling down, blue higher CTS risk
symptoms for at least arthritis
monthly follow ups,
abnormal NCS at 6
years
358
Garg,A. 2012 High N= 536 ; workers from a symptoms (tingling 1 to 2 distal Model 2: strain index ,age, BMI cox 2.66 (1.30 more distal
wide range of manufacturing and/or numbness) in upper extremity (continuous), number of other proportional 5.45) upper extremity
facilities in the Midwest at least 2 median musculoskeletal distal upper extremity hazard ratio musculoskeletal
nerve served digits, disorders vs musculoskeletal disorders, disorders is
symptoms at least zero disorders gardening, feeling down, blue associated with
25% of days in or depressed, rheumatoid higher CTS risk
symptoms for at least
monthly follow ups,
abnormal NCS at 6
years
Garg,A. 2012 High N= 536 ; workers from a symptoms (tingling 3 or more distal Model 2: strain index ,age, BMI cox 3.70 (1.02 more distal
wide range of manufacturing and/or numbness) in upper extremity (continuous), number of other proportional 13.46) upper extremity
facilities in the Midwest at least 2 median musculoskeletal distal upper extremity hazard ratio musculoskeletal
nerve served digits, disorders vs musculoskeletal disorders, disorders is
symptoms at least zero disorders gardening, feeling down, blue associated with
25% of days in or depressed, rheumatoid higher CTS risk
symptoms for at least
monthly follow ups,
abnormal NCS at 6
years
Bayrak,I.K. Low N= 290 ; CTS patients were clinically and bifid median bifid median nerve chi squared <.01 bifid median
2008 from electrophysiology electrophysiologically nerve p value nerve was more
clinic, and controls were frequent in CTS
selected from patients who case patients
underwent ultrasound for than in control
other reasons patients
359
Keese,G.R. Low N= 72 ; CTS cases and symptoms and Palmaris long matched by: age, Gender/Sex, odds ratio 10(1.18, odds of CTS is
2006 control patients selected from neurodiagnostic test us present vs industrial exposures, diabetes, 84.779) significantly
one clinic at 6 months Absent thyroid disease, alcohol abuse higher when
and rheumatoid arthritis ; Palmaris long
covariates: Palmaris long us us is present
present vs Absent
Vogelsang,L.M. Low N= 100 ; all were worked in diagnosed by GMP, Generic social readjustment scale, self- p value <.05 patients with
1994 what were considered high orthopaedist Musculoskeletal control schedule, life style logistic CTS were more
risk occupations(automotive Problems. approaches scale, self-control regression likely to have
parts or assembly workers, questionnaire, perceived stress related generic
keyboard operators, scales, Cohen-Hoberman musculoskeletal
electronics industry workers, Inventory of Physical problems
and garment industry workers Symptoms, related medical besides CTS
from East Tennessee, and condition, suspected medical
sign language interpreters). risk, related musculoskeletal
Each case was matched by problems
age, Gender/Sex,
race/ethnicity, height, weight,
body type, length of time, job
duties
Aktas,I. 2008 Moderate N= 90 ; patients referred to electrophysiologically benign joint benign joint hypermobility Pearsons 0.59 joint
electrophysiological diagnosed hypermobility correlation hypermobility
laboratory increases CTS
risk
Nordstrom,D.L. Moderate N= 417 ; only incident cases Diagnosed by Musculoskeletal matched by: age ; covariates: logistic 2.54 (l.03, Odds are
1997 diagnosed between 1994 and physician, or had condition musculoskeletal condition, regression 6.23) greater in
1995 were eligible as cases in explicit treatment for BMI, Parent/sibling/child has OR patients with
Marshfield Wisconsin, and CTS and hand CTS, power tool use, hours musculoskeletal
controls were a random symptoms within one bending or twisting wrists, conditions
sample from this area month of date of hours contacted with solvents
diagnosis. per day, IOSH job control
measure, cumulative hours
worked since 1993
360
TABLE 82 RISK FACTOR: OFFICE WORK

Roquelaure,Y. Moderate N= 194276 ; clinical and Lower-grade matched by: among relative risk 2.5 [2.2-3.0] risk
2008 French electrodiagnostic white-collar women ; ratio significantly
prospectively CTS tests at 3 years workers vs covariates: higher than in
surveillance system unemployed controlled for age, the unemployed
stratified by
gender/sex
Roquelaure,Y. Moderate N= 193802 ; clinical and Lower-grade matched by: among relative risk 1.3 [0.8-2.I] NS
2008 French electrodiagnostic white-collar men ; covariates: ratio
prospectively CTS tests at 3 years workers vs controlled for age,
surveillance system unemployed stratified by
gender/sex
361
TABLE 83 RISK FACTOR: OTHER

Jenkins,P.J. Low N= unclear ; prospective symptoms and Elementary matched by: all males ; univariate 3.08 (1.78 odds are higher
2013 audit database of phalen and occupations vs. covariates: Elementary odds ratios 5.51) than in
General Registrar Office tinel's sign at 66 Associate occupations vs. Associate associate
for Scotland months professional and professional and technical professional
technical occupations and technical
occupations occupations
Jenkins,P.J. Low N= unclear ; prospective symptoms and Elementary matched by: all females ; univariate 4.85 (3.21 odds are higher
2013 audit database of phalen and occupations vs. covariates: Elementary odds ratios 7.55) than in
General Registrar Office tinel's sign at 66 Associate occupations vs. Associate associate
for Scotland months professional and professional and technical professional
Kaplan,Y. 2008 Low N= 221 ; all were NCS home maker matched by: age matched odds ratio 1.10 (0.64, NS
postmenopausal women versus employed females ; covariates: 1.89)
outside of home homemaker versus
employed
Wolf,J.M. 2009 Low N= ; all were in military method of rank junior age, Gender/Sex, and Poisson 1.53 (1.47, junior enlisted
diagnosis not enlisted vs junior race/ethnicity regression 1.59) soldiers had a
explained and officer rate ratio significantly
done by multiple higher rate of
physicians and CTS than junior
specialists officers
Wolf,J.M. 2009 Low N= ; all were in military method of rank senior age, Gender/Sex, and Poisson 3.18 (3.06, senior enlisted
diagnosis not enlisted vs junior race/ethnicity regression 3.30) soldiers had a
362
Wolf,J.M. 2009 Low N= ; all were in military method of rank senior age, Gender/Sex, and Poisson 2.72 (2.60, senior officer
diagnosis not officer vs junior race/ethnicity regression 2.85) soldiers had a
Cartwright,M.S. Moderate N= 287 ; Latino manual diagnosed with a poultry worker vs age, BMI, Gender/Sex, logistic 2.51(1.8, 3.5) odds higher in
2012 labor workers in 4 North combination of not a poultry accounting for center and regression poultry workers
Carolina counties symptoms worker within person wrist
reported through correlation
Katz hand
diagram, and
nerve
conduction
studies
Cartwright,M.S. Moderate N= 173 ; Latino poultry diagnosed with a poultry worker vs age, BMI, Gender/Sex, logistic 1.81(.83, NS
2014 and non-poultry manual combination of not a poultry accounting for center and regression 3.98)
workers symptoms worker within person wrist odds ratio
reported through correlation
Katz hand
diagram, and
nerve
conduction
studies at 1 year
Roquelaure,Y. Moderate N= 193802 ; French clinical and Craftswomen, matched by: among men ; relative risk 0.8 [0.4-1.6] NS
2008 prospectively CTS electrodiagnostic saleswomen, and covariates: controlled for ratio
surveillance system tests at 3 years managers vs age, stratified by gender/sex
unemployed
Roquelaure,Y. Moderate N= 194276 ; French clinical and Craftswomen, matched by: among women relative risk 0.5 [0.3-1.2] NS
2008 prospectively CTS electrodiagnostic saleswomen, and ; covariates: controlled for ratio
surveillance system tests at 3 years managers vs age, stratified by gender/sex
unemployed
363
TABLE 84 RISK FACTOR: PARAPLEGIC

Akbar,M., 2014 Low N= 112 ; paraplegic history, phalen paraplegic vs matched by: age, odds ratio 21.67 (6.85, odds higher in
recruited from and Tinel healthy controls Gender/Sex ; 68.56) paraplegics
hospital database, covariates:
and controls paraplegic vs not
recruited through
advertisements in
the community
Akbar,M., 2014 Low N= 112 ; paraplegic electrodiagnostic paraplegic vs matched by: age, odds ratio 7.14 (3.07, odds higher in
recruited from healthy controls Gender/Sex ; 16.62) paraplegics
hospital database, covariates:
and controls paraplegic vs not
recruited through
advertisements in
the community
364
TABLE 85 RISK FACTOR: PIECEWORK PAYMENT

Petit,A. 2015 Moderate French salaried CTS symptoms payment on a Gender/Sex, age, Logistical 2 (1.1-3.5) payment on a
workers working in on the day of piecework basis use of vibrating Regression piecework basis
manufacturing medical exam hand tools, OR rather than
industry and (or for at least 4 exposure to cold according to
services sector as days during the temperature, working hours
skilled and preceding 7 holding objects in increases odds
unskilled blue days) pinch grip, extreme of CTS
collar workers wrist bending
posture, pressing
with palm base,
force, and work
organization factors
365
TABLE 86 RISK FACTOR: PRESSING

Armstrong,T. High N= 1071; following median using model 1:age, Gender/Sex, logistic 1.19 (0.80, NS
2008 worker populations: neuropathy fingers/thumbs as body mass index, wrist index, regression OR 1.76)
carpenters, cases pressing tool history of diabetes, and
workers, engineers, history of shoulder
computer workers, 2lbs/day, using vibrating
and hospital tools, assembly line work,
support staff. twisting forearm work,
bending wrist work, using
forceful hand grip, using
fingers/thumb as pressing
tool, using fingers in a pinch
grip
Dale, A.M. Moderate 710 clerical, Presence of peak exposure to age, BMI, Gender/Sex, med Logistical 1.12 (0.54, NS
2014 service, and specific nerve Thumb pressing history, pregnancy, history of Regression 2.35)
construction symptoms in CTS or peripheral OR
workers from eight survey and neuropathy, or other
participating median contraindication to receiving
employers and neuropathy by nerve conduction studies
three construction NCS (DML, (NCS), lifting objects,
trade unions MUDS, DSL) vibrating tools, forearm
between July at 3 years rotation, wrist bending,
2004and October forceful gripping, thumb
2006 into the pressing, finger pinching
PrediCTS study
366
Dale, A.M. Moderate 710 clerical, Presence of Thumb pressing age, BMI, Gender/Sex, med Logistical 1.71 (0.76, NS
2014 service, and specific nerve in most recent job history, pregnancy, history of Regression 3.86)
construction symptoms in CTS or peripheral OR
workers from eight survey and neuropathy, or other
participating median contraindication to receiving
employers and neuropathy by nerve conduction studies
three construction NCS (DML, (NCS), lifting objects,
trade unions MUDS, DSL) vibrating tools, forearm
between July at 3 years rotation, wrist bending,
2004and October forceful gripping, thumb
2006 into the pressing, finger pinching
PrediCTS study
367
TABLE 87 RISK FACTOR: PROFESSIONAL JOBS

Forst,L. 2006 Low N= 371 ; physician and Varied. Based practicing age, ethnicity, surgical logistic 4.24(1.54,4.81) surgeons with
non physician members of on modified professionally for specialty, obesity (body regression greater than or
North American Spine version of greater or equal mass index [BMI] 30), odds ratio equal to 5 years
Society (NASS) questionnaire, to 5 years working as a surgeon for experience had
and self- 5 years, use of the Kerrison significantly
diagnosis by rongeur (an instrument greater odds of
physicians used for bone removal) CTS than those
with less
experience
Forst,L. 2006 Low N= 371 ; physician and Varied. Based being a surgeon age, ethnicity, surgical logistic 2.72(1.54, surgeons who
non-physician members of on modified who uses the specialty, obesity (body regression 11.69) used the
North American Spine version of Kerrison rongeur mass index [BMI] 30), odds ratio Kerrison
Society (NASS) questionnaire, tool versus not working as a surgeon for rongeur tool
and self- using the tool 5 years, use of the Kerrison had
diagnosis by rongeur (an instrument significantly
physicians used for bone removal) higher odds of
CTS
Jenkins,P.J. Low N= unclear ; prospective symptoms and Professional matched by: all males ; univariate 2.45 (1.38 odds are higher
2013 audit database of General phalen and occupations vs. covariates: Professional odds ratios 4.56) than in
Registrar Office for tinel's sign at 66 Associate occupations vs. Associate associate
Scotland months professional and professional and technical professional
Jenkins,P.J. Low N= unclear ; prospective symptoms and Professional matched by: all females ; univariate 4.85 (3.16 odds are higher
2013 audit database of General phalen and occupations vs. covariates: Professional odds ratios 7.64) than in
Registrar Office for tinel's sign at 66 Associate occupations vs. Associate associate
Scotland months professional and professional and technical professional
368
Roquelaure,Y. Moderate N= 194276 ; French clinical and Professionals vs matched by: among women relative risk 0.9 [0.6-1.4] NS
2008 prospectively CTS electrodiagnostic unemployed ; covariates: controlled for ratio
surveillance system tests at 3 years age, stratified by
gender/sex
Roquelaure,Y. Moderate N= 193802 ; French clinical and Professionals vs matched by: among men ; relative risk 0.6 [0.4-1.0] NS
2008 prospectively CTS electrodiagnostic unemployed covariates: controlled for ratio
surveillance system tests at 3 years age, stratified by
gender/sex
369
TABLE 88 RISK FACTOR: RACE/ETHNICITY (WHITE VS NON-WHITE)

Wright, C. 2014 Low (3155 w/o CTS diagnosis clinically Race/Ethnicity age, race/ethnicity, Logistical 1.2 (0.7-2) NS
and 91 with CTS diagnosed with Black versus education, smoking, Regression
diagnosis); EMR of a ICD 9 diagnosis White parity, hypertension, OR
cohort of pregnant women code for CTS diabetes, maternal
receiving prenatal care at a weight category
large obstetrics unit; (constructed variable
representative of those including information
served by the urban about maternal BMI
academic center, with a and GWG), and
large proportion of black number prenatal care
patients visits
Nathan,P.A. Moderate N= 256; workers at 4 electrodiagnostic Race/Ethnicity repetitious movement, logistic 1.11 (.25 NS
2002 industrial sites (a steel mill, test and white vs heavy lifting, regression 4.89)
meat/food packaging, symptoms at 11 nonwhite keyboard use, odds ratio
electronics, and plastics). years vibration tools, force,
cigarette use,
Gender/Sex, age,
BMI, avocational
activities, hormone
use, race/ethnicity,
endocrine condition,
years on job
370
TABLE 89 RISK FACTOR: RAYNAUDS

Winn,F.J.,Jr., Low N= 58 ; cases were median nerve Raynauds matched by: age logistic 20.19(4.1,99.33) Raynauds
1989 seen at Baltimore or motor Symptoms and gender/sex ; regression Symptoms
neurology clinic, sensory covariates: odds ratio result in higher
healthy controls symptoms Raynauds CTS diagnosis
were selected by symptoms and odds
those who median nerve
responded to motor function
advertisements in
the same area
371
TABLE 90 RISK FACTOR: REPETITION

Armstrong,T. High N= 1071; follow worker factor analysis repetition Model 3 with O*NET factor logistic 1.79 (1.01-3.18) Work with
2008 populations: carpenters, (O*NET variables: age, Gender/Sex, regression high hand
workers, engineers, subscales: time body mass index, wrist OR repetition
laboratory workers, spent making index, history of diabetes, increases
computer workers, and repetitive and history of shoulder odds of CTS
hospital support staff. motions and tendonitis, lifting more than
time spent 2lbs/day, assembly line
handling work, hospital vs clerical
objects) 4th work, construction vs
quartile vs 1st clerical work
Armstrong,T. High N= 1071; follow worker factor analysis repetition Model 3 with O*NET factor logistic 1.11 (0.61-2) NS
2008 populations: carpenters, (O*NET variables: age, Gender/Sex, regression
workers, engineers, subscales: time body mass index, wrist OR
laboratory workers, spent making index, history of diabetes,
computer workers, and repetitive and history of shoulder
objects) 3rd work, construction vs
Armstrong,T. High N= 1071; follow worker factor analysis repetition Model 3 with O*NET factor logistic 1.48 (0.8-2.74) NS
2008 populations: carpenters, (O*NET variables: age, Gender/Sex, regression
workers, engineers, subscales: time body mass index, wrist OR
laboratory workers, spent making index, history of diabetes,
computer workers, and repetitive and history of shoulder
objects) 2nd work, construction vs
372
Evanoff,B. High 711 clerical, service, and Presence of specific Repetitive adjusted for age, Multivariable 2.48(1.05-5.86) Repetitive
2014 construction workers nerve symptoms in Motion required Gender/Sex, and BMI; past mixed Motion in
from eight participating survey and median diagnosis of CTS or other logistic Current Job
employers and three neuropathy by NCS upper extremity peripheral regression increases
construction trade unions (DML, MUDS, neuropathy, had a models OR odds of CTS
between July 2004and DSL) at 3 years pacemaker or internal
October 2006 into the defibrillator, or were
PrediCTS study pregnant at the time of
enrollment excluded
Yagev,Y. 2001 Low N= 145 ; all male patients electrodiagnostically low force-high matched by: all males ; logistic 2.2(0.5,9.9) NS
from one diagnosed repetitive motion covariates: job force- regression
electrophysiological lab jobs vs low repetition level, age, ethnic odds ratio
at one hospital force-low origin, education, obesity,
repetitive jobs smoking habits,
Yagev,Y. 2001 Low N= 120 ; all female electrodiagnostically low force-high matched by: all females ; logistic 7.4(1.9,28) odds of CTS
patients from one diagnosed repetitive motion covariates: job force- regression were
electrophysiological lab jobs vs low repetition level, age, ethnic odds ratio significantly
at one hospital force-low origin, education, obesity, greater
repetitive jobs smoking habits, among
females with
low force-
higher
repetitive
jobs than
those low
force low
repetitive
jobs
373
Yagev,Y. 2001 Low N= 265 ; all patients from electrodiagnostically low force-high job force-repetition level, logistic 4.72(1.8,12.5) odds of CTS
one electrophysiological diagnosed repetitive motion age, ethnic origin, regression were
lab at one hospital jobs vs low education, obesity, smoking odds ratio significantly
force-low habits, greater
repetitive jobs among
people with
low force-
high
repetitive
jobs than
those low
force low
repetitive
jobs
Yagev,Y. 2001 Low N= 102 ; all male patients electrodiagnostically high force-low matched by: all males ; logistic 2.8(1.1,6.9) odds of CTS
from one diagnosed repetitive motion covariates: job force- regression were
electrophysiological lab jobs vs low repetition level, age, ethnic odds ratio significantly
at one hospital force-low origin, education, obesity, greater
repetitive jobs smoking habits, among
males with
high force-
low
repetitive
jobs than
those low
force low
repetitive
jobs
Yagev,Y. 2001 Low N= 138 ; all female electrodiagnostically high force-low matched by: all females ; logistic 7.0(0.8,6.2) NS
patients from one diagnosed repetitive motion covariates: job force- regression
electrophysiological lab jobs vs low repetition level, age, ethnic odds ratio
at one hospital force-low origin, education, obesity,
repetitive jobs smoking habits,
374
Yagev,Y. 2001 Low N= 240 ; all patients from electrodiagnostically high force-low job force-repetition level, logistic 3.21(1.5,6.9) odds of CTS
one electrophysiological diagnosed repetitive motion age, ethnic origin, regression were
lab at one hospital jobs vs low education, obesity, smoking odds ratio significantly
force-low habits, greater
repetitive jobs among
people with
high force-
low
repetitive
jobs than
those low
force low
repetitive
jobs
Chiang,H.C. Moderate N= 269 ; workers at neurological job requires Age, gender/sex, length of logistic 1.87 (1.11, 3.16) repetitious
1990 frozen food plants examinations and repetitive employment, exposure to regression movement is
electrophysiological movement cold(frozen food packers), odds ratio associated
tests (frozen food repetitive movement (frozen with CTS
packers and non- and non-frozen food
frozen food packers), and
packers) vs no cold*repetitious movement
repetitive interaction
movement(office
work)
Chiang,H.C. Moderate N= 269 ; workers at neurological combined effect , length of employment, logistic 1.83 (1.35, 2.48) exposure to
1990 frozen food plants examinations and of repetitive exposure to cold(frozen regression cold
electrophysiological movement and food packers), repetitive odds ratio increases the
tests working in the movement (frozen and non- effect of
cold(interaction frozen food packers), and repetitious
term) cold*repetitious movement movement
interaction on CTS
odds
375
Coggon,D. Moderate N= 1230; cases were neurophysiologically use of other matched by: gender/sex, age logistic 1.5 (1.1-1.9) odds higher
2013 selected from the positive patients vs repeated ; covariates: ethnicity, BMI, regression in patients
neurophysiology healthy controls movements of smoking, mental health, OR with
department and controls the repeated movements, repeated
for the accident and wrist/fingers>4 vibrating tools, job control, movements
emergency services at hours per day level of supervisor/colleague >4 hours per
Southampton general support day
20-64
Goodson, J.T. Moderate 87 CTS and 74 (1)Electrodiagnostic occupational excluded confounding Logistical 1.84(1.27,2.67) occupational
2014 gender/sex-matched (EDX) testing repetition conditions; gender/sex, age, Regression repetition
general orthopedic results suggestive of BMI, education levels, OR increases
patients from an abnormal slowing of ethnicity, and EDX testing odds
outpatient orthopedic the median nerve, results
clinic in the Western US. (2) the presence of
clinical symptoms of
CTS, and (3) no
confounding
syndromes/disorders
Silverstein,B.A. Moderate N= 652 ; workers form based on phalen and high force-low Gender/Sex, age, years on logistic 1.8(0.16,20.59) NS
1987 seven different industrial tinel's signs and repetitive motion job, work repetition, level of regression
sites symptoms jobs vs low force involved in job, OR
mentioned in force-low dummy variables controlling
interview repetitive jobs for job center effects
Silverstein,B.A. Moderate N= 652 ; workers form based on phalen and low force-high Gender/Sex, age, years on logistic 2.7(0.26,28.36) NS
1987 seven different industrial tinel's signs and repetitive motion job, work repetition, level of regression
sites symptoms jobs vs low force involved in job, OR
mentioned in force-low dummy variables controlling
interview repetitive jobs for job center effects
376
Silverstein,B.A. Moderate N= 652 ; workers form based on phalen and high force-high Gender/Sex, age, years on logistic 15.52(1.7,141.52) working in a
1987 seven different industrial tinel's signs and repetitive motion job, work repetition, level of regression high force-
sites symptoms jobs vs low force involved in job, OR High
mentioned in force-low dummy variables controlling repetition
interview repetitive jobs for job center effects job was
associated
with higher
odds of CTS
than Low
force-low
repetition
jobs
377
TABLE 91 RISK FACTOR: ROTATION

Armstrong,T. High N= 1071; following median twisting forearm model 1:age, Gender/Sex, body logistic 1.78 (1.18, twisting
2008 worker populations: neuropathy mass index, wrist index, history regression OR 2.69) forearm is
carpenters, cases of diabetes, and history of associated with
workers, engineers, shoulder tendonitis, lifting more higher odds of
laboratory workers, than 2lbs/day, using vibrating median
computer workers, tools, assembly line work, neuropathy
pinch grip
Dale, A.M. Moderate 710 clerical, Presence of peak exposure to age, BMI, Gender/Sex, med Logistical 1.36 (0.66, NS
2014 service, and specific nerve Forearm rotation history, pregnancy, history of Regression 2.83)
construction symptoms in CTS or peripheral neuropathy, or OR
workers from eight survey and other contraindication to
three construction NCS (DML, vibrating tools, forearm rotation,
trade unions MUDS, DSL) wrist bending, forceful gripping,
2004and October
2006 into the
PrediCTS study
378
Dale, A.M. Moderate 710 clerical, Presence of Forearm rotation age, BMI, Gender/Sex, med Logistical 1.23 (0.51, NS
2014 service, and specific nerve in most recent job history, pregnancy, history of Regression 2.94)
construction symptoms in CTS or peripheral neuropathy, or OR
workers from eight survey and other contraindication to
three construction NCS (DML, vibrating tools, forearm rotation,
trade unions MUDS, DSL) wrist bending, forceful gripping,
2004and October
2006 into the
PrediCTS study
Evanoff,B. Moderate N= 745 ; newly symptoms and forearm rotation age, Gender/Sex, lifting at least NR NR NS
2012 employed workers NCS at 3 years 1kg, forceful grip, finger/thumb
pressing, using vibrating tools,
hand/wrist bending
379
TABLE 92 RISK FACTOR: SF-36 PHYSICAL COMPONENT

Goodson, J.T. Moderate 87 CTS and 74 (1)Electrodiagnostic Physical excluded confounding Logistical 0.94(0.9,0.99) Better SF-36
2014 gender/sex- (EDX) testing component conditions; gender/sex, Regression scores are
matched general results suggestive of summary scores age, education levels, OR associated with
orthopedic patients abnormal slowing of (subset of SF-36) ethnicity, and EDX decreased odds
from an outpatient the median nerve, testing results of CTS
orthopedic clinic in (2) the presence of
the Western US. clinical symptoms
of CTS, and (3) no
confounding
syndromes/disorders
380
TABLE 93 RISK FACTOR: SALES

Jenkins,P.J. Low N= unclear ; symptoms and Sales and matched by: all males ; univariate 2.26 (1.024 odds are higher
2013 prospective audit phalen and customer service covariates: Sales and odds ratios 4.83) than in
database of General tinel's sign at 66 occupations vs. customer service associate
Registrar Office for months Associate occupations vs. Associate professional
Scotland professional and professional and technical and technical
technical occupations occupations
occupations
Jenkins,P.J. Low N= unclear ; symptoms and Sales and matched by: all females ; univariate 2.17 (1.38 odds are higher
2013 prospective audit phalen and customer service covariates: Sales and odds ratios 3.48) than in
database of General tinel's sign at 66 occupations vs. customer service associate
Registrar Office for months Associate occupations vs. Associate professional
Scotland professional and professional and technical and technical
technical occupations occupations
occupations
381
TABLE 94 RISK FACTOR: SERVICE OCCUPATIONS

Jenkins,P.J. Low N= unclear ; symptoms and phalen Caring, leisure, matched by: all males ; univariate 5.64 (2.77 odds are higher
2013 prospective audit and tinel's sign at 66 and other service covariates: Caring, odds ratios 11.42) than in
database of General months occupations vs. leisure, and other associate
Registrar Office for Associate service occupations vs. professional
Scotland professional and Associate professional and technical
technical and technical occupations
Jenkins,P.J. Low N= unclear ; symptoms and phalen Caring, leisure, matched by: all females univariate 4.21 (2.77 odds are higher
2013 prospective audit and tinel's sign at 66 and other service ; covariates: Caring, odds ratios 6.56) than in
database of General months occupations vs. leisure, and other associate
Registrar Office for Associate service occupations vs. professional
Scotland professional and Associate professional and technical
technical and technical occupations
Bonfiglioli,R. Moderate N= 269 ; cashiers CTS symptoms Part-time cashiers work(cashiers vs office logistic 1.26(0.59 NS
2007 and office workers vs office worker workers), BMI, age, regression 2.67)
from 4 big previous at risk jobs, odds ratio
supermarket stores CTS family history,
presence of children, do
hand-knitting/needle
work, over 8 years of
education,
Bonfiglioli,R. Moderate N= 269 ; cashiers CTS symptoms Full-time cashiers work(cashiers vs office logistic 2.74(1.18 full time
2007 and office workers vs office worker workers), BMI, age, regression 6.32) cashiers are at
from 4 big previous at risk jobs, odds ratio higher odds
supermarket stores CTS family history, than office
presence of children, do workers
education,
382
Bonfiglioli,R. Moderate N= 269 ; cashiers CTS diagnosis with Part-time cashiers work(cashiers vs office logistic 1.06(0.35 NS
2007 and office workers clinical and vs office worker workers), BMI, age, regression 3.21)
from 4 big electrodiagnostic previous at risk jobs, odds ratio
supermarket stores examinations CTS family history,
education,
Bonfiglioli,R. Moderate N= 269 ; cashiers CTS diagnosis with Full-time cashiers work(cashiers vs office logistic 1.81(0.52 NS
2007 and office workers clinical and vs office worker workers), BMI, age, regression 6.34)
from 4 big electrodiagnostic previous at risk jobs, odds ratio
supermarket stores examinations CTS family history,
education,
Morgenstern,H. Moderate N= 1052 ; grocery symptoms of CTS use of laser matched by: all logistic 0.99(0.65, l NS
1991 store checkers indicated in scanner to check members were regression .49)
belonging to local questionnaire items members of union food odds ratio
California union and commercial
workers union ;
covariates: age, hours
per work week, years
worked, age*years
worked interaction, use
of laser scanner to
check items, unload
basket before checking,
load and lift grocery
bags after checking,
currently pregnant,
contraceptive use, use
of exogenous estrogen,
use of diuretics, history
of broken wrist
383
Morgenstern,H. Moderate N= 1054 ; grocery symptoms of CTS unload basket matched by: all logistic 0.97(0.66, NS
1991 store checkers indicated in before checking members were regression 1.44)
belonging to local questionnaire members of union food odds ratio
workers union ;
worked, age*years
of laser scanner to
check items, unload
currently pregnant,
of broken wrist
384
Morgenstern,H. Moderate N= 1049 ; grocery symptoms of CTS load and lift matched by: all logistic 0.94(0.35, NS
1991 store checkers indicated in groceries after members were regression 2.57)
belonging to local questionnaire checking members of union food odds ratio
workers union ;
worked, age*years
of laser scanner to
check items, unload
currently pregnant,
of broken wrist
385
TABLE 95 RISK FACTOR: SKILLED TRADES

Jenkins,P.J. Low N= unclear ; symptoms and Skilled trades matched by: all males ; univariate 4.19 (2.57 odds are higher
2013 prospective audit phalen and occupations vs. covariates: Skilled trades odds ratios 7.18) than in
database of General tinel's sign at 66 Associate occupations vs. Associate associate
Registrar Office for months professional and professional and technical professional
Scotland technical occupations and technical
Jenkins,P.J. Low N= unclear ; symptoms and Skilled trades matched by: all females ; univariate 8.26 (4.98 odds are higher
2013 prospective audit phalen and occupations vs. covariates: Skilled trades odds ratios 13.86) than in
database of General tinel's sign at 66 Associate occupations vs. Associate associate
Registrar Office for months professional and professional and technical professional
Scotland technical occupations and technical
386
TABLE 96 RISK FACTOR: SMOKING

Bland,J.D. 2005 Low N= 4155 ; all patients NCS confirmed CTS Smoking Gender/Sex, smoking, logistic 1.11(0.94,1.29) NS
referred to the age, BMI*age interaction regression
neurophysiology OR
suspicion of CTS
Wright, C. 2014 Low (3155 w/o CTS clinically diagnosed Non-Smoking age, race/ethnicity, Logistical 1.32 (0.37- NS
diagnosis and 91 with with ICD 9 versus smoker education, smoking, Regression 5.85)
CTS diagnosis); diagnosis code for parity, hypertension, OR
EMR of a cohort of CTS diabetes, maternal
pregnant women weight category
receiving prenatal (constructed variable
care at a large including information
obstetrics unit; about maternal BMI and
representative of GWG), and number
those served by the prenatal care visits
urban academic
proportion of black
patients
Coggon,D. Moderate N= 1230; cases were neurophysiologically ex-smoker vs matched by: gender/sex, logistic 1.1 (0.8-1.4) NS
2013 selected from the positive patients vs non smoker age ; covariates: regression
neurophysiology healthy controls ethnicity, BMI, smoking, OR
department and mental health, repeated
controls for the movements, vibrating
accident and tools, job control, level
emergency services at of supervisor/colleague
Southampton general support
hospital. All were
aged 20-64
387
Coggon,D. Moderate N= 1230; cases were neurophysiologically current smoker matched by: gender/sex, logistic 0.6 (0.4-0.8) odds lower in
2013 selected from the positive patients vs vs non smoker age ; covariates: regression smokers than
neurophysiology healthy controls ethnicity, BMI, smoking, OR non-smokers
department and mental health, repeated
controls for the movements, vibrating
accident and tools, job control, level
emergency services at of supervisor/colleague
Southampton general support
hospital. All were
aged 20-64
Coggon,D. Moderate N= 855; cases were neurophysiologically ex-smoker vs matched by: gender/sex, logistic 1.2 (0.9-1.7) NS
2013 selected from the positive patients vs non smoker age ; covariates: regression
neurophysiology negatively tested ethnicity, BMI, smoking OR
department and patients habits, diabetes, other
controls for the arthritis present, number
accident and of moderately distressing
emergency services at somatic symptoms per
Southampton general week, use of keyboard 4
hospital. All were or more hours per day,
aged 20-64 use of vibrating tools,
job includes
bonuses/targets/deadlines
Coggon,D. Moderate N= 855; cases were neurophysiologically current smoker matched by: gender/sex, logistic 0.8 (0.5-1.1) NS
2013 selected from the positive patients vs vs non smoker age ; covariates: regression
neurophysiology negatively tested ethnicity, BMI, smoking OR
department and patients habits, diabetes, other
controls for the arthritis present, number
accident and of moderately distressing
emergency services at somatic symptoms per
Southampton general week, use of keyboard 4
hospital. All were or more hours per day,
aged 20-64 use of vibrating tools,
job includes
bonuses/targets/deadlines
388
Eleftheriou,A. Moderate N= 441 ; 548 workers personal history of ever Keyboard strokes, age, logistic 1.99 (1.01 to having ever
2012 of a Governmental CTS smoked(yes vs physical activity, regression 3.54) smoked is
data entry & no) smoking OR associated
processing unit with CTS
Geoghegan,J.M. Moderate N= 3350 ; patients diagnosed CTS Smoker matched by: age, logistic 1.03 (0.93 NS
2004 from the UK General gender/sex, and general regression 1.13)
Practice Research practice ; covariates: OR
Database consulting rate, BMI,
smoking, diabetes,
insulin use, metformin
use, sulphonyl use,
hormone replacement
therapy, corticosteroid
use, combined oral
Thyroxine use,
Rheumatoid arthritis,
wrist fracture, arthritis,
also adjusted for missing
data on smoking and
BMI
389
Violante,F.S. Moderate Blue-collar workers occurrence within Smoking (ever gender/sex, age, Logistic 1.7(1.2-1.4) having ever
2007 of several factories last month of smoked versus biomechanical load, Regression smoked
(producing large and classic/ probable not) BMI*wrist interaction OR increases
small domestic or possible effect, height*forearm odds of CTS
appliances, symptoms of CTS interaction effect, family
underwear, ceramic history of CTS,
tiles, and shoes and pathologies facilitating
workers employed in CTS onset(diabetes
all municipal nursery mellitus, amyloidosis,
schools. gout, progressive
systemic sclerosis,
rheumatoid arthritis,
systemic lupus
disorders, tendonitis of
the finger flexors, and
chronic renal failure)
alcohol consumption,
smoking status, previous
exposure to
390
TABLE 97 RISK FACTOR: STATIC STRENGTH

Evanoff,B. High 711 clerical, Presence of Static strength adjusted for age, Gender/Sex, Multivariable 2.7(.85- 8.55) NS
2014 service, and specific nerve importance in and BMI; past diagnosis of mixed logistic
construction symptoms in current job CTS or other upper extremity regression
workers from eight survey and peripheral neuropathy, had a models OR
participating median pacemaker or internal
employers and neuropathy by defibrillator, or were
three construction NCS (DML, pregnant at the time of
trade unions MUDS, DSL) enrollment excluded
between July at 3 years
2004and October
2006 into the
PrediCTS study
391
TABLE 98 RISK FACTOR: STRAIN

Garg,A. 2012 High N= 536 ; workers symptoms (tingling Strain index Model 2: strain index ,age, cox 2.5 (1.00 having high job
from a wide range and/or numbness) in at above 6.1 vs less BMI (continuous), number of proportional 6.13) strain is
of manufacturing least 2 median nerve than or equal to other distal upper extremity hazard ratio associated with
facilities in the served digits, symptoms 6.1 musculoskeletal disorders, higher risk of
Midwest at least 25% of days in gardening, feeling down, CTS
previous month, blue or depressed,
symptoms for at least 2 or rheumatoid arthritis
more consecutive
monthly follow ups,
Burt,S. 2013 Moderate N= 347 ; workers electrodiagnostic test, Job Strain(Job model 2: threshold limit hazard ratios 2.13 (1.001, having high job
from hospital, symptoms, hand diagram Content value, BMI, Job strain 4.54) strain is
school bus at 2 years Questionnaire) associated with
manufacturing higher risk of
plant, and engine CTS
assembly plant
392
TABLE 99 RISK FACTOR: SYMPTOMS

Gell,N. 2005 Low N= 414 ; workers from numbness, tingling, median BMI>27,median ulnar peak logistic 1.29(1.2,1.4) for each one
4 industrial and 3 burning, or pain in the ulnar peak latency difference, numbness regression unit increase
clerical work sites distribution of the median latency tingling, burning, pain in the odds ratio in median
nerve (based on a hand difference hand at baseline ulnar peak
diagram score of latency
probable or definite) difference,
with ipsilateral median CTS odds
nerve conduction slowing are increase
at average 5.4 years by a factor
of 1.29
Vogelsang,L.M. Low N= 100 ; all were diagnosed by orthopaedist CHIPS, social readjustment scale, self- p value <.05 higher scores
1994 worked in what were Cohen- control schedule, life style logistic on the
considered high risk Hoberman approaches scale, self-control regression physical
occupations(automotive Inventory questionnaire, perceived stress symptoms
parts or assembly of Physical scales, Cohen-Hoberman inventory
workers, keyboard Symptoms Inventory of Physical increased the
operators, electronics Symptoms, related medical odds of CTS
industry workers, and condition, suspected medical
garment industry risk, related musculoskeletal
workers from East problems
Tennessee, and sign
language interpreters).
Each case was matched
by age, Gender/Sex,
weight, body type,
length of time, job
duties
393
Werner,R.A. Low N= 189 ; all were hand diagram symptoms, Median Gender/Sex, wrist/hand logistic 7.75(1.3, having a
2005 automobile assembly and median sensory ulnar peak tendonitis, diabetes, coworker regression 45.84) median
line workers evoked response that .5 latency at support, median ulnar peak odds ratio ulnar peak
msec longer than least 0.8 latency on dominant side, elbow latency at
ipsilateral ulnar sensory msec posture rating least 0.8
response at 1 year msec
significantly
increased the
odds of CTS
Winn,F.J.,Jr., Low N= 58 ; cases were median nerve or motor median matched by: age and gender/sex logistic 0.31(0.13,0.73) better
1989 seen at Baltimore sensory symptoms nerve ; covariates: Raynauds regression median
neurology clinic, motor symptoms and median nerve odds ratio nerve motor
healthy controls were function motor function function is
selected by those who associated
responded to with
advertisements in the decreased
same area CTS odds
Coggon,D. Moderate N= 855; cases were neurophysiologically 1 matched by: gender/sex, age ; logistic 0.7 (0.4-1.0) NS
2013 selected from the positive patients vs moderately covariates: ethnicity, BMI, regression
neurophysiology negatively tested patients distressing smoking habits, diabetes, other OR
department and somatic arthritis present, number of
controls for the symptom moderately distressing somatic
accident and vs no symptoms per week, use of
emergency services at distressing keyboard 4 or more hours per
Southampton general somatic day, use of vibrating tools, job
hospital. All were aged symptoms includes
20-64 in past bonuses/targets/deadlines
week
394
Coggon,D. Moderate N= 855; cases were neurophysiologically 2 or more matched by: gender/sex, age ; logistic 0.6 (0.4-0.9) positive
2013 selected from the positive patients vs moderately covariates: ethnicity, BMI, regression tested
neurophysiology negatively tested patients distressing smoking habits, diabetes, other OR patients were
department and somatic arthritis present, number of less likely to
controls for the symptom moderately distressing somatic have 2 or
accident and vs no symptoms per week, use of more
emergency services at distressing keyboard 4 or more hours per moderately
Southampton general somatic day, use of vibrating tools, job distressing
hospital. All were aged symptoms includes somatic
20-64 in past bonuses/targets/deadlines symptoms
week than
negative
tested
patients
395
TABLE 100 RISK FACTOR: TECHNICAL JOBS

Roquelaure,Y. Moderate N= 194276 ; clinical and Technicians matched by: among relative risk 0.6 [0.5-0.8] risk
2008 French electrodiagnostic associate women ; ratio significantly
prospectively CTS tests at 3 years professionals vs covariates: lower than in
surveillance system unemployed controlled for age, the unemployed
stratified by
gender/sex
Roquelaure,Y. Moderate N= 193802 ; clinical and Technicians matched by: among relative risk 0.6 [0.4-0.8] risk
2008 French electrodiagnostic associate men ; covariates: ratio significantly
prospectively CTS tests at 3 years professionals vs controlled for age, lower than in
surveillance system unemployed stratified by the unemployed
gender/sex
396
TABLE 101 RISK FACTOR: TENDONITIS

Armstrong,T. High N= 1071; following median shoulder model 2 best fitting model: logistic 2.66 (0.97, NS
2008 worker neuropathy tendonitis history age, Gender/Sex, body regression OR 7.29)
populations: cases mass index, wrist index,
carpenters, history of diabetes, and
workers, engineers, history of shoulder
computer workers, 2lbs/day, assembly line
and hospital work, hospital vs clerical
support staff. work, construction vs
clerical work
Armstrong,T. High N= 1071; following median shoulder Model 3 with O*NET logistic 2.95 (1.09, History of
2008 worker neuropathy tendonitis history factor variables: age, regression OR 7.95) shoulder
populations: cases gender, body mass index, tendonitis
carpenters, wrist index, history of increases odds of
workers, engineers, diabetes, and history CTS
laboratory workers, of shoulder tendonitis,
computer workers, lifting more than 2lbs/day,
and hospital assembly line work,
construction vs clerical
work
Werner,R.A. Low N= 189 ; all were hand diagram Wrist/hand/finger Gender/Sex, wrist/hand logistic 4.74(1.09 wrist/hand/finger
2005 automobile symptoms, and tendonitis at tendonitis, diabetes, regression 20.43) tendonitis
assembly line median sensory baseline coworker support, median odds ratio significantly
workers evoked ulnar peak latency on increased the
response that .5 dominant side, elbow odds of CTS
msec longer posture rating
than ipsilateral
ulnar sensory
response at 1
year
397
TABLE 102 RISK FACTOR: VARICOSIS

de Krom,M.C. Moderate N= 629; 28 cases clinical history varicosis matched by: age logistic 9.78(2.73, varicosis is
1990 and all controls and and gender/sex regression 34.95) significantly
were identified neurophysiologic stratified random odds ratio associated with
through random testing sample ; covariates: increased odds
sample of patients height, weight(kg), of CTS in
in the Netherlands. slimming males
An additional 128 courses(yes/no),
cases were added Hours/week in
from a single flexion activities,
hospital in the area hours/week for
extension activities,
Varicosis (for men
only), for women:
years since
menopause onset
vs pre-menopausal,
hysterectomy vs
premenopausal
398
TABLE 103 RISK FACTOR: VIBRATION

Armstrong,T. High N= 1071; following median neuropathy using vibrating model 1:age, Gender/Sex, body logistic 1.88(1.23, using
2008 worker populations: cases hand tools mass index, wrist index, history regression 2.85) vibrating hand
carpenters, workers, of diabetes, and history of OR tools is
engineers, laboratory shoulder tendonitis, lifting more associated
workers, computer than 2lbs/day, using vibrating with higher
workers, and hospital tools, assembly line work, odds of
support staff. twisting forearm work, bending median
wrist work, using forceful hand neuropathy
pinch grip
Armstrong,T. High N= 1071; following median neuropathy using vibrating model 2 best fitting model: age, logistic 1.50 (0.98, NS
2008 worker populations: cases hand tools Gender/Sex, body mass index, regression 2.31)
carpenters, workers, wrist index, history of diabetes, OR
engineers, laboratory and history of shoulder
workers, computer tendonitis, lifting more than
workers, and hospital 2lbs/day, assembly line work,
construction vs clerical work
Coggon,D. Moderate N= 1230; cases were neurophysiologically Work for > 1 matched by: gender/sex, age ; logistic 2.4 (1.6-3.8) odds higher in
2013 selected from the positive patients vs hour per day covariates: ethnicity, BMI, regression patients using
neurophysiology healthy controls with vibrating smoking, mental health, repeated OR vibrating tools
department and tools. movements, vibrating tools, job
controls for the control, level of
accident and supervisor/colleague support
emergency services at
Southampton general
20-64
399
Coggon,D. Moderate N= 855; cases were neurophysiologically work with matched by: gender/sex, age ; logistic 1.4 (0.9-2.2) NS
2013 selected from the positive patients vs vibrating tools covariates: ethnicity, BMI, regression
neurophysiology negatively tested >1 hours per smoking habits, diabetes, other OR
department and patients day arthritis present, number of
emergency services at keyboard 4 or more hours per
Southampton general day, use of vibrating tools, job
hospital. All were aged includes
Dale, A.M. Moderate 710 clerical, service, Presence of specific peak exposure age, BMI, Gender/Sex, med Logistical 2.24 (1.02, increased odds
2014 and construction nerve symptoms in to Using history, pregnancy, history of Regression 4.92) of CTS for
workers from eight survey and median vibrating tools CTS or peripheral neuropathy, or OR those using
participating employers neuropathy by NCS other contraindication to vibrating tool
and three construction (DML, MUDS, receiving nerve conduction use at work
trade unions between DSL) at 3 years studies (NCS), lifting objects,
July 2004and October vibrating tools, forearm rotation,
2006 into the PrediCTS wrist bending, forceful gripping,
study thumb pressing, finger pinching
Dale, A.M. Moderate 710 clerical, service, Presence of specific Using vibrating age, BMI, Gender/Sex, med Logistical 2.04 (0.82, NS
2014 and construction nerve symptoms in tools in most history, pregnancy, history of Regression 5.09)
workers from eight survey and median recent job CTS or peripheral neuropathy, or OR
participating employers neuropathy by NCS other contraindication to
and three construction (DML, MUDS, receiving nerve conduction
trade unions between DSL) at 3 years studies (NCS), lifting objects,
July 2004and October vibrating tools, forearm rotation,
2006 into the PrediCTS wrist bending, forceful gripping,
study thumb pressing, finger pinching
400
Nordstrom,D.L. Moderate N= 417 ; only incident Diagnosed by Power tool use matched by: age ; covariates: logistic 0.53 (0.17, NS
1997 cases diagnosed physician, or had 0.08-0.75 musculoskeletal condition, BMI, regression 1.64)
between 1994 and explicit treatment for hours/day vs Parent/sibling/child has CTS, OR
1995 were eligible as CTS and hand none power tool use, hours bending or
1997 cases diagnosed physician, or had 1-2 hours/day vs musculoskeletal condition, BMI, regression 3.90)
between 1994 and explicit treatment for none Parent/sibling/child has CTS, OR
1997 cases diagnosed physician, or had 2.5-5.5 musculoskeletal condition, BMI, regression 4.00)
between 1994 and explicit treatment for hours/day vs Parent/sibling/child has CTS, OR
1995 were eligible as CTS and hand none power tool use, hours bending or
Nordstrom,D.L. Moderate N= 417 ; only incident Diagnosed by Power tool use matched by: age ; covariates: logistic 3.30(1.11, odds higher in
1997 cases diagnosed physician, or had 6-11 hours/day musculoskeletal condition, BMI, regression 9.8) workers who
between 1994 and explicit treatment for vs none Parent/sibling/child has CTS, OR use power
1995 were eligible as CTS and hand power tool use, hours bending or tools 6-11
cases in Marshfield symptoms within twisting wrists, hours contacted hours/day
401
TABLE 104 RISK FACTOR: WORK LENGTH

Matias,A.C. Moderate N= 100 ; video display "medically work day duration work day duration logistic 1.015(.0479) longer work
1998 terminal operators at diagnosed" CTS regression day is
Midwestern university odds ratio associated with
increased CTS
odds
Mondelli,M. Moderate N= 145 ; female diagnosed current job length Age, BMI, duration of logistic 0.83 (0.26- NS
2006 hospital floor cleaners according to 2nd vs 1st occupational exposure to current regression OR 2.69)
in Italy AAN criteria: quartile job, occupational exposure to the
2006 hospital floor cleaners according to 3rd vs 1st quartile occupational exposure to current regression OR 2.43)
in Italy AAN criteria: job, occupational exposure to the
402
2006 hospital floor cleaners according to 4th vs 1st quartile occupational exposure to current regression OR 5.65)
in Italy AAN criteria: job, occupational exposure to the
Morgenstern,H. Moderate N= 1058 ; grocery store symptoms of hours worked per matched by: all members were logistic 1.03(p=.0081) NS
1991 checkers belonging to CTS indicated week members of union food and regression
local California union in questionnaire commercial workers union ; odds ratio
covariates: age, hours per work
wrist
403
Morgenstern,H. Moderate N= 1058 ; grocery store symptoms of years worked matched by: all members were logistic .1238(p=.055) NS
1991 checkers belonging to CTS indicated members of union food and regression
local California union in questionnaire commercial workers union ; odds ratio
covariates: age, hours per work
wrist
Nordstrom,D.L. Moderate N= 417 ; only incident Diagnosed by worked 3048- matched by: age ; covariates: logistic 1.54 (0.74, NS
1997 cases diagnosed physician, or 4857 vs 2954 musculoskeletal condition, BMI, regression OR 3.20)
between 1994 and 1995 had explicit hours Parent/sibling/child has CTS,
were eligible as cases treatment for power tool use, hours bending or
in Marshfield CTS and hand twisting wrists, hours contacted
Wisconsin, and symptoms with solvents per day, IOSH job
controls were a random within one control measure, cumulative
sample from this area month of date hours worked since 1993
of diagnosis.
Nordstrom,D.L. Moderate N= 417 ; only incident Diagnosed by Worked 5464- matched by: age ; covariates: logistic 0.43 (0.18, NS
1997 cases diagnosed physician, or 6507 vs 2954 musculoskeletal condition, BMI, regression OR 1.05)
between 1994 and 1995 had explicit hours Parent/sibling/child has CTS,
were eligible as cases treatment for power tool use, hours bending or
in Marshfield CTS and hand twisting wrists, hours contacted
Wisconsin, and symptoms with solvents per day, IOSH job
controls were a random within one control measure, cumulative
sample from this area month of date hours worked since 1993
of diagnosis.
404
Silverstein,B.A. Moderate N= 652 ; workers form based on phalen years on job Gender/Sex, age, years on job, logistic 0.9(0.8,1.02) NS
1987 seven different and tinel's signs work repetition, level of force regression OR
industrial sites and symptoms involved in job, dummy variables
mentioned in controlling for job center effects
interview
405
TABLE 105 RISK FACTOR: FINGER PINCH

Dale, A.M. Moderate 710 clerical, service, Presence of peak exposure to age, BMI, Gender/Sex, med Logistical 0.87 (0.39, NS
2014 and construction specific nerve Finger pinching history, pregnancy, history Regression 1.93)
participating employers survey and neuropathy, or other
and three construction median contraindication to receiving
trade unions between neuropathy by nerve conduction studies
July 2004and October NCS (DML, (NCS), lifting objects,
2006 into the PrediCTS MUDS, DSL) vibrating tools, forearm
study at 3 years rotation, wrist bending,
Dale, A.M. Moderate 710 clerical, service, Presence of Finger pinching age, BMI, Gender/Sex, med Logistical 0.62 (0.18, NS
2014 and construction specific nerve in most recent job history, pregnancy, history Regression 2.08)
participating employers survey and neuropathy, or other
and three construction median contraindication to receiving
trade unions between neuropathy by nerve conduction studies
July 2004and October NCS (DML, (NCS), lifting objects,
2006 into the PrediCTS MUDS, DSL) vibrating tools, forearm
study at 3 years rotation, wrist bending,
406
NONOPERATIVE TREATMENTS FOR CARPAL TUNNEL SYNDROME
A. IMMOBILIZATION
Strong evidence supports that the use of immobilization (brace/splint/orthosis)
should improve patient reported outcomes.

Rationale
There are two high quality studies (Hall 2013 and Manente 2001) that directly compare the use
of brace/splint to no use of brace/splint to treat carpal tunnel syndrome. Hall 2013 compared 8
weeks of full-time splinting versus no splinting. The authors showed statistically significant
improvement in pain and function (Boston Questionnaire for assessment of carpal tunnel
symptom functional status scale, Boston Questionnaire for assessment of carpal tunnel symptom
severity, AS, phalens, grip strength, Purdue Pegboard Test score, Semmes Weinstein
monofilaments). The authors describe statistically significant differences when comparing
percent change in these factors from pre to post treatment. There were some
baseline/pretreatment differences between the groups, such that it calls into question whether
these factors were actually statistically different after treatment. Manente 2001 compared four
weeks of night bracing to no intervention. The treated group showed a reduction in the Boston
Carpal Tunnel Questionnaire symptomatic score (from 2.75 to 1.54 at 4 weeks; p<0.001) and
functional score (from 1.89 to 1.48 at 4 weeks; p<0.001). Subjects Global Impression of Change
Questionnaire documented improvement in the braced group at 4 weeks (p=0.006). Subjects
Global Impression of Change Questionnaire documented improvement in the braced group at 4
weeks (p=0.006).

No harm in implementation of brace/splint use, if tolerated by patient.
B. STEROID INJECTIONS
Strong evidence supports that the use of steroid (methylprednisolone) injection
should improve patient reported outcomes.

Rationale
There is one high quality study (Atroshi 2013) that directly compares the use of steroid injection
to placebo to treat carpal tunnel syndrome. In a prospective, randomized, double-blinded,
placebo controlled study, the efficacies of 40mg methylprednisolone and 80mg
407
methylprednisolone were compared to placebo injection at various time lines (10 weeks and 1
year). At 10 weeks, there was greater improvement in the CTS symptom severity score in the
group receiving injections of 40mg or 80mg methylprednisolone (p<0.003) versus placebo
injections; but there was no difference amongst the groups at 1 year. However, patients
receiving 80mg methylprednisolone injection were less likely to go on to need surgery than
placebo injection (p=0.04). A small p-value (p<.05) indicates that this difference was not
observed due to chance, subsequently favoring the alternative hypothesis of methylprednisolone
injection improving patient outcomes.
Several high quality studies (Dammers 2006[1-3], Wong 2001, and Wong 2005) compare
various doses of injected or routes of administration of methylprednisolone to treat carpal tunnel
syndrome. In a double blinded, randomized study, Dammers 2006 compare the efficacy of 20,
40, and 60mg methylprednisolone injections to treat carpal tunnel syndrome. There was no
significant difference in treatment response at 1 year. In a randomized double blind controlled
trial, Wong 2005 compare a the effects of a single 80mg methylprednisolone injection with
saline injection at 8 weeks versus two 80mg methylprednisolone injections 8 weeks apart. There
was no significant difference between groups respect to Global Symptom Score,
electrophysiological study, or functional outcomes (p=0.26). In a prospective randomized
double-blind study, Wong 2001 compared 25mg methylprednisolone orally for 10 days and
placebo injection to 15mg methylprednisolone injection with oral placebo. The steroid injection
provided significant improvement based on Global Symptom Score at 12 weeks.

There is potential harm of corticosteroid injection in the vicinity of flexor tendons and
neurovascular structures.
C. MAGNET THERAPY
Strong evidence supports not using magnet therapy for the treatment of carpal
tunnel syndrome.
Rationale
Several high quality studies (Colbert 2010, Weintraub 2008) evaluated the use of magnets in
treating carpal tunnel syndrome. In a prospective randomized double-blinded controlled trial,
Weintraub 2008 evaluated the efficacy of a magnet (simultaneous static and time-varying
dynamic magnetic field stimulation 4 hours/day for two months). No significant measures of
improvement were noted. In a randomized, double-blind controlled trial, Colbert 2010 evaluated
the efficacy of magnet (wore nightly for 6 weeks a neodymium magnet of 15 or 45mTesla)
versus placebo magnet on the treatment of carpal tunnel syndrome. No significant measures of
improvement were noted.

Magnet use may lead to sleep disturbance.
408
D. ORAL TREATMENTS
Moderate evidence supports no benefit of oral treatments (diuretic, gabapentin,
astaxanthin capsules, NSAIDs, or pyridoxine) compared to placebo.
Rationale
Two high quality studies (Chang 1998 and Hui 2011) compare various oral regimens to treat
carpal tunnel syndrome. In a prospective randomized double-blind study placebo controlled
study, Chang 1993 compare various 4 week oral medication regimens (diuretic
[trichlormethiazide 2mg daily] versus NSAID [tenoxicam-SR 20mg daily] versus steroid [2
weeks of prednisolone 20mg daily followed by 2 weeks of 10mg daily]) to placebo. No
significant changes from baseline were noted in the placebo, diuretic, or NSAID arms. However,
the steroid arm improved significantly at 4 weeks, based on GSS Questionnaire. A review of the
data provided indicates that at 4 weeks, the steroid arm had statistically significant improvement
over the NSAID and diuretic arms based on GSS Questionnaire. Hui 2011 failed to show any
significance when comparing oral Gabapentin to placebo.

There is potential harm of oral NSAID or steroid use.
E. ORAL STEROIDS
Moderate evidence supports that oral steroids could improve patient reported
outcomes as compared to placebo.

Rationale
Two high quality studies (Chang 1998 and Hui 2011) compare various oral regimens to treat
carpal tunnel syndrome. In a prospective randomized double-blind study placebo controlled
study, Chang 1993 compare various 4 week oral medication regimens (diuretic
[trichlormethiazide 2mg daily] versus NSAID [tenoxicam-SR 20mg daily] versus steroid [2
weeks of prednisolone 20mg daily followed by 2 weeks of 10mg daily]) to placebo. No
significant changes from baseline were noted in the placebo, diuretic, or NSAID arms. However,
the steroid arm improved significantly at 4 weeks, based on GSS Questionnaire. A review of the
data provided indicates that at 4 weeks, the steroid arm had statistically significant improvement
over the NSAID and diuretic arms based on GSS Questionnaire. Hui 2011 failed to show any
significance when comparing oral Gabapentin to placebo.
409
There is potential harm of oral NSAID or steroid use.
F. KETOPROFEN PHONOPHORESIS
Moderate evidence supports that ketoprofen phonophoresis could provide
reduction in pain compared to placebo.

Rationale
In a randomized controlled trial, Soyupek 2012 compared phonophoresis with corticosteroid
versus phonophoresis with nonsteroidal anti-inflammatory drug use. Phonophoresis with
corticosteroid showed statistically significant improved in VAS score. In a prospective,
randomized, double-blinded controlled trial, Yildiz 2011 compared the efficacy of 2 weeks of
treatment with placebo ultrasound, ultrasound, or ketoprofen phonophoresis. The group that
underwent ketoprofen phonophoresis for two weeks demonstrated significant improvement in
VAS score over the sham ultrasound and the ultrasound group at two weeks and eight weeks.

No known harm in use of phonophoresis.
G. THERAPEUTIC ULTRASOUND
Limited evidence supports that therapeutic ultrasound might be effective compared
to placebo.

Rationale
One high quality study (Ebenbichler 1998) evaluated the use of ultrasound in treating carpal
tunnel syndrome. In a randomized controlled trial, Ebenbichler 1998 evaluated the efficacy of
ultrasound (20 sessions of 15 minute interventions of 1MHz, 1.0 W/cm, pulse mode 1:4 at 5
sessions/week for 2 weeks followed by 2 sessions/week) versus placebo ultrasound on the
treatment of carpal tunnel syndrome. Multiple measures showed significant improvement in the
ultrasound group: grip strength, motor distal latency (p<0.001), and pinch strength.

No known harm in use of ultrasound.
410
H. LASER THERAPY
Limited evidence supports that laser therapy might be effective compared to
placebo.
Rationale
Several high quality studies (Chang 2008, Evcik 2007, Fusakul 2014) evaluated the use of laser
therapy in treating carpal tunnel syndrome. In a randomized, controlled trial, Chang 2008
evaluated the efficacy of a laser (830nm diode with 10Hz, 50% duty cycle, 60 mW, 9.7J/cm)
versus placebo laser on the treatment of carpal tunnel syndrome. The treatment was rendered for
10 minutes daily for 5 days a week for two weeks. After 4 weeks, the laser treatment provided
significantly improved grip strengths, digital prehension, and lateral prehension (p<0.05). In a
randomized controlled trial, Evcik 2007 evaluated the efficacy of laser (7J/2min) versus placebo
laser. The treatment was rendered five times per week for two weeks. After four weeks,
significant improvement in grip strength and pinch strength was noted (p<0.001); there was also
significant improvement in sensory nerve velocity, sensory distal latency, and motor distal
latency (p<0.001). In a randomized double-blinded controlled trial, Fusakul 2014 evaluated the
efficacy of laser (gallium-aluminum-arsenide at a dose of 18J/session) versus placebo laser. Grip
strength and pinch strength was significantly improved. At 12 weeks follow up, distal motor
latency was significantly improved (p<0.05).

Potential harm of laser therapy is unknown.
Future Research for Nonoperative Treatments

Further research in acupuncture is warranted. In a prospective randomized double-blind
controlled study, Yao et al evaluated the efficacy of acupuncture (weekly sessions for 6 weeks)
versus placebo to treat carpal tunnel syndrome. No significant measures of improvement were
noted. Soft tissue manipulation: further research in manipulation is warranted. Many different
techniques are utilized and the terminology distinguishing them is loosely utilized. Further
research into linseed oils biological mechanism of action, along with technical refinements and
specifics in its manufacture are warranted.
411
STUDY QUALITY TABLE OF CONSERVATIVE TREATMENTS
Table 106. Intervention Quality Evaluations
Is there a
Random Incomplete Influence of All Dose-
Allocation Selective Other large
Study Sequence Blinding Outcome Plausible Residual Response Inclusion Strength
Concealment Reporting Bias magnitude
Generation Data Confounding Gradient
of effect?
High
Atroshi,I., 2013 Include
Quality
Bakhtiary,A.H., High
Include
2004 Quality
High
Burke,J., 2007 Include
Quality
Chang,M.H., High
Include
1998 Quality
Chang,W.D., High
Include
2008 Quality
Chang,Y.W., High
Include
2014 Quality
Colbert,A.P., High
Include
2010 Quality
Dammers,J.W., High
Include
2006 Quality
Ebenbichler,G.R., High
Include
1998 Quality
High
Evcik,D., 2007 Include
Quality
High
Fusakul,Y., 2014 Include
Quality
High
Hall,B., 2013 Include
Quality
High
Hui,A.C., 2011 Include
Quality
412
Is there a
of effect?
Madjdinasab,N., High
Include
2008 Quality
High
Manente,G., 2001 Include
Quality
High
Pratelli,E., 2015 Include
Quality
Saeed,F.-U., High
Include
2012 Quality
High
Soyupek,F., 2012 Include
Quality
Weintraub,M.I., High
Include
2008 Quality
High
Wong,S.M., 2001 Include
Quality
High
Wong,S.M., 2005 Include
Quality
High
Yagci,I., 2009 Include
Quality
High
Yang,C.P., 2011 Include
Quality
High
Yildiz,N., 2011 Include
Quality
413
RESULTS
TABLE 107: SUMMARY OF FINDINGS PICO 6 PART 1 IMMOBILIZATION (EARLY
FOLLOW-UP (<90DAYS))
High Quality
Favors treatment 1
Madjdinasab,N., 2008
Favors treatment 2
Soyupek,F., 2012 (1)

Manente,G., 2001
Not significant
Meta-Analysis
Yagci,I., 2009
Hall,B., 2013
Outcomes
Function
Grip Strength NA
NCS (CMAP) NA
NCS (DML)
NCS (DSL) NA
NCS (MCV) NA
NCS (NCV) NA
NCS (SNAP) NA
NCS (SNCV)
Phalen's test score NA
Questionnaire (Boston-FSS) NA
Semmes-Weinstein Monofilaments Test (SW test) NA
Tinel's Sign/Test NA
Ultrasound (US)
Anterior-prosterior diameter of median nerve NA
Cross-sectional area of median nerve NA
Transverse diameter of median nerve NA
Other
Purdue Pegboard test score NA
Questionnaire (GICQ)
Global Impression Change Questionnaire NA
Pain
Questionnaire/Scale (VAS-pain) NA
Symptoms
Questionnaire (Boston-SSS) NA
TABLE 108: SUMMARY OF FINDINGS PICO 6 PART 2 STEROID INJECTION (EARLY

FOLLOW-UP (<90DAYS))
414
High Quality
Favors treatment 1
Favors treatment 2
Atroshi,I., 2013 (1)

Not significant
Wong,S.M., 2001
Wong,S.M., 2005
Meta-Analysis
Outcomes
Function
Grip Strength NA
NCS (DML) NA
Pinch Strength NA
Two-point discrimination NA
Other
Questionnaire (General/Undefined)
SF-6D score
35 days NA
70 days NA
Pain
SF-36 bodily pain score NA
Symptoms
CTS symptom severity score NA
Questionnaire (DASH-Quick DASH) NA
Questionnaire/Scale (GSS) NA
415
TABLE 109: SUMMARY OF FINDINGS PICO 6 PART 2 STEROID INJECTION (LATE
FOLLOW-UP (>90DAYS))
High Quality
Favors treatment 1
Dammers,J.W., 2006 (1)

Favors treatment 2

Not significant
Wong,S.M., 2005
Meta-Analysis
Outcomes
Complications
Treatment Failure NA
Second Injection
180 days NA
365 days NA
Function
Grip Strength NA
Kilograms (left hand) NA
Kilograms (right hand) NA
NCS (DML)
Distal motor latency (left hand) NA
Distal motor latency (right hand) NA
Pinch Strength NA
Other
SF-6D score NA
Pain
SF-36 bodily pain score NA
Symptoms
CTS symptom severity score NA
Symptom relief (general) NA
416
TABLE 110: SUMMARY OF FINDINGS PICO 6 PART 4 ORAL TREATMENT (EARLY FOLLOW-UP
(<90DAYS))
High Quality
Favors treatment 1
Favors treatment 2
Chang,M.H., 1998 (1)

Chang,M.H., 1998 (2)
Chang,M.H., 1998 (3)
Chang,M.H., 1998 (4)
Chang,M.H., 1998 (5)
Chang,M.H., 1998 (6)
Spooner,G.R., 1993
Not significant
Meta-Analysis
Hui,A.C., 2011
Outcomes
Function
Grip Strength NA
Hand dexterity NA
NCS (DML) NA
NCS (MA) NA
NCS (MCV) NA
CTS Functional Scale, no mention of Boston or Levine NA
Questionnaire (DASH) NA
SF-36 (physical functioning)
Physical Component Summary Score (US norm=50) NA
42 days NA
84 days NA
Tactile perception threshold NA
Vibrometry NA
Other
SF-36 (mental health) NA
Symptoms
Not questionnaire, incidence of movement discomfort NA
Not questionnaire, incidence of night discomfort NA
Not questionnaire, incidence of poor coordination NA
Not questionnaire, incidence of swelling NA
417
TABLE 111: SUMMARY OF FINDINGS PICO 6 PART 5 TOPICAL TREATMENT (EARLY FOLLOW-UP
(<90DAYS))
High Quality
Favors treatment 1
Favors treatment 2

Not significant
Chang,Y.W., 2014
Yildiz,N., 2011 (1)

Yildiz,N., 2011 (2)
Meta-Analysis
Outcomes
Function
CTS Functional Scale, no mention of Boston or Levine NA
NCS (CMAP) NA
NCS (DML) NA
NCS (DSL) NA
NCS (NCV) NA
NCS (SNAP) NA
Pinch Strength NA
Ultrasound (US) NA
Pain
Symptoms
418
TABLE 112: SUMMARY OF FINDINGS PICO 6 PART 6 OTHER TREATMENTS (EARLY FOLLOW-UP
(<90DAYS))
High Quality
Favors treatment 1
Ebenbichler,G.R., 1998
Weintraub,M.I., 2008
Colbert,A.P., 2010 (1)
Favors treatment 2
Bakhtiary,A.H., 2004
Not significant
Chang,W.D., 2008
Saeed,F.-U., 2012
Yildiz,N., 2011 (3)

Fusakul,Y., 2014
Yang,C.P., 2011
Meta-Analysis
Evcik,D., 2007
Outcomes
Function
Grip Strength
Kilograms
0 days NA
28 days NA
49 days NA
84 days NA
Kilograms (digital prehension) (at 28 days) NA
Kilograms (lateral prehension)
28 days NA
Units not reported
35 days NA
49 days NA
84 days NA
NCS
Index SAP amplitude NA
Motor nerve velocity, (m/sn) NA
Sensory peak latency of the median nerve (ms) NA
Thumb SAP amplitude NA
NCS (CMAP) NA
NCS (DML)
Distal motor latency (ms)
0 days NA
28 days NA
30 days NA
42 days NA
49 days NA
84 days NA
90 days NA
Median motor distal latency NA
NCS (DSL) NA
NCS (Motor amplitude (uV)) NA
NCS (MCV) NA
NCS (Sensory amplitude, (uV)) NA
NCS (SNAP) NA
NCS (SNCV)
Sensory nerve conduction velocity (antidromic)
0 days NA
49 days NA
Sensory nerve conduction velocity (prolonged antidromic wristpalm) NA
Sensory nerve velocity, (m/sn) NA
Pinch Strength
Kilograms
0 days NA
28 days NA
49 days NA
84 days NA
Units not reported
35 days NA
49 days NA
84 days NA
419
CONTD SUMMARY OF FINDINGS PICO 6 PART 6 OTHER TREATMENTS (EARLY FOLLOW-UP
(<90DAYS))
High Quality
Favors treatment 1
Weintraub,M.I., 2008
Favors treatment 2
Bakhtiary,A.H., 2004
Not significant
Chang,W.D., 2008
Saeed,F.-U., 2012
Yildiz,N., 2011 (3)

Fusakul,Y., 2014
Yang,C.P., 2011
Meta-Analysis
Evcik,D., 2007
Outcomes
Pain
NPS 10. Neuropathic pain scale (NPS) NA
NPS NA. Neuropathic pain scale (NPS) NA
VAS pain (day): 0-10 scale
28 days NA
84 days NA
VAS pain (night): 0-10 scale
28 days NA
84 days NA
Questionnaire/Scale (VAS-patient satisfaction)
Sleep interference NA
Symptoms
Not a questionnaire, worst complaint (cm)
0 days NA
49 days NA
No mention of Boston scale, rather merely "symptom severity scale" NA
Questionnaire (Boston-SSS)
35 days NA
42 days NA
84 days NA
Sensory loss
0 days NA
49 days NA
Complications
Complications (general)
Pain or paraesthesia complaints
0 days NA
49 days NA
420
TABLE 113: SUMMARY OF FINDINGS PICO 6 PART 6 OTHER TREATMENTS (LATE FOLLOW-UP
(>90DAYS))
High Quality
Favors treatment 1
Favors treatment 2
Not significant
Yang,C.P., 2011
Meta-Analysis
Outcomes
Complications
Pain or paraesthesia complaints NA
Function
Grip strength (kilograms) NA
NCS (CMAP) NA
NCS (DML) NA
NCS (DSL) NA
NCS (MCV) NA
NCS (SNAP) NA
NCS (SNCV) NA
Pinch Strength (kilograms) NA
Symptoms
Not questionnaire, worst complaint (cm) NA
Sensory loss NA
421
TABLE 114: PICO 6 PART 1- IMMOBILIZATION: FUNCTION
Treatment Treatment Result

Reference Outcome 1 Group1 Mean1/P1 2 Group2 Mean2/P2 Effect (95% Favored
Title Quality Details Duration (Details) N (SD1) (Details) N (SD2) Measure CI) Treatment
Hall,B., 2013 High Grip 1.8 months Splint (Splint) 30 25.01(9.37 No splint (No 24 23.9(8.88) Mean 1.11(-3.78, Not Significant
Quality strength(Kilogra ) splint) Differen 5.995145) (P-value>.05)
ms) ce
Hall,B., 2013 High Questionnaire 1.8 months Splint (Splint) 30 2.04(0.74) No splint (No 24 2.08(0.70) Mean -0.04(-0.43, Not Significant
Quality (Boston- splint) Differen 0.345427) (P-value>.05)
FSS)(Boston ce
CTS
Questionnaire
(functional
status scale))
Hall,B., 2013 High Semmes- 1.8 months Splint (Splint) 30 89.78(78.9 No splint (No 24 99.68(87.9 Mean -9.9(-55.04, Not Significant
Quality Weinstein 8) splint) 6) Differen 35.23541) (P-value>.05)
Monofilaments ce
Test (SW
test)(swm score,
palmar side)
Hall,B., 2013 High Grip 1.8 months Splint (Splint) 30 Mean No splint (No 24 Mean Differen 0.78 (p value = Splint (Splint)
Quality strength(Kilogra change= splint) change= ce 0.02) (P-value>.05)
ms) 1.07 (p 1.85 (p between
value = value = Mean
0.018) 0.107) Changes
Hall,B., 2013 High Questionnaire 1.8 months Splint (Splint) 30 Mean No splint (No 24 Mean Differen 0.28 (p value = Splint (Splint)
Quality (Boston- change = splint) change= ce 0.015) (P-value>.05)
FSS)(Boston -0.20 (p 0.08 (p between
CTS value = value = Mean
Questionnaire 0.013) 0.413) Changes
(functional
status scale))
Hall,B., 2013 High Semmes- 1.8 months Splint (Splint) 30 Mean No splint (No 24 Mean Differen 1.52 (p value Splint (Splint)
Quality Weinstein change= splint) change= ce <0.001) (P-value>.05)
Monofilaments -11.13 (p -9.63 (p between
Test (SW value = value = Mean
test)(swm score, 0.073) 0.313) Changes
palmar side)
422
Madjdinasab, High NCS 1.4 months Splint (Splint- 21 5.21(1.17) Steroid 22 4.92(0.91) Mean 0.29(- Not Significant
N., 2008 Quality (DML)(Distal splint for six (Steroid (no Differen 0.34,0.918505) (P-value>.05)
motor latency weeks) splint)-daily ce
(ms)) for two
weeks)
Madjdinasab, High NCS 1.4 months Splint (Splint- 21 3.51(0.78) Steroid 22 3.31(0.45) Mean 0.2(- Not Significant
N., 2008 Quality (DSL)(Distal splint for six (Steroid (no Differen 0.18,0.582957) (P-value>.05)
sensory latency weeks) splint)-daily ce
(ms)) for two
weeks)
Madjdinasab, High NCS 1.4 months Splint (Splint- 21 52.04(4.46 Steroid 22 49.97(4.95 Mean 2.07(- Not Significant
N., 2008 Quality (MCV)(Motor splint for six ) (Steroid (no ) Differen 0.74,4.883790) (P-value>.05)
nerve weeks) splint)-daily ce
conduction for two
velocity (ms)) weeks)
Madjdinasab, High NCS 1.4 months Splint (Splint- 21 41.46(12.5 Steroid 22 44.38(8.47 Mean -2.92(- Not Significant
N., 2008 Quality (SNCV)(Sensor splint for six 1) (Steroid (no ) Differen 9.34,3.495321) (P-value>.05)
y conduction weeks) splint)-daily ce
velocity) for two
weeks)
Manente,G., High NCS 1 month Brace 40 4.45(1.30) No brace . 4.47(0.80) Mean -0.02(-.49,.45) Not Significant
2001 Quality (DML)(Distal (Immobilizati (Non- Differen (P-value>.05)
motor latency on-brace) immobilizatio ce
(ms)) n-no brace)
Manente,G., High NCS 1 month Brace 40 18.74(15.8 No brace 40 12.44(9.40 Mean 6.3(0.60,11.99) Brace
2001 Quality (SNAP)(Sensory (Immobilizati 0) (Non- ) Differen (Immobilizati
nerve action on-brace) immobilizatio ce on-brace)
potential (?V)) n-no brace) (P-value<.05)
Manente,G., High NCS 1 month Brace 40 37.2(11.70 No brace 40 37.92(11.7 Mean -0.72(-5.85,4.4) Not Significant
2001 Quality (SNCV)(Sensor (Immobilizati ) (Non- 0) Differen (P-value>.05)
y conduction on-brace) immobilizatio ce
velocity) n-no brace)
423
Manente,G., High Questionnaire 1 month Brace 40 1.48(0.50) No brace 40 2.03(0.70) Mean -0.55(-0.82,-0.28) Brace
2001 Quality (Boston- (Immobilizati (Non- Differen (Immobilizati
FSS)(Boston on-brace) immobilizatio ce on-brace)
CTS n-no brace) (P-value<.05)
Questionnaire
(functional
status scale))
Soyupek,F., High NCS 3 months Splinting 23 11.92(3.01 NSAID with 23 9.97(3.34) Mean 1.95(0.11,3.78) Splinting
2012 Quality (CMAP)(Compo (Splinting) ) ultrasound Differen (Splinting)
und muscle (Phonophores ce (P-value<.05)
action potential) is
(ultrasound)
with
nonsteroid
anti-
inflammatory
drug
(PNSAI))
Soyupek,F., High NCS 3 months Splinting 23 11.92(3.01 Steroid with 28 10.36(2.57 Mean 1.56(0.00,3.11) Splinting
2012 Quality (CMAP)(Compo (Splinting) ) ultrasound ) Differen (Splinting)
und muscle (Phonophores ce (P-value<.05)
action potential) is
(ultrasound)
with
corticosteroid
("PCS
group"))
Soyupek,F., High NCS 3 months Splinting 23 4.28(0.80) Steroid with 28 4.39(0.87) Mean -0.11(- Not Significant
2012 Quality (DML)(Distal (Splinting) ultrasound Differen 0.57,0.349067) (P-value>.05)
motor latency (Phonophores ce
(ms)) is
(ultrasound)
with
corticosteroid
("PCS
group"))
424
Soyupek,F., High NCS 3 months Splinting 23 4.28(0.80) NSAID with 23 4.5(1.15) Mean -0.22(- Not Significant
2012 Quality (DML)(Distal (Splinting) ultrasound Differen 0.79,0.352528) (P-value>.05)
motor latency (Phonophores ce
(ms)) is
(ultrasound)
with
nonsteroid
anti-
inflammatory
drug
(PNSAI))
Soyupek,F., High NCS 3 months Splinting 23 3.47(1.00) Steroid with 28 3.08(0.96) Mean 0.39(- Not Significant
2012 Quality (DSL)(Distal (Splinting) ultrasound Differen 0.15,0.931728) (P-value>.05)
sensory latency (Phonophores ce
(ms)) is
(ultrasound)
with
corticosteroid
("PCS
group"))
Soyupek,F., High NCS 3 months Splinting 23 3.47(1.00) NSAID with 23 3.52(1.02) Mean -0.05(- Not Significant
2012 Quality (DSL)(Distal (Splinting) ultrasound Differen 0.63,0.533780) (P-value>.05)
sensory latency (Phonophores ce
(ms)) is
(ultrasound)
with
nonsteroid
anti-
inflammatory
drug
(PNSAI))
425
Soyupek,F., High NCS 3 months Splinting 23 52.28(3.27 NSAID with 23 53.12(5.04 Mean -0.84(- Not Significant
2012 Quality (NCV)(Motor (Splinting) ) ultrasound ) Differen 3.30,1.615345) (P-value>.05)
nerve (Phonophores ce
conduction is
velocity) (ultrasound)
with
nonsteroid
anti-
inflammatory
drug
(PNSAI))
Soyupek,F., High NCS 3 months Splinting 23 52.28(3.27 Steroid with 28 52.26(4.00 Mean 0.02(- Not Significant
2012 Quality (NCV)(Motor (Splinting) ) ultrasound ) Differen 1.98,2.015292) (P-value>.05)
conduction is
with
corticosteroid
("PCS
group"))
Soyupek,F., High NCS 3 months Splinting 23 37.65(10.5 NSAID with 23 36.91(10.1 Mean 0.74(- Not Significant
2012 Quality (NCV)(Sensory (Splinting) 0) ultrasound 6) Differen 5.23,6.711264) (P-value>.05)
conduction is
with
nonsteroid
anti-
inflammatory
drug
(PNSAI))
426
Soyupek,F., High NCS 3 months Splinting 23 37.65(10.5 Steroid with 28 40.44(12.8 Mean -2.79(- Not Significant
2012 Quality (NCV)(Sensory (Splinting) 0) ultrasound 3) Differen 9.19,3.613043) (P-value>.05)
conduction is
with
corticosteroid
("PCS
group"))
Soyupek,F., High NCS 3 months Splinting 23 16.86(8.56 NSAID with 23 17.95(11.2 Mean -1.09(- Not Significant
2012 Quality (SNAP)(Sensory (Splinting) ) ultrasound 7) Differen 6.87,4.693862) (P-value>.05)
nerve action (Phonophores ce
potential is
amplitude) (ultrasound)
with
nonsteroid
anti-
inflammatory
drug
(PNSAI))
Soyupek,F., High NCS 3 months Splinting 23 16.86(8.56 Steroid with 28 17.7(9.04) Mean -0.84(- Not Significant
2012 Quality (SNAP)(Sensory (Splinting) ) ultrasound Differen 5.68,4.002603) (P-value>.05)
nerve action (Phonophores ce
potential is
amplitude) (ultrasound)
with
corticosteroid
("PCS
group"))
Soyupek,F., High Phalen's test 3 months Splinting 23 52.17% Steroid with 28 50.00% RR 1.04(0.61,1.79) Not Significant
2012 Quality score(% (Splinting) ultrasound (P-value>.05)
positive) (Phonophores
is
(ultrasound)
with
corticosteroid
("PCS
group"))
427
Soyupek,F., High Phalen's test 3 months Splinting 23 52.17% NSAID with 23 39.13% RR 1.33(0.70,2.54) Not Significant
2012 Quality score(% (Splinting) ultrasound (P-value>.05)
is
(ultrasound)
with
nonsteroid
anti-
inflammatory
drug
(PNSAI))
Soyupek,F., High Questionnaire 3 months Splinting 23 12.86(3.74 NSAID with 23 15.86(5.65 Mean -3(-5.77,- Splinting
2012 Quality (Boston- (Splinting) ) ultrasound ) Differen 0.23085) (Splinting)
FSS)(Boston (Phonophores ce (P-value<.05)
CTS is
Questionnaire (ultrasound)
(functional with
status scale)) nonsteroid
anti-
inflammatory
drug
(PNSAI))
Soyupek,F., High Questionnaire 3 months Splinting 23 12.86(3.74 Steroid with 28 15.6(6.37) Mean -2.74(- Not Significant
2012 Quality (Boston- (Splinting) ) ultrasound Differen 5.55,0.071306) (P-value>.05)
FSS)(Boston (Phonophores ce
CTS is
Questionnaire (ultrasound)
(functional with
status scale)) corticosteroid
("PCS
group"))
428
Soyupek,F., High Tinel's 3 months Splinting 23 60.87% NSAID with 23 65.22% RR 0.93(0.60,1.45) Not Significant
2012 Quality Sign/Test(% (Splinting) ultrasound (P-value>.05)
is
(ultrasound)
with
nonsteroid
anti-
inflammatory
drug
(PNSAI))
Soyupek,F., High Tinel's 3 months Splinting 23 60.87% Steroid with 28 50.00% RR 1.22(0.74,2.00) Not Significant
2012 Quality Sign/Test(% (Splinting) ultrasound (P-value>.05)
is
(ultrasound)
with
corticosteroid
("PCS
group"))
Soyupek,F., High Ultrasound 3 months Splinting 23 2.45(0.35) NSAID with 23 2.13(0.42) Mean 0.32(0.10,0.5434 NSAID with
2012 Quality (US)(anterior- (Splinting) ultrasound Differen 37) ultrasound
posterior (Phonophores ce (Phonophoresi
diameter of is s (ultrasound)
median nerve) (ultrasound) with
with nonsteroid
nonsteroid anti-
antiinflammatory
inflammatory drug (PNSAI))
drug (P-value<.05)
(PNSAI))
429
Soyupek,F., High Ultrasound 3 months Splinting 23 2.45(0.35) Steroid with 28 2.07(0.41) Mean 0.38(0.17,0.5886 Steroid with
2012 Quality (US)(anterior- (Splinting) ultrasound Differen 24) ultrasound
posterior (Phonophores ce (Phonophoresi
diameter of is s (ultrasound)
median nerve) (ultrasound) with
with corticosteroid
corticosteroid ("PCS
("PCS group")) (P-
group")) value<.05)
Soyupek,F., High Ultrasound 3 months Splinting 23 0.12(0.03) Steroid with 28 0.1(0.03) Mean 0.02(0.00,0.0365 Steroid with
2012 Quality (US)(cross- (Splinting) ultrasound Differen 47) ultrasound
sectional area of (Phonophores ce (Phonophoresi
median nerve) is s (ultrasound)
(ultrasound) with
with corticosteroid
corticosteroid ("PCS
("PCS group")) (P-
group")) value<.05)
Soyupek,F., High Ultrasound 3 months Splinting 23 0.12(0.03) NSAID with 23 0.11(0.02) Mean 0.01(- Not Significant
2012 Quality (US)(cross- (Splinting) ultrasound Differen 0.00,0.024735) (P-value>.05)
sectional area of (Phonophores ce
median nerve) is
(ultrasound)
with
nonsteroid
anti-
inflammatory
drug
(PNSAI))
Soyupek,F., High Ultrasound 3 months Splinting 23 6.82(1.03) Steroid with 28 6.61(1.20) Mean 0.21(- Not Significant
2012 Quality (US)(transverse (Splinting) ultrasound Differen 0.40,0.822181) (P-value>.05)
diameter of (Phonophores ce
median nerve) is
(ultrasound)
with
corticosteroid
("PCS
group"))
430
Soyupek,F., High Ultrasound 3 months Splinting 23 6.82(1.03) NSAID with 23 6.74(0.91) Mean 0.08(- Not Significant
2012 Quality (US)(transverse (Splinting) ultrasound Differen 0.48,0.641704) (P-value>.05)
diameter of (Phonophores ce
median nerve) is
(ultrasound)
with
nonsteroid
anti-
inflammatory
drug
(PNSAI))
Yagci,I., 2009 High Grip 3 months Splinting 24 26.83(7.16 Laser (w/ 21 30.49(6.93 Mean -3.66(- Not Significant
Quality strength(Kilogra (Splinting) ) splinting) ) Differen 7.78,0.462046) (P-value>.05)
ms) (Splinting + ce
Low-Level
Laser
Therapy)
Yagci,I., 2009 High NCS 3 months Splinting 24 11.94(2.83 Laser (w/ 21 10.3(2.15) Mean 1.64(0.18,3.0986 Splinting
Quality (CMAP)(Compo (Splinting) ) splinting) Differen 18) (Splinting)
und muscle (Splinting + ce (P-value<.05)
action potential) Low-Level
Laser
Therapy)
Yagci,I., 2009 High NCS 3 months Splinting 24 3.41(0.45) Laser (w/ 21 3.55(0.53) Mean -0.14(- Not Significant
Quality (DML)(Median (Splinting) splinting) Differen 0.43,0.149481) (P-value>.05)
motor nerve (Splinting + ce
distal latency) Low-Level
Laser
Therapy)
Yagci,I., 2009 High NCS 3 months Splinting 24 31.64(5.36 Laser (w/ 21 32.7(7.41) Mean -1.06(- Not Significant
Quality (SNAP)(Sensory (Splinting) ) splinting) Differen 4.89,2.766639) (P-value>.05)
nerve action (Splinting + ce
potential (palm- Low-Level
wrist median)) Laser
Therapy)
431
Yagci,I., 2009 High NCS 3 months Splinting 24 34.27(8.27 Laser (w/ 21 35.52(12.4 Mean -1.25(- Not Significant
Quality (SNAP)(Sensory (Splinting) ) splinting) 9) Differen 7.53,5.033712) (P-value>.05)
nerve action (Splinting + ce
potential Low-Level
amplitude (3rd Laser
digit-wrist Therapy)
median))
Yagci,I., 2009 High NCS 3 months Splinting 24 43.16(5.06 Laser (w/ 21 43.47(6.09 Mean -0.31(- Not Significant
Quality (SNCV)(Sensor (Splinting) ) splinting) ) Differen 3.61,2.988929) (P-value>.05)
y nerve (Splinting + ce
conduction Low-Level
velocity (3rd Laser
digit-wrist)) Therapy)
Yagci,I., 2009 High NCS 3 months Splinting 24 38.86(4.49 Laser (w/ 21 38.54(7.01 Mean 0.32(- Not Significant
Quality (SNCV)(Sensor (Splinting) ) splinting) ) Differen 3.18,3.815185) (P-value>.05)
y nerve (Splinting + ce
conduction Low-Level
velocity (Palm- Laser
wrist)) Therapy)
Yagci,I., 2009 High Questionnaire 3 months Splinting 24 2.38(0.71) Laser (w/ 21 2.1(0.63) Mean 0.28(- Not Significant
Quality (Boston- (Splinting) splinting) Differen 0.11,0.671530) (P-value>.05)
FSS)(Boston (Splinting + ce
CTS Low-Level
Questionnaire Laser
(functional Therapy)
status scale))
432
TABLE 115: PICO 6 PART 1- IMMOBILIZATION: OTHER

Hall,B., High Purdue 1.8 Splint (Splint) 30 51.4(15.30) No splint (No 24 53.72(11.29) Mean -2.32(- Not Significant
2013 Quality pegboard test months splint) Difference 9.42,4.777799) (P-value>.05)
score(t
(minutes))
Hall,B., High Purdue 1.8 Splint (Splint) 30 Mean No splint (No 24 Mean Difference 8.38 (p value Splint (Splint)
2013 Quality pegboard test months change= splint) change= between =0.021) (P-value>.05)
score(t 4.53 (p 12.91 (p Mean
(minutes)) value = value = Changes
0.477) 0.582)
Manente,G., High Questionnaire 1 month Brace 40 . % No brace (Non- . . % Author NA Brace
2001 Quality (GICQ)(Global (Immobilization- immobilization- Reported (Immobilization-
Impression brace) no brace) brace)
Change (P-value<.05)
Questionnaire)
433
TABLE 116: PICO 6 PART 1- IMMOBILIZATION: PAIN

Hall,B., High Questionnaire/Scale 1.8 Splint 30 4.26(2.67) No splint (No 24 5.65(2.54) Mean -1.39(- Not
2013 Quality (VAS-pain)(VAS months (Splint) splint) Difference 2.78,0.004835) Significant
pain) (P-
value>.05)
Hall,B., High Questionnaire/Scale 1.8 Splint 30 Mean No splint (No 24 Mean Difference 2.23 (p value Splint
2013 Quality (VAS-pain)(VAS months (Splint) change= splint) change= between =0.001) (Splint)
pain) -1.58 (p 0.65 (p Mean (P-
value = value = Changes value>.05)
0.001) 0.118)
Soyupek,F., High Questionnaire/Scale 3 months Splinting 23 37.91(23.94) NSAID with 23 45.65(23.65) Mean -7.74(- Not
2012 Quality (VAS-pain)( ) (Splinting) ultrasound Difference 21.49,6.013110) Significant
(Phonophoresis (P-
(ultrasound) value>.05)
with nonsteroid
anti-
inflammatory
drug (PNSAI))
Soyupek,F., High Questionnaire/Scale 3 months Splinting 23 37.91(23.94) Steroid with 28 30.35(18.15) Mean 7.56(- Not
2012 Quality (VAS-pain)( ) (Splinting) ultrasound Difference 4.31,19.43111) Significant
(Phonophoresis (P-
(ultrasound) value>.05)
with
corticosteroid
("PCS group"))
434
TABLE 117: PICO 6 PART 1- IMMOBILIZATION: SYMPTOMS

Hall,B., High Questionna 1.8 Splint (Splint) 30 2.38(0.77) No splint (No 24 2.6(0.62) Mean -0.22(- Not Significant
2013 Quality ire (Boston- months splint) Differenc 0.59,0.150745 (P-value>.05)
SSS)(Bosto e )
n CTS
Questionna
ire
(symptom
severity
scale))
Hall,B., High Questionna 1.8 Splint (Splint) 30 Mean No splint (No 24 Mean Differenc 0.45 (p value Splint (Splint)
2013 Quality ire (Boston- months change= splint) change= e between <0.001) (P-value>.05)
SSS)(Bosto -0.42 (p 0.03 (p Mean
n CTS value value = Changes
Questionna <0.001) 0.749)
ire
(symptom
severity
scale))
Manente,G. High Questionna 1 month Brace 40 1.54(0.40) No brace (Non- 40 2.61(0.60) Mean -1.07(-1.29,- Brace
, 2001 Quality ire (Boston- (Immobilization immobilization Differenc 0.84652) (Immobilization
SSS)(Bosto -brace) -no brace) e -brace)
n CTS (P-value<.05)
Questionna
ire
(symptom
severity
scale))
Soyupek,F., High Questionna 3 months Splinting 23 14.08(6.67 NSAID with 23 26(5.43) Mean -11.92(- Splinting
2012 Quality ire (Boston- (Splinting) ) ultrasound Differenc 15.44,- (Splinting)
SSS)(Bosto (Phonophoresis e 8.40495) (P-value<.05)
n CTS (ultrasound)
Questionna with nonsteroid
ire anti-
(symptom inflammatory
severity drug (PNSAI))
scale))
435
Soyupek,F., High Questionna 3 months Splinting 23 14.08(6.67 Steroid with 28 23.46(5.95 Mean -9.38(-12.89,- Splinting
2012 Quality ire (Boston- (Splinting) ) ultrasound ) Differenc 5.87457) (Splinting)
SSS)(Bosto (Phonophoresis e (P-value<.05)
n CTS (ultrasound)
Questionna with
ire corticosteroid
(symptom ("PCS group"))
severity
scale))
Yagci,I., High Questionna 3 months Splinting 24 2.35(0.65) Laser (w/ 21 2.25(0.79) Mean 0.1(- Not Significant
2009 Quality ire (Boston- (Splinting) splinting) Differenc 0.33,0.527054 (P-value>.05)
SSS)(Bosto (Splinting + e )
n CTS Low-Level
Questionna Laser Therapy)
ire
(symptom
severity
scale))
436
TABLE 118: PICO 6 PART 2- INJECTION (STEROID): COMPLICATIONS
Treatment Group Mean1/P Treatment Group Mean2/P Result

Reference Outcome 1 1 1 2 2 2 Effect (95% Favored
Atroshi,I., High Treatment 1 years 40mg 37 81.08% No steroid 37 72.97% RR 1.11(0.87,1.4 Not Significant (P-
2013 Quality Failure(Rate of Methylprednisol (placebo) 3) value>.05)
surgery @ 1 one injection (Placebo
year) (40mg injection)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Treatment 1 years 40mg 37 81.08% 80mg 37 72.97% RR 1.11(0.87,1.4 Not Significant (P-
2013 Quality Failure(Rate of Methylprednisol Methylprednisolo 3) value>.05)
surgery @ 1 one injection ne injection
year) (40mg (80mg
Methylprednisol Methylprednisolo
one injection ne injection
(corticosteroid)) (corticosteroid))
Atroshi,I., High Treatment 1 years 80mg 37 72.97% No steroid 37 72.97% RR 1.00(0.76,1.3 Not Significant (P-
2013 Quality Failure(Rate of Methylprednisol (placebo) 2) value>.05)
surgery @ 1 one injection (Placebo
year) (80mg injection)
Methylprednisol
one injection
(corticosteroid))
Dammers,J. High Treatment 5.9 Steroid 45 13.33% Steroid 43 6.98% RR 1.91(0.51,7.1 Not Significant (P-
W., 2006 Quality Failure(Referr months (injection)-20mg (injection)-40mg 6) value>.05)
ed to surgery) (20mg (40mg
one injection) ne injection)
437
W., 2006 Quality Failure(Second months (injection)-20mg (injection)-40mg 2) value>.05)
Injection) (20mg (40mg
W., 2006 Quality Failure(Second months (injection)-20mg (injection)-60mg 5) value>.05)
Dammers,J. High Treatment 1 years Steroid 45 13.33% Steroid 43 9.30% RR 1.43(0.43,4.7 Not Significant (P-
W., 2006 Quality Failure(Referr (injection)-20mg (injection)-40mg 3) value>.05)
W., 2006 Quality Failure(Second (injection)-20mg (injection)-40mg 6) value>.05)
438
Dammers,J. High Treatment 5.9 Steroid 43 39.53% Steroid 44 18.18% RR 2.17(1.05,4.5 Steroid
W., 2006 Quality Failure(Second months (injection)-40mg (injection)-60mg 0) (injection)-60mg
Injection) (40mg (60mg (60mg
Methylprednisol Methylprednisolo Methylprednisolo
one injection) ne injection) ne injection)
(P-value<.05)
439
TABLE 119: PICO 6 PART 2- INJECTION (STEROID): FUNCTION
Treatment Grou Mean1/ Treatment Grou Mean2/ Result

Reference Outcome 1 p1 P1 2 p2 P2 Effect (95% Favored
Atroshi,I., High Grip 2.3 40mg 37 2.3(4.40 No steroid 35 0.1(6.00 Mean 2.2(- Not Significant
2013 Quality strength(Kilograms) months Methylprednisol ) (placebo) ) Differenc 0.24,4.641608) (P-value>.05)
one injection (Placebo e
(40mg injection)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Grip 2.3 40mg 37 2.3(4.40 80mg 36 2.8(4.10 Mean -0.5(- Not Significant
2013 Quality strength(Kilograms) months Methylprednisol ) Methylprednisol ) Differenc 2.45,1.450360) (P-value>.05)
one injection one injection e
(40mg (80mg
Methylprednisol Methylprednisol
one injection one injection
Atroshi,I., High Grip 1 years 40mg 37 1.6(8.70 No steroid 37 0.6(5.10 Mean 1(- Not Significant
2013 Quality strength(Kilograms) Methylprednisol ) (placebo) ) Differenc 2.25,4.249493) (P-value>.05)
(40mg injection)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Grip 1 years 40mg 37 1.6(8.70 80mg 37 1.9(7.50 Mean -0.3(- Not Significant
2013 Quality strength(Kilograms) Methylprednisol ) Methylprednisol ) Differenc 4.00,3.401207) (P-value>.05)
(40mg (80mg
Atroshi,I., High Grip 2.3 80mg 36 2.8(4.10 No steroid 35 0.1(6.00 Mean 2.7(0.30,5.0969 80mg
2013 Quality strength(Kilograms) months Methylprednisol ) (placebo) ) Differenc 09) Methylprednisol
one injection (Placebo e one injection
(80mg injection) (80mg
Significant
(P-value<.05)
440
Atroshi,I., High Grip 1 years 80mg 37 1.9(7.50 No steroid 37 0.6(5.10 Mean 1.3(- Not Significant
2013 Quality strength(Kilograms) Methylprednisol ) (placebo) ) Differenc 1.62,4.222466) (P-value>.05)
(80mg injection)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Pinch 2.3 40mg 37 0.7(1.50 No steroid 35 0.3(1.40 Mean 0.4(- Not Significant
2013 Quality Strength(Kilograms) months Methylprednisol ) (placebo) ) Differenc 0.27,1.069880) (P-value>.05)
(40mg injection)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Pinch 2.3 40mg 37 0.7(1.50 80mg 36 1.2(1.10 Mean -0.5(- Not Significant
2013 Quality Strength(Kilograms) months Methylprednisol ) Methylprednisol ) Differenc 1.10,0.102271) (P-value>.05)
(40mg (80mg
Atroshi,I., High Pinch 1 years 40mg 37 1.3(1.90 No steroid 37 1.1(1.50 Mean 0.2(- Not Significant
2013 Quality Strength(Kilograms) Methylprednisol ) (placebo) ) Differenc 0.58,0.980016) (P-value>.05)
(40mg injection)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Pinch 1 years 40mg 37 1.3(1.90 80mg 37 1.5(1.80 Mean -0.2(- Not Significant
2013 Quality Strength(Kilograms) Methylprednisol ) Methylprednisol ) Differenc 1.04,0.643335) (P-value>.05)
(40mg (80mg
441
Atroshi,I., High Pinch 2.3 80mg 36 1.2(1.10 No steroid 35 0.3(1.40 Mean 0.9(0.31,1.4867 80mg
2013 Quality Strength(Kilograms) months Methylprednisol ) (placebo) ) Differenc 28) Methylprednisol
one injection (Placebo e one injection
(80mg injection) (80mg
(P-value<.05)
Atroshi,I., High Pinch 1 years 80mg 37 1.5(1.80 No steroid 37 1.1(1.50 Mean 0.4(- Not Significant
2013 Quality Strength(Kilograms) Methylprednisol ) (placebo) ) Differenc 0.35,1.154990) (P-value>.05)
(80mg injection)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Two-point 2.3 40mg 37 - No steroid 35 0.02(0.9 Mean -0.08(- Not Significant
2013 Quality discrimination(Milli months Methylprednisol 0.06(1.0 (placebo) 0) Differenc 0.52,0.359013) (P-value>.05)
meters) one injection 0) (Placebo e
(40mg injection)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Two-point 2.3 40mg 37 - 80mg 36 - Mean 0.01(- Not Significant
2013 Quality discrimination(Milli months Methylprednisol 0.06(1.0 Methylprednisol 0.07(1.5 Differenc 0.58,0.596452) (P-value>.05)
meters) one injection 0) one injection 0) e
(40mg (80mg
Atroshi,I., High Two-point 1 years 40mg 37 - No steroid 37 - Mean 0.21(- Not Significant
2013 Quality discrimination(Milli Methylprednisol 0.26(0.9 (placebo) 0.47(0.9 Differenc 0.20,0.620121) (P-value>.05)
meters) one injection 0) (Placebo 0) e
(40mg injection)
Methylprednisol
one injection
(corticosteroid))
442
Atroshi,I., High Two-point 1 years 40mg 37 - 80mg 37 - Mean 0.08(- Not Significant
2013 Quality discrimination(Milli Methylprednisol 0.26(0.9 Methylprednisol 0.34(0.7 Differenc 0.29,0.447389) (P-value>.05)
meters) one injection 0) one injection 0) e
(40mg (80mg
Atroshi,I., High Two-point 2.3 80mg 36 - No steroid 35 0.02(0.9 Mean -0.09(- Not Significant
2013 Quality discrimination(Milli months Methylprednisol 0.07(1.5 (placebo) 0) Differenc 0.66,0.483590) (P-value>.05)
meters) one injection 0) (Placebo e
(80mg injection)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Two-point 1 years 80mg 37 - No steroid 37 - Mean 0.13(- Not Significant
2013 Quality discrimination(Milli Methylprednisol 0.34(0.7 (placebo) 0.47(0.9 Differenc 0.24,0.497389) (P-value>.05)
meters) one injection 0) (Placebo 0) e
(80mg injection)
Methylprednisol
one injection
(corticosteroid))
Wong,S.M. High Grip 1.8 Steroid (single 20 20.4(5.1 Steroid (double 20 20.6(6.2 Mean -0.2(- Not Significant
, 2005 Quality strength(Kilograms months injection) 0) injection) 0) Differenc 3.72,3.318459) (P-value>.05)
(left hand)) (Single injection (Double e
(methylprednisol injection
one acetate)) (methylprednisol
one
acetate+saline))
Wong,S.M. High Grip 1.8 Steroid (single 20 20.9(6.2 Steroid (double 20 21.9(7.2 Mean -1(- Not Significant
(right hand)) (Single injection (Double e
one
acetate+saline))
443
Wong,S.M. High Grip 9.2 Steroid (single 20 20.2(6.6 Steroid (double 20 18.2(6.6 Mean 2(- Not Significant
(left hand)) (Single injection (Double e
one
acetate+saline))
Wong,S.M. High Grip 9.2 Steroid (single . 21.4(6.6 Steroid (double 20 20(7.00) Mean 1.4(.,) Not Significant
, 2005 Quality strength(Kilograms months injection) 0) injection) Differenc (P-value>.05)
(right hand)) (Single injection (Double e
one
acetate+saline))
Wong,S.M. High NCS (DML)(Distal NA Steroid (single 20 4.5(1.00 Steroid (double 20 5.4(1.90 Mean -0.9(- Not Significant
, 2005 Quality motor latency (right injection) ) injection) ) Differenc 1.84,0.041004) (P-value>.05)
hand)) (Single injection (Double e
one
acetate+saline))
Wong,S.M. High NCS (DML)(Distal 1.8 Steroid (single 20 4.4(0.90 Steroid (double 20 4.3(1.10 Mean 0.1(- Not Significant
, 2005 Quality motor latency (left months injection) ) injection) ) Differenc 0.52,0.722897) (P-value>.05)
one
acetate+saline))
Wong,S.M. High NCS (DML)(Distal 1.8 Steroid (single 20 4.5(1.00 Steroid (double 20 5(1.50) Mean -0.5(- Not Significant
, 2005 Quality motor latency (right months injection) ) injection) Differenc 1.29,0.290101) (P-value>.05)
one
acetate+saline))
444
Wong,S.M. High NCS (DML)(Distal 9.2 Steroid (single 20 4.2(1.10 Steroid (double 20 4.5(1.00 Mean -0.3(- Not Significant
, 2005 Quality motor latency (left months injection) ) injection) ) Differenc 0.95,0.351534) (P-value>.05)
one
acetate+saline))
Wong,S.M. High NCS (DML)(Distal 9.2 Steroid (single 20 4.3(1.00 Steroid (double 20 5.2(1.50 Mean -0.9(-1.69,- Steroid (single
, 2005 Quality motor latency (right months injection) ) injection) ) Differenc 0.10989) injection) (Single
hand)) (Single injection (Double e injection
(methylprednisol injection (methylprednisol
one acetate)) (methylprednisol one acetate))
one (P-value<.05)
acetate+saline))
445
TABLE 120: PICO 6 PART 2- INJECTION (STEROID): OTHER
Treatment Group Mean1/ Treatment Group Mean2/ Effect Result

Reference Outcome 1 1 P1 2 2 P2 Measur (95% Favored
Title Quality Details Duration (Details) N (SD1) (Details) N (SD2) e CI) Treatment
Atroshi,I., High Questionnaire 1.2 40mg 37 0.14(0.1 No steroid 37 0.06(0.1 Mean 0.08(0.02,0.1354 40mg
2013 Quality (General/undefin months Methylprednisol 4) (placebo) 0) Differen 37) Methylprednisol
ed)(SF-6D one injection (Placebo ce one injection
score) (40mg injection) (40mg
(P-value<.05)
Atroshi,I., High Questionnaire 1.2 40mg 37 0.14(0.1 80mg 36 0.1(0.10) Mean 0.04(- Not Significant
2013 Quality (General/undefin months Methylprednisol 4) Methylprednisol Differen 0.02,0.095696) (P-value>.05)
ed)(SF-6D one injection one injection ce
score) (40mg (80mg
Atroshi,I., High Questionnaire 2.3 40mg 37 0.08(0.1 No steroid 35 0(0.11) Mean 0.08(0.02,0.1405 40mg
2013 Quality (General/undefin months Methylprednisol 5) (placebo) Differen 32) Methylprednisol
(P-value<.05)
Atroshi,I., High Questionnaire 2.3 40mg 37 0.08(0.1 80mg 36 0.06(0.1 Mean 0.02(- Not Significant
2013 Quality (General/undefin months Methylprednisol 5) Methylprednisol 0) Differen 0.04,0.078337) (P-value>.05)
score) (40mg (80mg
446
Atroshi,I., High Questionnaire 5.5 40mg 37 0.07(0.1 No steroid 35 0.09(0.1 Mean -0.02(- Not Significant
2013 Quality (General/undefin months Methylprednisol 2) (placebo) 6) Differen 0.09,0.045612) (P-value>.05)
ed)(SF-6D one injection (Placebo ce
score) (40mg injection)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Questionnaire 5.5 40mg 37 0.07(0.1 80mg 36 0.08(0.1 Mean -0.01(- Not Significant
2013 Quality (General/undefin months Methylprednisol 2) Methylprednisol 2) Differen 0.07,0.045061) (P-value>.05)
score) (40mg (80mg
Atroshi,I., High Questionnaire 1 years 40mg 37 0.11(0.1 No steroid 37 0.1(0.17) Mean 0.01(- Not Significant
2013 Quality (General/undefin Methylprednisol 3) (placebo) Differen 0.06,0.078958) (P-value>.05)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Questionnaire 1 years 40mg 37 0.11(0.1 80mg 37 0.12(0.1 Mean -0.01(- Not Significant
2013 Quality (General/undefin Methylprednisol 3) Methylprednisol 5) Differen 0.07,0.053959) (P-value>.05)
score) (40mg (80mg
Atroshi,I., High Questionnaire 1.2 80mg 36 0.1(0.10) No steroid 37 0.06(0.1 Mean 0.04(- Not Significant
2013 Quality (General/undefin months Methylprednisol (placebo) 0) Differen 0.01,0.085884) (P-value>.05)
Methylprednisol
one injection
(corticosteroid))
447
Atroshi,I., High Questionnaire 2.3 80mg 36 0.06(0.1 No steroid 35 0(0.11) Mean 0.06(0.01,0.1089 80mg
2013 Quality (General/undefin months Methylprednisol 0) (placebo) Differen 40) Methylprednisol
(P-value<.05)
2013 Quality (General/undefin months Methylprednisol 2) (placebo) 6) Differen 0.08,0.055927) (P-value>.05)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Questionnaire 1 years 80mg 37 0.12(0.1 No steroid 37 0.1(0.17) Mean 0.02(- Not Significant
2013 Quality (General/undefin Methylprednisol 5) (placebo) Differen 0.05,0.093052) (P-value>.05)
Methylprednisol
one injection
(corticosteroid))
448
TABLE 121: PICO 6 PART 2- INJECTION (STEROID): PAIN

Atroshi,I., High Questionnaire 1.2 40mg 37 30(32.60) No steroid 37 8.8(18.90 Mean 21.2(9.06,33.3421 40mg
2013 Quality (General/undefined months Methylprednisol (placebo) ) Differenc 2) Methylprednisol
)(SF-36 bodily pain one injection (Placebo e one injection
(P-value<.05)
Atroshi,I., High Questionnaire 1.2 40mg 37 30(32.60) 80mg 36 34.3(29.5 Mean -4.3(- Not Significant
2013 Quality (General/undefined months Methylprednisol Methylprednisol 0) Differenc 18.56,9.955123) (P-value>.05)
)(SF-36 bodily pain one injection one injection e
score) (40mg (80mg
2013 Quality (General/undefined months Methylprednisol 0) (placebo) ) Differenc 1) Methylprednisol
(P-value<.05)
Atroshi,I., High Questionnaire 2.3 40mg 37 24.6(29.9 80mg 36 23.4(28.5 Mean 1.2(- Not Significant
2013 Quality (General/undefined months Methylprednisol 0) Methylprednisol 0) Differenc 12.20,14.59770) (P-value>.05)
score) (40mg (80mg
449
2013 Quality (General/undefined months Methylprednisol 0) (placebo) 0) Differenc 18.59,7.189768) (P-value>.05)
)(SF-36 bodily pain one injection (Placebo e
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Questionnaire 5.5 40mg 37 19.6(28.4 80mg 36 28.8(30.1 Mean -9.2(- Not Significant
2013 Quality (General/undefined months Methylprednisol 0) Methylprednisol 0) Differenc 22.63,4.232202) (P-value>.05)
score) (40mg (80mg
Atroshi,I., High Questionnaire 1 years 40mg 37 30(32.60) No steroid 37 29.3(33.0 Mean 0.7(- Not Significant
2013 Quality (General/undefined Methylprednisol (placebo) 0) Differenc 14.25,15.64693) (P-value>.05)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Questionnaire 1 years 40mg 37 30(32.60) 80mg 37 34.3(29.5 Mean -4.3(- Not Significant
2013 Quality (General/undefined Methylprednisol Methylprednisol 0) Differenc 18.47,9.866816) (P-value>.05)
score) (40mg (80mg
(P-value<.05)
450
(P-value<.05)
Atroshi,I., High Questionnaire 5.5 80mg 36 28.8(30.1 No steroid 35 25.3(27.4 Mean 3.5(- Not Significant
2013 Quality (General/undefined months Methylprednisol 0) (placebo) 0) Differenc 9.88,16.88225) (P-value>.05)
Methylprednisol
one injection
(corticosteroid))
Atroshi,I., High Questionnaire 1 years 80mg 37 34.3(29.5 No steroid 37 29.3(33.0 Mean 5(-9.26,19.26264) Not Significant
2013 Quality (General/undefined Methylprednisol 0) (placebo) 0) Differenc (P-value>.05)
Methylprednisol
one injection
(corticosteroid))
451
TABLE 122: PICO 6 PART 2- INJECTION (STEROID): SYMPTOMS
Treatment Grou Mean1/P Treatment Grou Mean2/P Result

Reference Outcome 1 p1 1 2 p2 2 Effect (95% Favored
Atroshi,I., High Questionnaire 1.2 40mg 37 - No steroid 37 - Mean -0.86(-1.23,- 40mg
2013 Quality (General/undefined)( months Methylpredniso 1.33(0.98 (placebo) 0.47(0.60 Differenc 0.48973) Methylprednisol
CTS symptom lone injection ) (Placebo ) e one injection
severity score) (40mg injection) (40mg
Methylpredniso Methylprednisol
lone injection one injection
(P-value<.05)
Atroshi,I., High Questionnaire 1.2 40mg 37 - 80mg 36 - Mean -0.21(- Not Significant
2013 Quality (General/undefined)( months Methylpredniso 1.33(0.98 Methylprednisol 1.12(0.93 Differenc 0.65,0.22818 (P-value>.05)
CTS symptom lone injection ) one injection ) e 9)
severity score) (40mg (80mg
2013 Quality (General/undefined)( months Methylpredniso 1.17(0.95 (placebo) 0.3(0.66) Differenc 0.49381) Methylprednisol
CTS symptom lone injection ) (Placebo e one injection
(P-value<.05)
2013 Quality (General/undefined)( months Methylpredniso 1.17(0.95 Methylprednisol 0.9(1.00) Differenc 0.72,0.17767 (P-value>.05)
CTS symptom lone injection ) one injection e 7)
452
Atroshi,I., High Questionnaire 5.5 40mg 37 - No steroid 35 - Mean 0.33(- Not Significant
2013 Quality (General/undefined)( months Methylpredniso 1.16(0.86 (placebo) 1.49(0.82 Differenc 0.06,0.71806 (P-value>.05)
CTS symptom lone injection ) (Placebo ) e 3)
severity score) (40mg injection)
Methylpredniso
lone injection
(corticosteroid))
Atroshi,I., High Questionnaire 5.5 40mg 37 - 80mg 36 - Mean 0.06(- Not Significant
2013 Quality (General/undefined)( months Methylpredniso 1.16(0.86 Methylprednisol 1.22(0.93 Differenc 0.35,0.47119 (P-value>.05)
Atroshi,I., High Questionnaire 1 years 40mg 37 - No steroid 37 - Mean 0.03(- Not Significant
2013 Quality (General/undefined)( Methylpredniso 1.52(1.08 (placebo) 1.55(0.79 Differenc 0.40,0.46116 (P-value>.05)
Methylpredniso
lone injection
(corticosteroid))
Atroshi,I., High Questionnaire 1 years 40mg 37 - 80mg 37 - Mean -0.15(- Not Significant
2013 Quality (General/undefined)( Methylpredniso 1.52(1.08 Methylprednisol 1.37(0.86 Differenc 0.59,0.29485 (P-value>.05)
2013 Quality (General/undefined)( months Methylpredniso 1.12(0.93 (placebo) 0.47(0.60 Differenc 0.28989) Methylprednisol
CTS symptom lone injection ) (Placebo ) e one injection
(P-value<.05)
453
2013 Quality (General/undefined)( months Methylpredniso 0.9(1.00) (placebo) 0.3(0.66) Differenc 0.20690) Methylprednisol
CTS symptom lone injection (Placebo e one injection
(P-value<.05)
2013 Quality (General/undefined)( months Methylpredniso 1.22(0.93 (placebo) 1.49(0.82 Differenc 0.14,0.67755 (P-value>.05)
Methylpredniso
lone injection
(corticosteroid))
2013 Quality (General/undefined)( Methylpredniso 1.37(0.86 (placebo) 1.55(0.79 Differenc 0.20,0.55628 (P-value>.05)
Methylpredniso
lone injection
(corticosteroid))
Atroshi,I., High Questionnaire 1.2 40mg 37 - No steroid 37 - Mean -12.8(- 40mg
2013 Quality (DASH-Quick months Methylpredniso 22.6(20.5 (placebo) 9.8(12.90 Differenc 20.60,- Methylprednisol
DASH)(Primarily lone injection 0) (Placebo ) e 4.99543) one injection
symptomatic domain (40mg injection) (40mg
but includes a Methylpredniso Methylprednisol
functional lone injection one injection
component as well) (corticosteroid)) (corticosteroid))
(P-value<.05)
2013 Quality (DASH-Quick months Methylpredniso 22.6(20.5 Methylprednisol 20.2(17.6 Differenc 11.16,6.3571 (P-value>.05)
DASH)(Primarily lone injection 0) one injection 0) e 76)
symptomatic domain (40mg (80mg
454
(P-value<.05)
2013 Quality (DASH-Quick months Methylpredniso 16.8(17.6 (placebo) 25.3(22.8 Differenc 0.95,17.9455 (P-value>.05)
DASH)(Primarily lone injection 0) (Placebo 0) e 8)
symptomatic domain (40mg injection)
but includes a Methylpredniso
functional lone injection
component as well) (corticosteroid))
Atroshi,I., High Questionnaire 5.5 40mg 37 - 80mg 36 - Mean 2.4(- Not Significant
2013 Quality (DASH-Quick Methylpredniso 27.3(20.9 (placebo) 28.7(21.9 Differenc 8.35,11.1544 (P-value>.05)
455
Atroshi,I., High Questionnaire 1 years 40mg 37 - 80mg 37 - Mean -1.3(- Not Significant
2013 Quality (DASH-Quick Methylpredniso 27.3(20.9 Methylprednisol 26(18.40) Differenc 10.27,7.6724 (P-value>.05)
DASH)(Primarily lone injection 0) one injection e 22)
(P-value<.05)
(P-value<.05)
2013 Quality (DASH-Quick months Methylpredniso 19.2(22.1 (placebo) 25.3(22.8 Differenc 4.35,16.5487 (P-value>.05)
2013 Quality (DASH-Quick Methylpredniso 26(18.40) (placebo) 28.7(21.9 Differenc 6.52,11.9167 (P-value>.05)
DASH)(Primarily lone injection (Placebo 0) e 3)
456
Dammers,J. High Symptom relief 5.9 Steroid 45 55.56% Steroid 44 72.73% RR 0.76(0.56,1.0 Not Significant
W., 2006 Quality (general)(No or only months (injection)- (injection)-60mg 5) (P-value>.05)
minor symptoms 20mg (20mg (60mg
requiring no further Methylpredniso Methylprednisol
treatment) lone injection) one injection)
Dammers,J. High Symptom relief 1 years Steroid 45 46.67% Steroid 44 52.27% RR 0.89(0.59,1.3 Not Significant
W., 2006 Quality (general)(No or only (injection)- (injection)-60mg 6) (P-value>.05)
457
Wong,S.M., High Questionnaire/Scale 1.8 Steroid 30 13.67(8.2 Steroid (oral) 30 20.83(8.7 Mean -7.16(- Steroid
2001 Quality (GSS)( ) months (injection) 7) (oral placebo 3) Differenc 11.46,- (injection)
(prednisolone daily for 10 days e 2.85683) (prednisolone 25
25 mg daily for and a single 15- mg daily for 10
10 days and the mg days and the
same volume of methylprednisol same volume of
saline injection one acetate saline injection
into the carpal injection3 locally into the carpal
tunnel) into the carpal tunnel) (P-
tunnel) value<.05)
Wong,S.M., High Questionnaire/Scale 2.8 Steroid 30 14.3(8.42 Steroid (oral) 30 21.4(9.64 Mean -7.1(-11.68,- Steroid
2001 Quality (GSS)( ) months (injection) ) (oral placebo ) Differenc 2.51977) (injection)
(prednisolone daily for 10 days e (prednisolone 25
25 mg daily for and a single 15- mg daily for 10
10 days and the mg days and the
same volume of methylprednisol same volume of
saline injection one acetate saline injection
into the carpal injection3 locally into the carpal
tunnel) into the carpal tunnel) (P-
tunnel) value<.05)
Wong,S.M., High Questionnaire/Scale 1.8 Steroid (single 20 15.2(9.90 Steroid (double 20 11.4(7.60 Mean 3.8(- Not Significant
2005 Quality (GSS)(Both hands) months injection) ) injection) ) Differenc 1.67,9.26994 (P-value>.05)
(Single (Double e 5)
injection injection
(methylpredniso (methylprednisol
lone acetate)) one
acetate+saline))
Wong,S.M., High Questionnaire/Scale 5.5 Steroid (single 20 15.9(10.6 Steroid (double 20 13(9.70) Mean 2.9(- Not Significant
2005 Quality (GSS)(Both hands) months injection) 0) injection) Differenc 3.40,9.19721 (P-value>.05)
injection injection
lone acetate)) one
acetate+saline))
458
Wong,S.M., High Questionnaire/Scale 9.2 Steroid (single 20 12.6(9.10 Steroid (double 20 14.1(11.0 Mean -1.5(- Not Significant
2005 Quality (GSS)(Both hands) months injection) ) injection) 0) Differenc 7.76,4.75682 (P-value>.05)
injection injection
lone acetate)) one
acetate+saline))
459
TABLE 123: PICO 6 PART 4- ORAL TREATMENTS: SYMPTOMS

Chang,M.H., High Questionnaire/Scale 1 month Steroid 23 10(7.50) Placebo 16 20.8(6.60) Mean -10.8(-15.26,- Steroid
1998 Quality (GSS)(Global (Steroid) (Placebo) Difference 6.34422) (Steroid)
symptom score) (P-
value<.05)
Chang,M.H., High Questionnaire/Scale 1 month Diuretic 16 21.6(6.30) Steroid 23 10(7.50) Mean 11.6(7.25,15.95026) Steroid
1998 Quality (GSS)(Global (oral (Steroid) Difference (Steroid)
symptom score) treatment) (P-
(Diuretic value<.05)
(oral
treatment))
Chang,M.H., High Questionnaire/Scale 1 month Diuretic 16 21.6(6.30) Placebo 16 20.8(6.60) Mean 0.8(-3.67,5.270830) Not
1998 Quality (GSS)(Global (oral (Placebo) Difference Significant
(Diuretic value>.05)
(oral
treatment))
Chang,M.H., High Questionnaire/Scale 1 month Diuretic 16 21.6(6.30) NSAID 18 24(9.70) Mean -2.4(- Not
1998 Quality (GSS)(Global (oral (NSAID) Difference 7.84,3.041549) Significant
(Diuretic value>.05)
(oral
treatment))
Chang,M.H., High Questionnaire/Scale 1 month NSAID 18 24(9.70) Steroid 23 10(7.50) Mean 14(8.57,19.42919) Steroid
1998 Quality (GSS)(Global (NSAID) (Steroid) Difference (Steroid)
symptom score) (P-
value<.05)
Chang,M.H., High Questionnaire/Scale 1 month Placebo 16 20.8(6.60) NSAID 18 24(9.70) Mean -3.2(- Not
1998 Quality (GSS)(Global (Placebo) (NSAID) Difference 8.73,2.326269) Significant
symptom score) (P-
value>.05)
460
Hui,A.C., High Questionnaire/Scale 1.8 Oral 71 13.4(9.70) Oral treatment 69 12.5(8.90) Mean 0.9(-2.18,3.982365) Not
2011 Quality (GSS)(Global months treatment (placebo) Difference Significant
symptom score) (Gabapentin) (Same as (P-
(300 mg active value>.05)
once daily treatment
for 1 week, group, but a
300 mg placebo)
twice daily
for 1 week,
and from
then on three
times daily)
461
TABLE 124: PICO 6 PART 5- TOPICAL TREATMENTS: FUNCTION
Treatment Treatment Result Favored

Reference Outcome 1 Group1 Mean1/P1 2 Group2 Mean2/P2 Effect (95% Treatmen
Title Quality Details Duration (Details) N (SD1) (Details) N (SD2) Measure CI) t
Chang,Y.W. High NCS (DML)(Distal 1.8 Paraffin therapy 43 4.98(1.51) Ultrasound 37 5.08(1.30) Mean -0.1(- Not
, 2014 Quality motor latency (ms)) months (Paraffin & splint) (Ultrasound & Difference 0.72,0.515768) Significant
splint) (P-
value>.05)
Chang,Y.W. High NCS (DSL)(Distal 1.8 Paraffin therapy 43 3.4(0.80) Ultrasound 37 3.6(1.40) Mean -0.2(- Not
, 2014 Quality sensory latency (ms)) months (Paraffin & splint) (Ultrasound & Difference 0.71,0.310566) Significant
splint) (P-
value>.05)
Chang,Y.W. High Pinch 1.8 Paraffin therapy 43 3.6(1.50) Ultrasound 37 3.6(1.10) Mean 0(- Not
, 2014 Quality Strength(Kilograms) months (Paraffin & splint) (Ultrasound & Difference 0.57,0.571528) Significant
splint) (P-
value>.05)
Chang,Y.W. High Questionnaire 1.8 Paraffin therapy 23 1.8(0.90) Ultrasound 24 1.6(0.70) Mean 0.2(- Not
, 2014 Quality (Boston-FSS)(Boston months (Paraffin & splint) (Ultrasound & Difference 0.26,0.662302) Significant
CTS Questionnaire splint) (P-
(functional status value>.05)
scale))
Chang,Y.W. High Semmes Weinstein 1.8 Paraffin therapy 43 30.7(3.00) Ultrasound 37 30.9(2.70) Mean -0.2(- Not
, 2014 Quality Monofilaments Test months (Paraffin & splint) (Ultrasound & Difference 1.45,1.049381) Significant
(SW test)( ) splint) (P-
value>.05)
Soyupek,F., High NCS 3 months NSAID with 23 9.97(3.34) Steroid with 28 10.36(2.57) Mean -0.39(- Not
2012 Quality (CMAP)(Compound ultrasound ultrasound Difference 2.05,1.274172) Significant
muscle action (Phonophoresis (Phonophoresis (P-
potential) (ultrasound) with (ultrasound) value>.05)
nonsteroid anti- with
inflammatory drug corticosteroid
(PNSAI)) ("PCS group"))
462
Soyupek,F., High NCS (DML)(Distal 3 months NSAID with 23 4.5(1.15) Steroid with 28 4.39(0.87) Mean 0.11(- Not
2012 Quality motor latency (ms)) ultrasound ultrasound Difference 0.46,0.679858) Significant
(Phonophoresis (Phonophoresis (P-
(ultrasound) with (ultrasound) value>.05)
Soyupek,F., High NCS (DSL)(Distal 3 months NSAID with 23 3.52(1.02) Steroid with 28 3.08(0.96) Mean 0.44(- Not
2012 Quality sensory latency (ms)) ultrasound ultrasound Difference 0.11,0.987921) Significant
Soyupek,F., High NCS (NCV)(Motor 3 months NSAID with 23 53.12(5.04) Steroid with 28 52.26(4.00) Mean 0.86(- Not
2012 Quality nerve conduction ultrasound ultrasound Difference 1.68,3.397307) Significant
velocity) (Phonophoresis (Phonophoresis (P-
Soyupek,F., High NCS (NCV)(Sensory 3 months NSAID with 23 36.91(10.16) Steroid with 28 40.44(12.83) Mean -3.53(- Not
2012 Quality nerve conduction ultrasound ultrasound Difference 9.84,2.780761) Significant
velocity) (Phonophoresis (Phonophoresis (P-
Soyupek,F., High NCS (SNAP)(Sensory 3 months NSAID with 23 17.95(11.27) Steroid with 28 17.7(9.04) Mean 0.25(- Not
2012 Quality nerve action potential ultrasound ultrasound Difference 5.44,5.944442) Significant
amplitude) (Phonophoresis (Phonophoresis (P-
463
Soyupek,F., High Phalen's test score(% 3 months NSAID with 23 39.13% Steroid with 28 50.00% RR 0.78(0.42,1.47 Not
2012 Quality positive) ultrasound ultrasound ) Significant
Soyupek,F., High Questionnaire 3 months NSAID with 23 15.86(5.65) Steroid with 28 15.6(6.37) Mean 0.26(- Not
2012 Quality (Boston-FSS)(Boston ultrasound ultrasound Difference 3.04,3.561369) Significant
CTS Questionnaire (Phonophoresis (Phonophoresis (P-
(functional status (ultrasound) with (ultrasound) value>.05)
scale)) nonsteroid anti- with
Soyupek,F., High Tinel's Sign/Test(% 3 months NSAID with 23 65.22% Steroid with 28 50.00% RR 1.30(0.81,2.10 Not
2012 Quality positive) ultrasound ultrasound ) Significant
Soyupek,F., High Ultrasound 3 months NSAID with 23 2.13(0.42) Steroid with 28 2.07(0.41) Mean 0.06(- Not
2012 Quality (US)(anterior- ultrasound ultrasound Difference 0.17,0.289187) Significant
posterior diameter of (Phonophoresis (Phonophoresis (P-
median nerve) (ultrasound) with (ultrasound) value>.05)
2012 Quality (US)(cross-sectional ultrasound ultrasound Difference 0.00,0.023794) Significant
area of median nerve) (Phonophoresis (Phonophoresis (P-
464
2012 Quality (US)(transverse ultrasound ultrasound Difference 0.45,0.709553) Significant
diameter of median (Phonophoresis (Phonophoresis (P-
nerve) (ultrasound) with (ultrasound) value>.05)
Yildiz,N., High NCS (DML)(Median 1.8 Sham ultrasound (w/ 17 4.32(0.60) Ketoprofen 17 4.15(0.34) Mean 0.17(- Not
2011 Quality motor distal latency) months splinting) (Sham phonophoresis Difference 0.16,0.497832) Significant
ultrasound+splinting. (w/ splinting) (P-
Included the (Ketoprofen value>.05)
intention-intention-to- phonophoresis
treat analysis data) (w/ splinting).
Included the
intention-
intention-to-
treat analysis
data)
Yildiz,N., High NCS (DML)(Median 1.8 Ultrasound (w/ 17 4.43(0.55) Ketoprofen 17 4.15(0.34) Mean 0.28(- Not
2011 Quality motor distal latency) months splinting) phonophoresis Difference 0.03,0.587377) Significant
(Ultrasound+splinting (w/ splinting) (P-
. Included the (Ketoprofen value>.05)
treat analysis data (w/ splinting).
(Group 2)) Included the
intention-
intention-to-
treat analysis
data)
465
Yildiz,N., High NCS (DSL)(Median 1.8 Sham ultrasound (w/ 17 3.94(0.47) Ketoprofen 17 3.79(0.33) Mean 0.15(- Not
2011 Quality sensory distal latency) months splinting) (Sham phonophoresis Difference 0.12,0.422996) Significant
ultrasound+splinting. (w/ splinting) (P-
Included the
intention-
intention-to-
treat analysis
data)
Yildiz,N., High NCS (DSL)(Median 1.8 Ultrasound (w/ 17 3.87(0.29) Ketoprofen 17 3.79(0.33) Mean 0.08(- Not
2011 Quality sensory distal latency) months splinting) phonophoresis Difference 0.13,0.288838) Significant
(Ultrasound+splinting (w/ splinting) (P-
intention-
intention-to-
treat analysis
data)
Yildiz,N., High Questionnaire 1.8 Sham ultrasound (w/ 17 2.19(0.89) Ketoprofen 17 1.79(0.80) Mean 0.4(- Not
2011 Quality (General/undefined)(F months splinting) (Sham phonophoresis Difference 0.17,0.968876) Significant
SS) ultrasound+splinting. (w/ splinting) (P-
Included the
intention-
intention-to-
treat analysis
data)
466
Yildiz,N., High Questionnaire 1.8 Ultrasound (w/ 17 1.98(0.78) Ketoprofen 17 1.79(0.80) Mean 0.19(- Not
2011 Quality (General/undefined)(F months splinting) phonophoresis Difference 0.34,0.721139) Significant
SS) (Ultrasound+splinting (w/ splinting) (P-
intention-
intention-to-
treat analysis
data)
467
TABLE 125: PICO 6 PART 5- TOPICAL TREATMENTS: PAIN
Treatment Group Treatment Group Result

Reference Outcome 1 1 Mean1/P1 2 2 Mean2/P2 Effect (95% Favored
Chang,Y. High Questionnaire 1.8 Paraffin therapy 23 50.7(22.70 Ultrasound 24 54.2(22.60 Mean -3.5(- Not
W., 2014 Quality /Scale (VAS- months (Paraffin & splint) ) (Ultrasound ) Differen 16.45,9.454633) Significant
pain)(0-100) & splint) ce (P-value>.05)
Soyupek,F. High Questionnaire 3 months NSAID with 23 45.65(23.6 Steroid with 28 30.35(18.1 Mean 15.3(3.53,27.073 Steroid with
, 2012 Quality /Scale (VAS- ultrasound 5) ultrasound 5) Differen 62) ultrasound
pain)( ) (Phonophoresis (Phonophore ce (Phonophore
(ultrasound) with sis sis
nonsteroid anti- (ultrasound) (ultrasound)
inflammatory drug with with
(PNSAI)) corticosteroid corticosteroi
("PCS d ("PCS
group")) group"))
(P-value<.05)
Yildiz,N., High Questionnaire 1.8 Sham ultrasound 17 3.28(2.74) Ketoprofen 17 0.98(1.65) Mean 2.3(0.78,3.82044 Ketoprofen
2011 Quality /Scale (VAS- months (w/ splinting) phonophoresi Differen 7) phonophoresi
pain)( ) (Sham s (w/ ce s (w/
ultrasound+splintin splinting) splinting)
g. Included the (Ketoprofen (Ketoprofen
intention-intention- phonophoresi phonophoresi
to-treat analysis s (w/ s (w/
data) splinting). splinting).
Included the Included the
intention- intention-
intention-to- intention-to-
treat analysis treat analysis
data) data)
(P-value<.05)
468
Treatment Group Treatment Group Result
Reference Outcome 1 1 Mean1/P1 2 2 Mean2/P2 Effect (95% Favored
Yildiz,N., High Questionnaire 1.8 Ultrasound (w/ 17 2.77(2.74) Ketoprofen 17 0.98(1.65) Mean 1.79(0.27,3.3104 Ketoprofen
2011 Quality /Scale (VAS- months splinting) phonophoresi Differen 47) phonophoresi
pain)( ) (Ultrasound+splinti s (w/ ce s (w/
ng. Included the splinting) splinting)
intention-intention- (Ketoprofen (Ketoprofen
to-treat analysis phonophoresi phonophoresi
data (Group 2)) s (w/ s (w/
splinting). splinting).
Included the Included the
intention- intention-
intention-to- intention-to-
treat analysis treat analysis
data) data)
(P-value<.05)
469
TABLE 126: PICO 6 PART 5- TOPICAL TREATMENTS: SYMPTOMS

Chang,Y.W., High Questionnaire 1.8 Paraffin 23 1.9(0.70) Ultrasound 24 2.1(0.80) Mean -0.2(- Not
2014 Quality (Boston- months therapy (Ultrasound & Difference 0.63,0.229284) Significant
SSS)(Boston (Paraffin & splint) (P-
CTS splint) value>.05)
Questionnaire
(symptom
severity
scale))
Soyupek,F., High Questionnaire 3 months NSAID with 23 26(5.43) Steroid with 28 23.46(5.95) Mean 2.54(- Not
2012 Quality (Boston- ultrasound ultrasound Difference 0.59,5.667614) Significant
SSS)(Boston (Phonophoresis (Phonophoresis (P-
CTS (ultrasound) (ultrasound) value>.05)
Questionnaire with with
(symptom nonsteroid corticosteroid
severity anti- ("PCS group"))
scale)) inflammatory
drug (PNSAI))
470
TABLE 127: PICO 6 PART 6- OTHER TREATMENTS: COMPLICATIONS

Ebenbichler, High Complications NA Ultrasound (20 34 3.3(2.80) Sham 34 2(1.90) Mean 1.3(0.16,2.437416) Sham
G.R., 1998 Quality (general)(Pain or sessions of ultrasound ultrasound Difference ultrasound (No
paraesthesia (active) treatment (1 (No ultrasound) (P-
complaints) MHz, 1.0 W/cm2, ultrasound) value<.05)
pulsed mode 1:4, 15
minutes per session)
applied to the area
over the carpal tunnel
of one wrist, and
indistinguishable
sham ultrasound
treatment applied to
the other. The first 10
treatments were
performed daily (5
sessions/week); 10
further treatments
were twice weekly for
5 weeks.)
471
Ebenbichler, High Complications 1.6 Ultrasound (20 34 - Sham 34 - Mean -1.97(-3.23,-0.71) Ultrasound (20
G.R., 1998 Quality (general)(Pain or months sessions of ultrasound 2.14(3.03) ultrasound 0.17(2.20) Difference sessions of
paraesthesia (active) treatment (1 (No ultrasound
complaints) MHz, 1.0 W/cm2, ultrasound) (active)
pulsed mode 1:4, 15 treatment (1
minutes per session) MHz, 1.0
applied to the area W/cm2, pulsed
over the carpal tunnel mode 1:4, 15
of one wrist, and minutes per
indistinguishable session) applied
sham ultrasound to the area over
treatment applied to the carpal
the other. The first 10 tunnel of one
treatments were wrist, and
performed daily (5 indistinguishabl
sessions/week); 10 e sham
further treatments ultrasound
were twice weekly for treatment
5 weeks.) applied to the
other. The first
10 treatments
were performed
daily (5
sessions/week);
10 further
treatments were
twice weekly for
5 weeks.)
(P-value<.05)
472
Ebenbichler, High Complications 7.9 Ultrasound (20 34 - Sham 34 - Mean -2.68(-4.10,-1.26) Ultrasound (20
G.R., 1998 Quality (general)(Pain or months sessions of ultrasound 2.76(3.06) ultrasound 0.08(2.92) Difference sessions of
paraesthesia (active) treatment (1 (No ultrasound
complaints) MHz, 1.0 W/cm2, ultrasound) (active)
pulsed mode 1:4, 15 treatment (1
minutes per session) MHz, 1.0
applied to the area W/cm2, pulsed
over the carpal tunnel mode 1:4, 15
of one wrist, and minutes per
indistinguishable session) applied
sham ultrasound to the area over
treatment applied to the carpal
the other. The first 10 tunnel of one
treatments were wrist, and
performed daily (5 indistinguishabl
sessions/week); 10 e sham
further treatments ultrasound
were twice weekly for treatment
5 weeks.) applied to the
other. The first
10 treatments
were performed
daily (5
sessions/week);
10 further
treatments were
twice weekly for
5 weeks.)
(P-value<.05)
473
Yildiz,N., High Questionnaire 1.8 Sham ultrasound (w/ 17 2.08(0.82) Ketoprofen 17 1.63(0.73) Mean 0.45(- Not Significant
2011 Quality (General/undefine months splinting) (Sham phonophore Difference 0.07,0.971890) (P-value>.05)
d)(SSS) ultrasound+splinting. sis (w/
Included the splinting)
intention-intention-to- (Ketoprofen
treat analysis data) phonophore
sis (w/
splinting).
Included the
intention-
intention-to-
treat
analysis
data)
Yildiz,N., High Questionnaire 1.8 Ultrasound (w/ 17 1.97(0.65) Ketoprofen 17 1.63(0.73) Mean 0.34(- Not Significant
2011 Quality (General/undefine months splinting) phonophore Difference 0.12,0.804648) (P-value>.05)
d)(SSS) (Ultrasound+splinting. sis (w/
Included the splinting)
intention-intention-to- (Ketoprofen
treat analysis data phonophore
(Group 2)) sis (w/
splinting).
Included the
intention-
intention-to-
treat
analysis
data)
474
TABLE 128: PICO 6 PART 6- OTHER TREATMENTS: FUNCTION
Treatment Grou Mean1/ Treatment Grou Mean2/ Effect Result

Reference Outcome 1 p1 P1 2 p2 P2 Measur (95% Favored
Bakhtiary,A. High Grip strength(Units 1.6 Ultrasound . . % Laser (15 daily . . % Author NA Ultrasound
H., 2004 Quality not reported) months (Ultrasound treatment Reporte (Ultrasound
treatment (1 sessions (5 d treatment (1
MHz, 1.0 sessions/week).) MHz, 1.0
W/cm2, pulse W/cm2,
1:4, 15 pulse 1:4, 15
min/session)) min/session))
(P-value<.05)
Bakhtiary,A. High NCS(Index SAP 1.6 Ultrasound . . % Laser (15 daily . . % Author NA Ultrasound
H., 2004 Quality amplitude (?A)) months (Ultrasound treatment Reporte (Ultrasound
W/cm2, pulse W/cm2,
1:4, 15 pulse 1:4, 15
(P-value<.05)
Bakhtiary,A. High NCS(Thumb SAP 1.6 Ultrasound . . % Laser (15 daily . . % Author NA Ultrasound
H., 2004 Quality amplitude (?A)) months (Ultrasound treatment Reporte (Ultrasound
W/cm2, pulse W/cm2,
1:4, 15 pulse 1:4, 15
(P-value<.05)
Bakhtiary,A. High NCS 1.6 Ultrasound . . % Laser (15 daily . . % Author NA Not
H., 2004 Quality (CMAP)(Compound months (Ultrasound treatment Reporte Significant
muscle action treatment (1 sessions (5 d (P-value>.05)
potential (mV)) MHz, 1.0 sessions/week).)
W/cm2, pulse
1:4, 15
min/session))
475
Bakhtiary,A. High NCS (DML)(Distal 1.6 Ultrasound . . % Laser (15 daily . . % Author NA Ultrasound
H., 2004 Quality motor latency (ms)) months (Ultrasound treatment Reporte (Ultrasound
W/cm2, pulse W/cm2,
1:4, 15 pulse 1:4, 15
(P-value<.05)
Bakhtiary,A. High NCS 1.6 Ultrasound . . % Laser (15 daily . . % Author NA Ultrasound
H., 2004 Quality (DSL)(Antidromic months (Ultrasound treatment Reporte (Ultrasound
index sensory latency treatment (1 sessions (5 d treatment (1
(ms)) MHz, 1.0 sessions/week).) MHz, 1.0
W/cm2, pulse W/cm2,
1:4, 15 pulse 1:4, 15
(P-value<.05)
Bakhtiary,A. High NCS 1.6 Ultrasound . . % Laser (15 daily . . % Author NA Ultrasound
H., 2004 Quality (DSL)(Antidromic months (Ultrasound treatment Reporte (Ultrasound
thumb sensory latency treatment (1 sessions (5 d treatment (1
(ms)) MHz, 1.0 sessions/week).) MHz, 1.0
W/cm2, pulse W/cm2,
1:4, 15 pulse 1:4, 15
(P-value<.05)
Bakhtiary,A. High Pinch Strength(Units 1.6 Ultrasound . . % Laser (15 daily . . % Author NA Ultrasound
H., 2004 Quality not reported) months (Ultrasound treatment Reporte (Ultrasound
W/cm2, pulse W/cm2,
1:4, 15 pulse 1:4, 15
(P-value<.05)
Chang,W.D., High Grip strength(Digital 1 month Laser (Laser 20 5.2(0.83) Placebo (Sham 20 4.43(1.0 Mean 0.77(0.18,1.360 Laser (Laser
2008 Quality prehension treatment) laser (placebo)) 6) Differen 038) treatment)
(kilograms)) ce (P-value<.05)
476
Chang,W.D., High Grip 1 month Laser (Laser 20 21.19(4. Placebo (Sham 20 17.38(3. Mean 3.81(1.42,6.196 Laser (Laser
2008 Quality strength(Kilograms) treatment) 12) laser (placebo)) 56) Differen 375) treatment)
ce (P-value<.05)
Chang,W.D., High Grip 1 month Laser (Laser 20 5.33(1.3 Placebo (Sham 20 4.35(1.0 Mean 0.98(0.23,1.733 Laser (Laser
2008 Quality strength(Kilograms treatment) 3) laser (placebo)) 9) Differen 644) treatment)
(lateral prehension)) ce (P-
value<.05)
Chang,W.D., High NCS(Sensory peak 1 month Laser (Laser 20 3.67(0.2 Placebo (Sham 20 3.8(0.11) Mean -0.13(-0.23,- Laser (Laser
2008 Quality latency of the median treatment) 1) laser (placebo)) Differen 0.02610) treatment)
n. (ms)) ce (P-value<.05)
Chang,W.D., High NCS (DML)(Distal 1 month Laser (Laser 20 3.87(0.3 Placebo (Sham 20 4.1(0.21) Mean -0.23(-0.39,- Laser (Laser
2008 Quality motor latency (ms)) treatment) 0) laser (placebo)) Differen 0.06950) treatment)
ce (P-value<.05)
Chang,W.D., High Questionnaire 1 month Laser (Laser 20 11.04(0. Placebo (Sham 20 19.6(1.0 Mean -8.56(-9.05,- Laser (Laser
2008 Quality (General/undefined)(F treatment) 43) laser (placebo)) 2) Differen 8.07486) treatment)
unctional Status ce (P-value<.05)
Scale)
Colbert,A.P., High NCS 1.4 Magnet therapy 19 5.1(2.60) Magnet therapy 19 5.6(2.70) Mean -0.5(- Not
2010 Quality (CMAP)(Compound months (15mT) (Magnet (45mT) (Magnet Differen 2.19,1.185456) Significant
muscle action therapy (15mT)-) therapy (45mT)- ce (P-value>.05)
potential (mV)) )
Colbert,A.P., High NCS 4.1 Magnet therapy 19 4.8(2.10) Magnet therapy 19 4.3(0.70) Mean 0.5(- Not
2010 Quality (CMAP)(Compound months (15mT) (Magnet (45mT) (Magnet Differen 0.50,1.495353) Significant
muscle action therapy (15mT)-) therapy (45mT)- ce (P-value>.05)
potential (mV)) )
Colbert,A.P., High NCS 1.4 Sham magnet 20 5.9(1.90) Magnet therapy 19 5.1(2.60) Mean 0.8(- Not
2010 Quality (CMAP)(Compound months therapy (No (15mT) (Magnet Differen 0.64,2.235343) Significant
muscle action magnet therapy therapy (15mT)- ce (P-value>.05)
potential (mV)) (sham 0mT)) )
477
Colbert,A.P., High NCS 4.1 Sham magnet 20 5.9(3.00) Magnet therapy 19 4.3(0.70) Mean 1.6(0.25,2.9519 Sham
2010 Quality (CMAP)(Compound months therapy (No (45mT) (Magnet Differen 58) magnet
muscle action magnet therapy therapy (45mT)- ce therapy (No
potential (mV)) (sham 0mT)) ) magnet
therapy
(sham 0mT))
(P-value<.05)
Colbert,A.P., High NCS (DML)(Distal 1.4 Magnet therapy 19 5.1(1.60) Magnet therapy 19 5(0.80) Mean 0.1(- Not
2010 Quality motor latency (ms)) months (15mT) (Magnet (45mT) (Magnet Differen 0.70,0.904367) Significant
therapy (15mT)-) therapy (45mT)- ce (P-value>.05)
)
Colbert,A.P., High NCS (DML)(Distal 4.1 Magnet therapy 19 5.2(1.00) Magnet therapy 19 5.2(2.40) Mean 0(- Not
2010 Quality motor latency (ms)) months (15mT) (Magnet (45mT) (Magnet Differen 1.17,1.169102) Significant
)
Colbert,A.P., High NCS (DML)(Distal 1.4 Sham magnet 20 5(1.30) Magnet therapy 19 5.1(1.60) Mean -0.1(- Not
2010 Quality motor latency (ms)) months therapy (No (15mT) (Magnet Differen 1.02,0.817725) Significant
magnet therapy therapy (15mT)- ce (P-value>.05)
(sham 0mT)) )
Colbert,A.P., High NCS (DML)(Distal 1.4 Sham magnet 20 5(1.30) Magnet therapy 19 5(0.80) Mean 0(- Not
(sham 0mT)) )
Colbert,A.P., High NCS (DML)(Distal 4.1 Sham magnet 20 5.1(1.30) Magnet therapy 19 5.2(1.00) Mean -0.1(- Not
(sham 0mT)) )
Colbert,A.P., High NCS (DML)(Distal 4.1 Sham magnet 20 5.1(1.30) Magnet therapy 19 5.2(2.40) Mean -0.1(- Not
(sham 0mT)) )
478
Colbert,A.P., High NCS (DSL)(Distal 1.4 Magnet therapy 19 4.2(0.50) Magnet therapy 19 4.7(1.00) Mean -0.5(- Not
2010 Quality sensory latency (ms)) months (15mT) (Magnet (45mT) (Magnet Differen 1.00,0.002729) Significant
)
Colbert,A.P., High NCS (DSL)(Distal 4.1 Magnet therapy 19 4.3(0.70) Magnet therapy 19 4.8(1.20) Mean -0.5(- Not
2010 Quality sensory latency (ms)) months (15mT) (Magnet (45mT) (Magnet Differen 1.12,0.124680) Significant
)
Colbert,A.P., High NCS (DSL)(Distal 1.4 Sham magnet 20 4.2(0.90) Magnet therapy 19 4.2(0.50) Mean 0(- Not
2010 Quality sensory latency (ms)) months therapy (No (15mT) (Magnet Differen 0.45,0.454017) Significant
(sham 0mT)) )
Colbert,A.P., High NCS (DSL)(Distal 1.4 Sham magnet 20 4.2(0.90) Magnet therapy 19 4.7(1.00) Mean -0.5(- Not
(sham 0mT)) )
Colbert,A.P., High NCS (DSL)(Distal 4.1 Sham magnet 20 4.3(0.90) Magnet therapy 19 4.3(0.70) Mean 0(- Not
(sham 0mT)) )
Colbert,A.P., High NCS (DSL)(Distal 4.1 Sham magnet 20 4.3(0.90) Magnet therapy 19 4.8(1.20) Mean -0.5(- Not
(sham 0mT)) )
Colbert,A.P., High NCS (SNAP)(Sensory 1.4 Magnet therapy 19 18.5(8.3 Magnet therapy 19 16(8.80) Mean 2.5(- Not
2010 Quality nerve action potential months (15mT) (Magnet 0) (45mT) (Magnet Differen 2.94,7.939336) Significant
(uV)) therapy (15mT)-) therapy (45mT)- ce (P-value>.05)
)
Colbert,A.P., High NCS (SNAP)(Sensory 4.1 Magnet therapy 19 16.9(6.3 Magnet therapy 19 16.2(10. Mean 0.7(- Not
2010 Quality nerve action potential months (15mT) (Magnet 0) (45mT) (Magnet 30) Differen 4.73,6.129105) Significant
(uV)) therapy (15mT)-) therapy (45mT)- ce (P-value>.05)
)
Colbert,A.P., High NCS (SNAP)(Sensory 1.4 Sham magnet 20 18.2(7.7 Magnet therapy 19 16(8.80) Mean 2.2(- Not
2010 Quality nerve action potential months therapy (No 0) (45mT) (Magnet Differen 3.00,7.400574) Significant
(uV)) magnet therapy therapy (45mT)- ce (P-value>.05)
(sham 0mT)) )
479
Colbert,A.P., High NCS (SNAP)(Sensory 1.4 Sham magnet 20 18.2(7.7 Magnet therapy 19 18.5(8.3 Mean -0.3(- Not
2010 Quality nerve action potential months therapy (No 0) (15mT) (Magnet 0) Differen 5.33,4.731625) Significant
(sham 0mT)) )
Colbert,A.P., High NCS (SNAP)(Sensory 4.1 Sham magnet 20 18.3(7.9 Magnet therapy 19 16.2(10. Mean 2.1(- Not
(sham 0mT)) )
Colbert,A.P., High NCS (SNAP)(Sensory 4.1 Sham magnet 20 18.3(7.9 Magnet therapy 19 16.9(6.3 Mean 1.4(- Not
(sham 0mT)) )
Colbert,A.P., High Questionnaire 1.4 Magnet therapy 19 1.7(0.50) Magnet therapy 19 1.8(0.60) Mean -0.1(- Not
2010 Quality (Boston-FSS)(Boston months (15mT) (Magnet (45mT) (Magnet Differen 0.45,0.251191) Significant
CTS Questionnaire therapy (15mT)-) therapy (45mT)- ce (P-value>.05)
(functional status )
scale))
Colbert,A.P., High Questionnaire 4.1 Magnet therapy 19 1.9(0.80) Magnet therapy 19 2(0.80) Mean -0.1(- Not
2010 Quality (Boston-FSS)(Boston months (15mT) (Magnet (45mT) (Magnet Differen 0.61,0.408726) Significant
CTS Questionnaire therapy (15mT)-) therapy (45mT)- ce (P-value>.05)
(functional status )
scale))
Colbert,A.P., High Questionnaire 1.4 Sham magnet 20 1.7(0.40) Magnet therapy 19 1.7(0.50) Mean 0(- Not
2010 Quality (Boston-FSS)(Boston months therapy (No (15mT) (Magnet Differen 0.29,0.285096) Significant
CTS Questionnaire magnet therapy therapy (15mT)- ce (P-value>.05)
(functional status (sham 0mT)) )
scale))
Colbert,A.P., High Questionnaire 1.4 Sham magnet 20 1.7(0.40) Magnet therapy 19 1.8(0.60) Mean -0.1(- Not
scale))
480
Colbert,A.P., High Questionnaire 4.1 Sham magnet 20 1.8(0.60) Magnet therapy 19 1.9(0.80) Mean -0.1(- Not
scale))
Colbert,A.P., High Questionnaire 4.1 Sham magnet 20 1.8(0.60) Magnet therapy 19 2(0.80) Mean -0.2(- Not
scale))
Ebenbichler, High Grip NA Ultrasound (20 34 15.8(10. Sham ultrasound 34 19.8(10. Mean -4(- Not
G.R., 1998 Quality strength(Kilograms) sessions of 90) (No ultrasound) 00) Differen 8.97,0.972218) Significant
ultrasound ce (P-value>.05)
(active) treatment
(1 MHz, 1.0
W/cm2, pulsed
mode 1:4, 15
minutes per
session) applied
to the area over
the carpal tunnel
of one wrist, and
indistinguishable
sham ultrasound
treatment applied
to the other. The
first 10
treatments were
performed daily
(5
sessions/week);
10 further
treatments were
twice weekly for
5 weeks.)
481
Ebenbichler, High Grip 1.6 Ultrasound (20 34 3.87(5.3 Sham ultrasound 34 - Mean 3.96(1.32,6.60) Ultrasound
G.R., 1998 Quality strength(Kilograms) months sessions of 5) (No ultrasound) 0.09(5.7 Differen (20 sessions
ultrasound 7) ce of
(active) treatment ultrasound
(1 MHz, 1.0 (active)
W/cm2, pulsed treatment (1
mode 1:4, 15 MHz, 1.0
minutes per W/cm2,
session) applied pulsed mode
to the area over 1:4, 15
the carpal tunnel minutes per
of one wrist, and session)
indistinguishable applied to
sham ultrasound the area over
treatment applied the carpal
to the other. The tunnel of one
first 10 wrist, and
treatments were indistinguish
performed daily able sham
(5 ultrasound
sessions/week); treatment
10 further applied to
treatments were the other.
twice weekly for The first 10
5 weeks.) treatments
were
performed
daily (5
sessions/wee
k); 10
further
treatments
were twice
weekly for 5
weeks.)
(P-value<.05)
482
Ebenbichler, High Grip 7.9 Ultrasound (20 34 5.44(7.5 Sham ultrasound 34 - Mean 7.43(4.16,10.70 Ultrasound
G.R., 1998 Quality strength(Kilograms) months sessions of 0) (No ultrasound) 1.99(6.1 Differen ) (20 sessions
ultrasound 9) ce of
mode 1:4, 15 MHz, 1.0
minutes per W/cm2,
first 10 wrist, and
(5 ultrasound
were
performed
daily (5
sessions/wee
k); 10
further
treatments
were twice
weekly for 5
weeks.)
(P-value<.05)
483
Ebenbichler, High NCS (DML)(Distal NA Ultrasound (20 34 5.2(1.00) Sham ultrasound 34 5.2(1.20) Mean 0(- Not
G.R., 1998 Quality motor latency (ms)) sessions of (No ultrasound) Differen 0.53,0.525063) Significant
(active) treatment
(1 MHz, 1.0
W/cm2, pulsed
mode 1:4, 15
minutes per
session) applied
to the area over
the carpal tunnel
of one wrist, and
indistinguishable
sham ultrasound
treatment applied
to the other. The
first 10
treatments were
performed daily
(5
sessions/week);
10 further
treatments were
twice weekly for
5 weeks.)
484
Ebenbichler, High NCS (DML)(Distal 1.6 Ultrasound (20 34 - Sham ultrasound 34 0.06(0.4 Mean -0.61(-0.83,- Ultrasound
G.R., 1998 Quality motor latency (ms)) months sessions of 0.55(0.4 (No ultrasound) 5) Differen 0.39) (20 sessions
ultrasound 8) ce of
mode 1:4, 15 MHz, 1.0
minutes per W/cm2,
first 10 wrist, and
(5 ultrasound
were
performed
daily (5
sessions/wee
k); 10
further
treatments
were twice
weekly for 5
weeks.)
(P-value<.05)
485
Ebenbichler, High NCS (DML)(Distal 7.9 Ultrasound (20 34 - Sham ultrasound 34 0.04(0.4 Mean -0.35(-0.55,- Ultrasound
G.R., 1998 Quality motor latency (ms)) months sessions of 0.31(0.3 (No ultrasound) 5) Differen 0.15) (20 sessions
ultrasound 9) ce of
mode 1:4, 15 MHz, 1.0
minutes per W/cm2,
first 10 wrist, and
(5 ultrasound
were
performed
daily (5
sessions/wee
k); 10
further
treatments
were twice
weekly for 5
weeks.)
(P-value<.05)
486
Ebenbichler, High NCS (SNCV)(Sensory NA Ultrasound (20 34 40(7.20) Sham ultrasound 34 42.1(7.2 Mean -2.1(- Not
G.R., 1998 Quality nerve conduction sessions of (No ultrasound) 0) Differen 5.52,1.322662) Significant
velocity (antidromic)) ultrasound ce (P-value>.05)
(active) treatment
(1 MHz, 1.0
W/cm2, pulsed
mode 1:4, 15
minutes per
session) applied
to the area over
the carpal tunnel
of one wrist, and
indistinguishable
sham ultrasound
treatment applied
to the other. The
first 10
treatments were
performed daily
(5
sessions/week);
10 further
treatments were
twice weekly for
5 weeks.)
487
Ebenbichler, High NCS (SNCV)(Sensory 1.6 Ultrasound (20 34 7.35(1.0 Sham ultrasound 34 - Mean 8.24(7.81,8.67) Ultrasound
G.R., 1998 Quality nerve conduction months sessions of 7) (No ultrasound) 0.89(0.6 Differen (20 sessions
velocity (antidromic)) ultrasound 8) ce of
mode 1:4, 15 MHz, 1.0
minutes per W/cm2,
first 10 wrist, and
(5 ultrasound
were
performed
daily (5
sessions/wee
k); 10
further
treatments
were twice
weekly for 5
weeks.)
(P-value<.05)
488
Ebenbichler, High NCS (SNCV)(Sensory 7.9 Ultrasound (20 34 2.69(0.8 Sham ultrasound 34 - Mean 2.96(2.58,3.34) Ultrasound
G.R., 1998 Quality nerve conduction months sessions of 9) (No ultrasound) 0.27(0.7 Differen (20 sessions
velocity (antidromic)) ultrasound 1) ce of
mode 1:4, 15 MHz, 1.0
minutes per W/cm2,
first 10 wrist, and
(5 ultrasound
were
performed
daily (5
sessions/wee
k); 10
further
treatments
were twice
weekly for 5
weeks.)
(P-value<.05)
489
Ebenbichler, High Pinch NA Ultrasound (20 34 5.5(1.80) Sham ultrasound 34 5.8(1.80) Mean -0.3(- Not
G.R., 1998 Quality Strength(Kilograms) sessions of (No ultrasound) Differen 1.16,0.555665) Significant
(active) treatment
(1 MHz, 1.0
W/cm2, pulsed
mode 1:4, 15
minutes per
session) applied
to the area over
the carpal tunnel
of one wrist, and
indistinguishable
sham ultrasound
treatment applied
to the other. The
first 10
treatments were
performed daily
(5
sessions/week);
10 further
treatments were
twice weekly for
5 weeks.)
490
Ebenbichler, High Pinch 1.6 Ultrasound (20 34 0.33(0.5 Sham ultrasound 34 0.06(0.9 Mean 0.27(- Ultrasound
G.R., 1998 Quality Strength(Kilograms) months sessions of 1) (No ultrasound) 5) Differen 0.09,0.63) (20 sessions
ultrasound ce of
mode 1:4, 15 MHz, 1.0
minutes per W/cm2,
first 10 wrist, and
(5 ultrasound
were
performed
daily (5
sessions/wee
k); 10
further
treatments
were twice
weekly for 5
weeks.)
491
Ebenbichler, High Pinch 7.9 Ultrasound (20 34 0.49(0.6 Sham ultrasound 34 - Mean 0.71(0.45,0.97) Ultrasound
G.R., 1998 Quality Strength(Kilograms) months sessions of 2) (No ultrasound) 0.22(0.4 Differen (20 sessions
ultrasound 8) ce of
mode 1:4, 15 MHz, 1.0
minutes per W/cm2,
first 10 wrist, and
(5 ultrasound
were
performed
daily (5
sessions/wee
k); 10
further
treatments
were twice
weekly for 5
weeks.)
(P-value<.05)
492
Evcik,D., High Grip 1 month Laser (Low-level 41 22.4(6.7 Laser (sham) 40 19.7(6.5 Mean 2.7(- Not
2007 Quality strength(Kilograms) laser therapy 0) (No laser 0) Differen 0.17,5.574677) Significant
(LLLT)) therapy ce (P-value>.05)
(placebo))
Evcik,D., High Grip 2.8 Laser (Low-level 41 22.8(6.9 Laser (sham) 40 19.6(7.3 Mean 3.2(0.11,6.2949 Laser (Low-
2007 Quality strength(Kilograms) months laser therapy 0) (No laser 0) Differen 81) level laser
(LLLT)) therapy ce therapy
(placebo)) (LLLT))
(P-value<.05)
Evcik,D., High NCS(Motor nerve 3 months Laser (Low-level 41 52(6.20) Laser (sham) 40 50.3(6.3 Mean 1.7(- Not
2007 Quality velocity, (m/sn)) laser therapy (No laser 0) Differen 1.02,4.422785) Significant
(placebo))
Evcik,D., High NCS (DML)(Distal 3 months Laser (Low-level 41 4.1(0.70) Laser (sham) 40 4.2(1.08) Mean -0.1(- Not
2007 Quality motor latency (ms)) laser therapy (No laser Differen 0.50,0.297407) Significant
(placebo))
Evcik,D., High NCS (DSL)(Sensory 3 months Laser (Low-level 41 3(0.50) Laser (sham) 40 3.1(0.60) Mean -0.1(- Not
2007 Quality distal latancy, (msn)) laser therapy (No laser Differen 0.34,0.140829) Significant
(placebo))
Evcik,D., High NCS (MA)(Motor 3 months Laser (Low-level 41 6.9(3.40) Laser (sham) 40 7.2(4.00) Mean -0.3(- Not
2007 Quality amplitude (uV)) laser therapy (No laser Differen 1.92,1.318574) Significant
(placebo))
Evcik,D., High NCS (SA)(Sensory 3 months Laser (Low-level 41 29.6(12. Laser (sham) 40 27.9(13. Mean 1.7(- Not
2007 Quality amplitude, (uV)) laser therapy 90) (No laser 40) Differen 4.03,7.430371) Significant
(placebo))
Evcik,D., High NCS (SNCV)(Sensory 3 months Laser (Low-level 41 42.9(6.7 Laser (sham) 40 41.1(7.1 Mean 1.8(- Not
2007 Quality nerve velocity, (m/sn)) laser therapy 0) (No laser 0) Differen 1.21,4.807899) Significant
(placebo))
493
Evcik,D., High Pinch 1 month Laser (Low-level 41 5.2(1.50) Laser (sham) 40 4.6(1.50) Mean 0.6(- Not
2007 Quality Strength(Kilograms) laser therapy (No laser Differen 0.05,1.253383) Significant
(placebo))
Evcik,D., High Pinch 2.8 Laser (Low-level 41 5.7(1.60) Laser (sham) 40 4.8(1.50) Mean 0.9(0.22,1.5752 Laser (Low-
2007 Quality Strength(Kilograms) months laser therapy (No laser Differen 44) level laser
(LLLT)) therapy ce therapy
(placebo)) (LLLT))
(P-value<.05)
Fusakul,Y., High Grip strength(Units 1.2 Laser+splint 56 22.65(1. Placebo+splint 56 23.25(0. Mean -0.6(-1.00,- Placebo+spli
2014 Quality not reported) months (LLLT+splint 17) (Placebo+splint 99) Differen 0.19857) nt
(multiple (multiple ce (Placebo+spl
treatments)) treatments)) int (multiple
treatments))
(P-value<.05)
Fusakul,Y., High Grip strength(Units 2.8 Laser+splint 56 24.49(1. Placebo+splint 56 23.6(1.0 Mean 0.89(0.49,1.289 Laser+splint
2014 Quality not reported) months (LLLT+splint 15) (Placebo+splint 0) Differen 153) (LLLT+splin
(multiple (multiple ce t (multiple
treatments)) treatments)) treatments))
(P-value<.05)
Fusakul,Y., High NCS 2.8 Laser+splint 56 9.95(0.3 Placebo+splint 56 9.94(0.3 Mean 0.01(- Not
2014 Quality (CMAP)(Compound months (LLLT+splint 3) (Placebo+splint 9) Differen 0.12,0.143808) Significant
muscle action (multiple (multiple ce (P-value>.05)
potential (mV)) treatments)) treatments))
Fusakul,Y., High NCS (DML)(Distal 2.8 Laser+splint 56 4.73(0.1 Placebo+splint 56 6.63(1.1 Mean -1.9(-2.19,- Laser+splint
2014 Quality motor latency (ms)) months (LLLT+splint 3) (Placebo+splint 0) Differen 1.60988) (LLLT+splin
(P-value<.05)
Fusakul,Y., High NCS (DSL)(Distal 2.8 Laser+splint 56 4.48(0.1 Placebo+splint 56 4.66(0.1 Mean -0.18(-0.24,- Laser+splint
2014 Quality sensory latency (ms)) months (LLLT+splint 3) (Placebo+splint 8) Differen 0.12184) (LLLT+splin
(P-value<.05)
494
Fusakul,Y., High NCS (SNAP)(Sensory 2.8 Laser+splint 56 23(1.74) Placebo+splint 56 21.91(1. Mean 1.09(0.44,1.740 Laser+splint
2014 Quality nerve action potential months (LLLT+splint (Placebo+splint 77) Differen 084) (LLLT+splin
amplitude) (multiple (multiple ce t (multiple
(P-value<.05)
Fusakul,Y., High Pinch Strength(Units 1.2 Laser+splint 56 8(3.56) Placebo+splint 56 4.65(0.3 Mean 3.35(2.41,4.285 Laser+splint
2014 Quality not reported) months (LLLT+splint (Placebo+splint 0) Differen 725) (LLLT+splin
(P-value<.05)
Fusakul,Y., High Pinch Strength(Units 2.8 Laser+splint 56 5.4(0.28) Placebo+splint 56 5.47(0.3 Mean -0.07(- Not
2014 Quality not reported) months (LLLT+splint (Placebo+splint 1) Differen 0.18,0.039410) Significant
(multiple (multiple ce (P-value>.05)
treatments)) treatments))
Fusakul,Y., High Questionnaire 1.2 Laser+splint 56 1.75(0.6 Placebo+splint 56 1.54(0.6 Mean 0.21(- Not
2014 Quality (Boston-FSS)(Boston months (LLLT+splint 2) (Placebo+splint 2) Differen 0.02,0.439651) Significant
CTS Questionnaire (multiple (multiple ce (P-value>.05)
(functional status treatments)) treatments))
scale))
Fusakul,Y., High Questionnaire 2.8 Laser+splint 56 1.53(0.5 Placebo+splint 56 1.37(0.4 Mean 0.16(- Not
2014 Quality (Boston-FSS)(Boston months (LLLT+splint 7) (Placebo+splint 9) Differen 0.04,0.356873) Significant
CTS Questionnaire (multiple (multiple ce (P-value>.05)
(functional status treatments)) treatments))
scale))
Saeed,F.-U., High NCS (DML)(Distal 1 month Ultrasound 50 - Laser (Laser 50 - Mean 0.62(0.55,0.693 Laser (Laser
2012 Quality motor latency (ms)) (Ultrasound 0.18(0.1 therapy) 0.8(0.23) Differen 231) therapy)
therapy) 3) ce (P-value<.05)
Saeed,F.-U., High NCS (DSL)(Distal 1 month Ultrasound 50 - Laser (Laser 50 - Mean 0.47(0.39,0.550 Laser (Laser
2012 Quality sensory latency (ms)) (Ultrasound 0.07(0.0 therapy) 0.54(0.2 Differen 000) therapy)
therapy) 7) 8) ce (P-value<.05)
495
Saeed,F.-U., High Questionnaire 1 month Ultrasound 50 - Laser (Laser 50 - Mean 0.35(0.29,0.407 Laser (Laser
2012 Quality (General/undefined)( (Ultrasound 0.4(0.17) therapy) 0.75(0.1 Differen 678) therapy)
No mention of Boston therapy) 2) ce (P-value<.05)
scale, rather merely
"functional status
scale")
Yang,C.P., High NCS 1 month Acupuncture 38 7.2(2.70) Steroid (2 weeks 39 7.6(2.80) Mean -0.4(- Not
2011 Quality (CMAP)(Compound (Acupuncture of prednisolone Differen 1.63,0.828511) Significant
muscle action administered in 8 20 mg daily ce (P-value>.05)
potential (mV)) sessions over 4 followed by 2
weeks (Group 1)) weeks of
prednisolone 10
mg daily (Group
2))
Yang,C.P., High NCS 1.1 years Acupuncture 38 7.8(2.50) Steroid (2 weeks 39 8(3.60) Mean -0.2(- Not
2011 Quality (CMAP)(Compound (Acupuncture of prednisolone Differen 1.58,1.181461) Significant
muscle action administered in 8 20 mg daily ce (P-value>.05)
potential (mV)) sessions over 4 followed by 2
prednisolone 10
mg daily (Group
2))
Yang,C.P., High NCS (DML)(Distal 1 month Acupuncture 38 4(0.70) Steroid (2 weeks 39 4.7(1.00) Mean -0.7(-1.08,- Acupuncture
2011 Quality motor latency (ms)) (Acupuncture of prednisolone Differen 0.31524) (Acupunctur
administered in 8 20 mg daily ce e
sessions over 4 followed by 2 administered
weeks (Group 1)) weeks of in 8 sessions
prednisolone 10 over 4 weeks
mg daily (Group (Group 1))
2)) (P-value<.05)
Yang,C.P., High NCS (DML)(Distal 1.1 years Acupuncture 38 4.2(0.80) Steroid (2 weeks 39 5.5(1.80) Mean -1.3(-1.92,- Acupuncture
2011 Quality motor latency (ms)) (Acupuncture of prednisolone Differen 0.68044) (Acupunctur
administered in 8 20 mg daily ce e
2)) (P-value<.05)
496
Yang,C.P., High NCS (DSL)(Distal 1 month Acupuncture 38 3.3(0.70) Steroid (2 weeks 39 3(0.60) Mean 0.3(0.01,0.5915 Steroid (2
2011 Quality sensory latency (ms)) (Acupuncture of prednisolone Differen 43) weeks of
administered in 8 20 mg daily ce prednisolone
sessions over 4 followed by 2 20 mg daily
weeks (Group 1)) weeks of followed by 2
prednisolone 10 weeks of
mg daily (Group prednisolone
2)) 10 mg daily
(Group 2))
(P-value<.05)
Yang,C.P., High NCS (DSL)(Distal 1.1 years Acupuncture 38 3.4(0.60) Steroid (2 weeks 39 3.7(1.10) Mean -0.3(- Not
2011 Quality sensory latency (ms)) (Acupuncture of prednisolone Differen 0.69,0.094439) Significant
administered in 8 20 mg daily ce (P-value>.05)
sessions over 4 followed by 2
prednisolone 10
mg daily (Group
2))
Yang,C.P., High NCS (MCV)(Motor 1 month Acupuncture 38 53.7(3.8 Steroid (2 weeks 39 52.4(3.6 Mean 1.3(- Not
2011 Quality nerve conduction (Acupuncture 0) of prednisolone 0) Differen 0.35,2.954207) Significant
velocity (ms)) administered in 8 20 mg daily ce (P-value>.05)
prednisolone 10
mg daily (Group
2))
Yang,C.P., High NCS (MCV)(Motor 1.1 years Acupuncture 38 52.7(4.0 Steroid (2 weeks 39 49.7(4.6 Mean 3(1.08,4.92401 Acupuncture
2011 Quality nerve conduction (Acupuncture 0) of prednisolone 0) Differen 4) (Acupunctur
velocity (ms)) administered in 8 20 mg daily ce e
2)) (P-value<.05)
497
Yang,C.P., High NCS (SNAP)(Sensory 1 month Acupuncture 38 18.4(9.8 Steroid (2 weeks 39 20.8(9.9 Mean -2.4(- Not
2011 Quality nerve action potential (Acupuncture 0) of prednisolone 0) Differen 6.80,2.000383) Significant
amplitude) administered in 8 20 mg daily ce (P-value>.05)
prednisolone 10
mg daily (Group
2))
Yang,C.P., High NCS (SNAP)(Sensory 1.1 years Acupuncture 38 18.2(9.3 Steroid (2 weeks 39 18.5(10. Mean -0.3(- Not
2011 Quality nerve action potential (Acupuncture 0) of prednisolone 40) Differen 4.70,4.104284) Significant
amplitude) administered in 8 20 mg daily ce (P-value>.05)
prednisolone 10
mg daily (Group
2))
Yang,C.P., High NCS (SNCV)(Sensory 1 month Acupuncture 38 43.9(8.0 Steroid (2 weeks 39 48.6(6.2 Mean -4.7(-7.90,- Steroid (2
2011 Quality nerve conduction (Acupuncture 0) of prednisolone 0) Differen 1.49742) weeks of
velocity (prolonged administered in 8 20 mg daily ce prednisolone
antidromic wrist sessions over 4 followed by 2 20 mg daily
palm)) weeks (Group 1)) weeks of followed by 2
prednisolone 10 weeks of
mg daily (Group prednisolone
2)) 10 mg daily
(Group 2))
(P-value<.05)
Yang,C.P., High NCS (SNCV)(Sensory 1.1 years Acupuncture 38 44.7(7.0 Steroid (2 weeks 39 45.6(8.7 Mean -0.9(- Not
2011 Quality nerve conduction (Acupuncture 0) of prednisolone 0) Differen 4.42,2.622683) Significant
velocity (prolonged administered in 8 20 mg daily ce (P-value>.05)
antidromic wrist sessions over 4 followed by 2
palm)) weeks (Group 1)) weeks of
prednisolone 10
mg daily (Group
2))
498
Yildiz,N., High NCS (DML)(Median 1.8 Ultrasound (w/ 17 4.43(0.5 Sham ultrasound 17 4.32(0.6 Mean 0.11(- Not
2011 Quality motor distal latency) months splinting) 5) (w/ splinting) 0) Differen 0.28,0.496923) Significant
(Ultrasound+spli (Sham ce (P-value>.05)
nting. Included ultrasound+splin
the intention- ting. Included
intention-to-treat the intention-
analysis data intention-to-treat
(Group 2)) analysis data)
Yildiz,N., High NCS (DSL)(Median 1.8 Ultrasound (w/ 17 3.87(0.2 Sham ultrasound 17 3.94(0.4 Mean -0.07(- Not
2011 Quality sensory distal latency) months splinting) 9) (w/ splinting) 7) Differen 0.33,0.192531) Significant
(Ultrasound+spli (Sham ce (P-value>.05)
Yildiz,N., High Questionnaire 1.8 Ultrasound (w/ 17 1.98(0.7 Sham ultrasound 17 2.19(0.8 Mean -0.21(- Not
2011 Quality (General/undefined)(F months splinting) 8) (w/ splinting) 9) Differen 0.77,0.352565) Significant
SS) (Ultrasound+spli (Sham ce (P-value>.05)
499
TABLE 129: PICO 6 PART 6- OTHER TREATMENTS: PAIN
Treatment Group Treatment Group Effect Result

Reference Outcome 1 1 Mean1/P1 2 2 Mean2/P2 Measur (95% Favored
Chang,W.D., high Questionnaire/Sc 1 month Laser (Laser 20 . % Placebo (Sham 20 . % Author NA Laser (Laser
2008 Quality ale (VAS- treatment) laser (placebo)) Reporte treatment)
pain)(VAS pain) d (P-
value<.05)
Bakhtiary,A. High Questionnaire/Sc 1.6 months Ultrasound . . % Laser (15 daily . . % Author NA Ultrasound
H., 2004 Quality ale (VAS-pain)( (Ultrasound treatment Reporte (Ultrasound
) treatment (1 sessions (5 d treatment (1
W/cm2, pulse W/cm2,
1:4, 15 pulse 1:4, 15
(P-
value<.05)
Evcik,D., High Questionnaire/Sc 1 month Laser (Low- 41 3(0.98) Laser (sham) (No 40 3(1.61) Mean 0(-0.58,0.58) Not
2007 Quality ale (VAS- level laser laser therapy Differen Significant
pain)(VAS pain therapy (LLLT)) (placebo)) ce (P-value>.05)
(day): 0-10
scale)
Evcik,D., High Questionnaire/Sc 1 month Laser (Low- 41 3.8(1.63) Laser (sham) (No 40 3.5(2.26) Mean 0.3(-0.56,1.16) Not
(night): 0-10
scale)
Evcik,D., High Questionnaire/Sc 2.8 months Laser (Low- 41 2.2(0.98) Laser (sham) (No 40 2.8(2.58) Mean -0.6(-1.45,0.25) Not
(day): 0-10
scale)
Evcik,D., High Questionnaire/Sc 2.8 months Laser (Low- 41 2.7(1.96) Laser (sham) (No 40 2.9(2.58) Mean -0.2(-1.20,0.80) Not
(night): 0-10
scale)
500
Fusakul,Y., High Questionnaire/Sc 1.2 months Laser+splint 56 4.25(0.34) Placebo+splint 56 3.15(0.30) Mean 1.1(0.98,1.21876 Placebo+spli
2014 Quality ale (VAS-pain)( (LLLT+splint (Placebo+splint Differen 0) nt
) (multiple (multiple ce (Placebo+spl
treatments))
(P-
value<.05)
Fusakul,Y., High Questionnaire/Sc 2.8 months Laser+splint 56 3.45(0.38) Placebo+splint 56 2.48(0.36) Mean 0.97(0.83,1.1070 Placebo+spli
2014 Quality ale (VAS-pain)( (LLLT+splint (Placebo+splint Differen 99) nt
) (multiple (multiple ce (Placebo+spl
treatments))
(P-
value<.05)
Saeed,F.-U., High Questionnaire/Sc 1 month Ultrasound 50 -2.6(1.07) Laser (Laser 50 -4.9(1.46) Mean 2.3(1.80,2.80173 Laser (Laser
2012 Quality ale (VAS-pain)( (Ultrasound therapy) Differen 7) therapy)
) therapy) ce (P-
value<.05)
Weintraub,M High Questionnaire 2 months No magnet 10 37.6(15.36 Magnet (Magnet 11 36.27(19.6 Mean 1.33(- Not
.I., 2008 Quality (General/undefin (sham) (Sham ) therapy) 1) Differen 13.67,16.32780) Significant
ed) (NPS 10. (no magnet ce (P-value>.05)
Neuropathic pain therapy))
scale (NPS))
.I., 2008 Quality (General/undefin (sham) (Sham 5) therapy) 6) Differen 14.01,21.97188) Significant
scale (NPS))
.I., 2008 Quality (General/undefin (sham) (Sham ) therapy) 4) Differen 13.32,16.42201) Significant
scale (NPS))
501
.I., 2008 Quality (General/undefin (sham) (Sham 1) therapy) 8) Differen 12.50,17.50490) Significant
ed) (NPS NA. (no magnet ce (P-value>.05)
scale (NPS))
Weintraub,M High Questionnaire/Sc 2 months No magnet 10 3.78(2.27) Magnet (Magnet 11 4.15(2.13) Mean -0.37(- Not
.I., 2008 Quality ale (VAS-pain)( (sham) (Sham therapy) Differen 2.26,1.517852) Significant
) (no magnet ce (P-value>.05)
therapy))
Yildiz,N., High Questionnaire/Sc 1.8 months Ultrasound (w/ 17 2.77(2.74) Sham ultrasound 17 3.28(2.74) Mean -0.51(- Not
2011 Quality ale (VAS-pain)( splinting) (w/ splinting) Differen 2.35,1.332032) Significant
) (Ultrasound+spli (Sham ce (P-value>.05)
nting. Included ultrasound+splint
the intention- ing. Included the
intention-to-treat intention-
502
TABLE 130: PICO 6 PART 6- OTHER TREATMENTS: QUALITY OF LIFE

Weintraub,M.I., High Questionnaire/Scale 2 months No magnet 10 1.1(1.37) Magnet 11 3.29(2.48) Mean -2.19(- No magnet
2008 Quality (VAS-patient (sham) (Sham (Magnet Difference 3.88,- (sham)
satisfaction)(Sleep (no magnet therapy) 0.49619) (Sham (no
interference) therapy)) magnet
therapy))
(P-
value<.05)
503
TABLE 131: PICO 6 PART 6- OTHER TREATMENTS: SYMPTOMS
Treatment Mean1/ Treatment Mean2/ Effect Result

Reference Outcome 1 Group1 P1 2 Group2 P2 Measur (95% Favored
Chang,W.D., High Questionnaire 1 month Laser (Laser 20 19.35(0. Placebo (Sham 20 28.71(0. Mean -9.36(-9.82,- Laser (Laser
2008 Quality (General/undefined) treatment) 63) laser (placebo)) 85) Differen 8.89630) treatment)
(Symptom Severity ce (P-value<.05)
Scale)
Colbert,A.P., High Questionnaire 1.4 months Magnet therapy 19 2.1(0.70) Magnet therapy 19 2.2(0.50) Mean -0.1(- Not
2010 Quality (Boston- (15mT) (Magnet (45mT) (Magnet Differen 0.49,0.286807) Significant
SSS)(Boston CTS therapy (15mT)-) therapy (45mT)- ce (P-value>.05)
Questionnaire )
(symptom severity
scale))
Colbert,A.P., High Questionnaire 4.1 months Magnet therapy 19 2.4(0.80) Magnet therapy 19 2.3(0.80) Mean 0.1(- Not
2010 Quality (Boston- (15mT) (Magnet (45mT) (Magnet Differen 0.41,0.608726) Significant
SSS)(Boston CTS therapy (15mT)-) therapy (45mT)- ce (P-value>.05)
Questionnaire )
(symptom severity
scale))
Colbert,A.P., High Questionnaire 1.4 months Sham magnet 20 2(0.80) Magnet therapy 19 2.1(0.70) Mean -0.1(- Not
2010 Quality (Boston- therapy (No (15mT) (Magnet Differen 0.57,0.371173) Significant
SSS)(Boston CTS magnet therapy therapy (15mT)- ce (P-value>.05)
Questionnaire (sham 0mT)) )
(symptom severity
scale))
Colbert,A.P., High Questionnaire 1.4 months Sham magnet 20 2(0.80) Magnet therapy 19 2.2(0.50) Mean -0.2(- Not
(symptom severity
scale))
Colbert,A.P., High Questionnaire 4.1 months Sham magnet 20 2.3(0.70) Magnet therapy 19 2.3(0.80) Mean 0(- Not
(symptom severity
scale))
504
Colbert,A.P., High Questionnaire 4.1 months Sham magnet 20 2.3(0.70) Magnet therapy 19 2.4(0.80) Mean -0.1(- Not
(symptom severity
scale))
Ebenbichler, High Questionnaire NA Ultrasound (20 34 6.5(2.60) Sham ultrasound 34 5.8(2.80) Mean 0.7(- Not
G.R., 1998 Quality (General/undefined) sessions of (No ultrasound) Differen 0.58,1.984378) Significant
(Not questionnaire, ultrasound ce (P-value>.05)
worst complaint (active) treatment
(cm)) (1 MHz, 1.0
W/cm2, pulsed
mode 1:4, 15
minutes per
session) applied
to the area over
the carpal tunnel
of one wrist, and
indistinguishable
sham ultrasound
treatment applied
to the other. The
first 10
treatments were
performed daily
(5
sessions/week);
10 further
treatments were
twice weekly for
5 weeks.)
505
Ebenbichler, High Questionnaire 1.6 months Ultrasound (20 34 - Sham ultrasound 34 - Mean -2.35(-3.89,- Ultrasound
G.R., 1998 Quality (General/undefined) sessions of 3.91(3.4 (No ultrasound) 1.56(3.0 Differen 0.81) (20 sessions
(Not questionnaire, ultrasound 5) 3) ce of ultrasound
worst complaint (active) treatment (active)
(cm)) (1 MHz, 1.0 treatment (1
W/cm2, pulsed MHz, 1.0
mode 1:4, 15 W/cm2,
minutes per pulsed mode
session) applied 1:4, 15
to the area over minutes per
the carpal tunnel session)
of one wrist, and applied to
indistinguishable the area over
sham ultrasound the carpal
treatment applied tunnel of one
to the other. The wrist, and
first 10 indistinguish
treatments were able sham
performed daily ultrasound
(5 treatment
sessions/week); applied to
10 further the other.
treatments were The first 10
twice weekly for treatments
5 weeks.) were
performed
daily (5
sessions/week
); 10 further
treatments
were twice
weekly for 5
weeks.)
(P-value<.05)
506
Ebenbichler, High Questionnaire 7.9 months Ultrasound (20 34 - Sham ultrasound 34 - Mean -3.83(-5.67,- Ultrasound
G.R., 1998 Quality (General/undefined) sessions of 4.78(3.2 (No ultrasound) 0.95(4.4 Differen 1.99) (20 sessions
(Not questionnaire, ultrasound 1) 3) ce of ultrasound
worst complaint (active) treatment (active)
(cm)) (1 MHz, 1.0 treatment (1
mode 1:4, 15 W/cm2,
(5 treatment
5 weeks.) were
performed
daily (5
sessions/week
); 10 further
treatments
were twice
weekly for 5
weeks.)
(P-value<.05)
507
Ebenbichler, High Sensory loss( ) NA Ultrasound (20 34 2.4(2.40) Sham ultrasound 34 2(2.40) Mean 0.4(- Not
G.R., 1998 Quality sessions of (No ultrasound) Differen 0.74,1.540887) Significant
(active) treatment
(1 MHz, 1.0
W/cm2, pulsed
mode 1:4, 15
minutes per
session) applied
to the area over
the carpal tunnel
of one wrist, and
indistinguishable
sham ultrasound
treatment applied
to the other. The
first 10
treatments were
performed daily
(5
sessions/week);
10 further
treatments were
twice weekly for
5 weeks.)
508
Ebenbichler, High Sensory loss( ) 1.6 months Ultrasound (20 34 - Sham ultrasound 34 - Mean -1.07(- Ultrasound
G.R., 1998 Quality sessions of 1.14(2.5 (No ultrasound) 0.07(2.3 Differen 2.23,0.09) (20 sessions
ultrasound 3) 5) ce of ultrasound
(active) treatment (active)
(1 MHz, 1.0 treatment (1
mode 1:4, 15 W/cm2,
(5 treatment
5 weeks.) were
performed
daily (5
sessions/week
); 10 further
treatments
were twice
weekly for 5
weeks.)
(P-value<.05)
509
Ebenbichler, High Sensory loss( ) 7.9 months Ultrasound (20 34 - Sham ultrasound 34 - Mean -1.52(-2.79,- Ultrasound
G.R., 1998 Quality sessions of 1.6(2.83) (No ultrasound) 0.08(2.5 Differen 0.25) (20 sessions
ultrasound 0) ce of ultrasound
(active) treatment (active)
(1 MHz, 1.0 treatment (1
mode 1:4, 15 W/cm2,
(5 treatment
5 weeks.) were
performed
daily (5
sessions/week
); 10 further
treatments
were twice
weekly for 5
weeks.)
(P-value<.05)
510
Fusakul,Y., High Questionnaire 1.2 months Laser+splint 56 1.68(0.6 Placebo+splint 56 1.43(0.4 Mean 0.25(0.03,0.465 Placebo+spli
2014 Quality (Boston- (LLLT+splint 6) (Placebo+splint 9) Differen 297) nt
SSS)(Boston CTS (multiple (multiple ce (Placebo+spli
Questionnaire treatments)) treatments)) nt (multiple
(symptom severity treatments))
scale)) (P-value<.05)
Fusakul,Y., High Questionnaire 2.8 months Laser+splint 56 1.49(0.5 Placebo+splint 56 1.35(0.5 Mean 0.14(- Not
2014 Quality (Boston- (LLLT+splint 8) (Placebo+splint 1) Differen 0.06,0.342286) Significant
SSS)(Boston CTS (multiple (multiple ce (P-value>.05)
Questionnaire treatments)) treatments))
(symptom severity
scale))
Saeed,F.-U., High Questionnaire 1 month Ultrasound 50 - Laser (Laser 50 - Mean 0.43(0.36,0.500 Laser (Laser
2012 Quality (General/undefined) (Ultrasound 0.44(0.1 therapy) 0.87(0.1 Differen 56) therapy)
(No mention of therapy) 8) 8) ce (P-value<.05)
Boston scale, rather
merely "symptom
severity scale")
Yang,C.P., High Questionnaire/Scale 1 month Acupuncture 38 4.4(3.10) Steroid (2 weeks 39 5(3.70) Mean -0.6(- Not
2011 Quality (GSS)(Global (Acupuncture of prednisolone Differen 2.12,0.923161) Significant
symptom score administered in 8 20 mg daily ce (P-value>.05)
(GSS)) sessions over 4 followed by 2
prednisolone 10
mg daily (Group
2))
Yang,C.P., High Questionnaire/Scale 6.9 months Acupuncture 38 3.4(5.80) Steroid (2 weeks 39 7.2(5.40) Mean -3.8(-6.30,- Acupuncture
2011 Quality (GSS)(Global (Acupuncture of prednisolone Differen 1.29537) (Acupunctur
symptom score administered in 8 20 mg daily ce e
(GSS)) sessions over 4 followed by 2 administered
2)) (P-value<.05)
511
Yang,C.P., High Questionnaire/Scale 1.1 years Acupuncture 38 4.5(7.70) Steroid (2 weeks 39 11(8.60) Mean -6.5(-10.14,- Acupuncture
2011 Quality (GSS)(Global (Acupuncture of prednisolone Differen 2.85594) (Acupunctur
symptom score administered in 8 20 mg daily ce e
(GSS)) sessions over 4 followed by 2 administered
2)) (P-value<.05)
Yildiz,N., High Questionnaire 1.8 months Ultrasound (w/ 17 1.97(0.6 Sham ultrasound 17 2.08(0.8 Mean -0.11(- Not
2011 Quality (General/undefined) splinting) 5) (w/ splinting) 2) Differen 0.61,0.387414) Significant
(SSS) (Ultrasound+spli (Sham ce (P-value>.05)
512
META-ANALYSES
FIGURE 11: PICO 6 PART 1 IMMOBILIZATION VERSUS NO IMMOBILIZATION: NCS DML-FUNCTION
513
FIGURE 12: PICO 6 PART 1 IMMOBILIZATION VERSUS NO IMMOBILIZATION: NCS SNCV
reference_title_1_ WMD (95% CI) Weight
Madjdinasab,N., 2008 -2.92 (-9.34, 3.50) 16.85
Manente,G., 2001 -0.72 (-5.85, 4.41) 26.38
Yagci,I., 2009 0.32 (-3.18, 3.82) 56.77
Overall (I-squared = 0.0%, p = 0.682) -0.50 (-3.13, 2.13) 100.00
NOTE: Weights are from random effects analysis
-9.34 0 9.34
No Immobilization Immobilization
514
SURGICAL RELEASE FOR CARPAL TUNNEL SYNDROME (CTS)
GUIDELINE RECOMMENDATIONS
A. SURGICAL RELEASE LOCATION

Strong evidence supports that surgical release of the transverse carpal ligament
should relieve symptoms and improve function.

Rationale
There were 17 high quality (Atroshi 2006, Castillo 2014, Cellocco 2005, Cellocco 2009,
Cresswell 2008, Gerritsen 2002, Hamed 2009, Hui 2005, Ismatullah 2013, Jarvik 2009, Larsen
2013, Malhotra 2007, Saw 2003, Sennwald 1995, Suppaphol 2012, Trumble 2002, and Zyluk
2006) and 10 moderate quality (Andreu 2013, Aslani 2012, Capa-Grasa 2014, Dumontier 1995,
Elsharif 2014, Faraj 2012, Ly-Pen 2012, Tarallo 2014, Tian 2007, and Ucar 2012) studies
demonstrating that release of the transverse carpal ligament is an effective treatment for patients
with CTS.

The risks associated with implementing this recommendation are those of a small outpatient
operative procedure.
B. SURGICAL RELEASE PROCEDURE

Limited evidence supports that if surgery is chosen, a practitioner might consider
using endoscopic carpal tunnel release based on possible short term benefits.

Rationale
Eleven high quality (Atroshi 2006, Atroshi 2009, Ejiri 2012, Kang 2013, Larsen 2013,
MacDermid 2003, Malhotra 2007, Saw 2003, Sennwald 1995, Trumble 2002, and Wong 2003)
and 6 moderate quality (Agee 1992, Aslani 2012, Dumontier 1995, Ferdinand 2002, Jacobsen
1996, and Tian 2007) studies evaluated whether endoscopic carpal tunnel release provided any
benefit over open or mini-open release at early follow up (3 months to one year). Three high
quality studies (Atroshi 2009, Saw 2003 and Trumble 2002) favored endoscopic release for
symptom relief in the first 3-6 months after surgery and one study (Saw 2003) demonstrated an
earlier return to work. One high quality (Atroshi 2009) and one moderate quality study (Tian
515
2007) examined long term outcomes for endoscopic release versus open release and did not find
any advantage of one method over the other. Studies comparing mini-open to standard release
were inconclusive.

C. SURGICAL PROCEDURES VERSUS NONOPERATIVE

TREATMENTS
Strong evidence supports that surgical treatment of carpal tunnel syndrome should
have a greater treatment benefit at 6 and 12 months as compared to splinting,
NSAIDs/therapy, and a single steroid injection.

Rationale
Four high quality (Gerritsen 2002, Hui 2005, Ismatullah 2013, and Jarvik 2009) and 3 moderate
quality (Andreu 2013, Ly 2005, and Ly-Pen 2012) studies compared the effectiveness of surgical
treatment to non-operative treatment for the relief of CTS symptoms. All three studies showed
that surgery was superior for the relief of daytime and nocturnal paresthesias and return of grip
strength. Of these, one high quality (Gerritson 2002) and one moderate quality study (Andreu
2013) examined the long term outcomes for surgery versus conservative treatment and found
better results with surgery

Future Research for Surgical Release of Carpal Tunnel Syndrome

Future research should focus on stratifying treatment outcomes based on preoperative symptom
severity.
516
STUDY QUALITY TABLE FOR SURGICAL TREATMENTS
TABLE 132: INTERVENTION QUALITY EVALUATIONS
Random Sequence Allocation Incomplete Selective Other Is there a large magnitude Influence of All Plausible Dose-Response
Study Generation Concealment
Blinding
Outcome Data Reporting Bias of effect? Residual Confounding Gradient
Inclusion Strength
Moderate
Agee,J.M., 1992 Include
Quality
Andreu,J.L., Moderate
Include
2013 Quality
Aslani,H.R., Moderate
Include
2012 Quality
High
Quality
High
Quality
Capa-Grasa,A., Moderate
Include
2014 Quality
Castillo,T.N., High
Include
2014 Quality
Cellocco,P., High
Include
2005 Quality
Cellocco,P., High
Include
2009 Quality
Cresswell,T.R., High
Include
2008 Quality
Dumontier,C., Moderate
Include
1995 Quality
High
Ejiri,S., 2012 Include
Quality
Elsharif,M., Moderate
Include
2014 Quality
Moderate
Faraj,A.A., 2012 Include
Quality
517
Blinding
Inclusion Strength
Ferdinand,R.D., Moderate
Include
2002 Quality
Gerritsen,A.A., High
Include
2002 Quality
Hamed,A.R., High
Include
2009 Quality
High
Hui,A.C., 2005 Include
Quality
Ismatullah,I., High
Include
2013 Quality
Jacobsen,M.B., Moderate
Include
1996 Quality
High
Jarvik,J.G., 2009 Include
Quality
High
Jugovac,I., 2002 Include
Quality
High
Kang,H.J., 2013 Include
Quality
Larsen,M.B., High
Include
2013 Quality
Moderate
Ly,Pen D., 2005 Include
Quality
Moderate
Ly-Pen,D., 2012 Include
Quality
MacDermid,J.C., High
Include
2003 Quality
Malhotra,R., High
Include
2007 Quality
High
Saw,N.L., 2003 Include
Quality
518
Blinding
Inclusion Strength
Sennwald,G.R., High
Include
1995 Quality
Suppaphol,S., High
Include
2012 Quality
Moderate
Tarallo,M., 2014 Include
Quality
Moderate
Tian,Y., 2007 Include
Quality
Trumble,T.E., High
Include
2002 Quality
Moderate
Ucar,B.Y., 2012 Include
Quality
Wong,K.C., High
Include
2003 Quality
Yucetas,S.C., High
Include
2013 Quality
High
Zyluk,A., 2006 Include
Quality
519
RESULTS
TABLE 133: SUMMARY OF FINDINGS PICO 7 PART 1 ENDOSCOPIC (EARLY FOLLOW-UP (3 MONTHS
UP TO 1 YEAR))

Favors treatment 1
Favors treatment 2
Larsen,M.B., 2013 (1)

Larsen,M.B., 2013 (2)
Ferdinand,R.D., 2002
Sennwald,G.R., 1995
Jacobsen,M.B., 1996
Aslani,H.R., 2012 (1)
Aslani,H.R., 2012 (2)
Dumontier,C., 1995
Trumble,T.E., 2002
Not significant
Malhotra,R., 2007
Wong,K.C., 2003
Agee,J.M., 1992
Kang,H.J., 2013
Atroshi,I., 2006
Atroshi,I., 2009
Meta-Analysis
Saw,N.L., 2003
Ejiri,S., 2012
Outcomes
Complications
Symptom occurrence (pillar pain) NA
Symptom occurrence (scar tenderness) NA
Function
Grip Strength NA
Percentage of contralateral hand
84 days NA
168 days NA
Hand dexterity NA
Jebsen taylor score NA
Key pinch strength NA
NCS (DML) NA
NCS (NCV) NA
Pinch Strength NA
Pinch Strength (key pinch) NA
Pinch strength (pulp pinch) NA
Pinch Strength (tripod pinch) NA
Questionnaire (CTQ-functional status scale) NA
Questionnaire (Levine-FSS) NA
84 days NA
182 days NA
364 days NA
Range of motion
Manual motor testing for thumb abduction (patients testing normal) NA
Other
Patient satisfaction (general-1=least satisfied to 5=most satisfied)
84 days NA
182 days NA
364 days NA
Preferred Endoscopic CTR NA
Questionnaire (SF-36) NA
520
CONTD SUMMARY OF FINDINGS PICO 7 PART 1 ENDOSCOPIC (EARLY FOLLOW-UP (3 MONTHS UP
TO 1 YEAR))

Favors treatment 1
Favors treatment 2
Not significant
Larsen,M.B., 2013 (1)
Larsen,M.B., 2013 (2)
Ferdinand,R.D., 2002
Jacobsen,M.B., 1996
Aslani,H.R., 2012 (1)
Aslani,H.R., 2012 (2)
Dumontier,C., 1995
Trumble,T.E., 2002
Meta-Analysis
Malhotra,R., 2007
Wong,K.C., 2003
Agee,J.M., 1992
Kang,H.J., 2013
Atroshi,I., 2006
Atroshi,I., 2009
Saw,N.L., 2003
Ejiri,S., 2012
Outcomes
Pain
Symptom recurrence (general)
Night pain NA
Wrist pain NA
Symptom recurrence (pain)
Patients reporting pain in 4-6 range on 10cm VAS scale NA
Symptom relief (pain)
50-75% improvement NA
McGill pain questionnaire NA
Patients reporting pain in 0-3 range on 10cm VAS scale NA
Postoperative Pain Control
Analgesia (duration) NA
Quality Of Life
Activity of daily living (ADL)
Book Holding (100mm VAS) NA
Buttoning (100mm VAS) NA
Carpal tunnel syndrome functional status NA
Chopstick use (100mm VAS) NA
Receiver holding (100mm VAS) NA
Writing (100mm VAS) NA
Patient satisfaction (general)
Subjective improvement-excellent (Excellent, good, no improvement, or worse) NA
Subjective improvement-good (Excellent, good, no improvement, or worse) NA
Return to Work NA
Symptoms
Paresthesia (VAS scale) NA
Questionnaire (CTSQ symptoms severity scale) NA
Questionnaire (Levine-SSS) NA
84 days NA
182 days NA
364 days NA
SemmesWeinstein Monofilaments Test (SW test)
Thumb, patients testing normal NA
Symptom recurrence (general) NA
Score range from 0 (no pain or tenderness in scar or proximal palm and no activity
limitation) to 100 (severe pain in scar or proximal palm and severe activity limitation
because of pain or tenderness)
90 days NA
360 days NA
Score range; carpal tunnel syndrome, 1 (no symptoms or disability) to 5 (most severe
symptoms or disability)
90 days NA
360 days NA
Symptom recurrence (numbness) NA
Symptom recurrence (tingling) NA
Symptom recurrence (weakness) NA
>75% improvement NA
100% improvement NA
521
TABLE 134: SUMMARY OF FINDINGS PICO 7 PART 1 ENDOSCOPIC (LATE FOLLOW-UP (> 1 YEAR))

Favors treatment 1
Atroshi,I., 2009
Favors treatment 2
Tian,Y., 2007
Not significant Meta-Analysis
Outcomes
Complications
Surgery failure (reoperation) NA
Function
Questionnaire (CTSQ functional status scale) NA
Other
Patient satisfaction (general) NA
Pain
No scar or palm pain NA
Symptoms
Questionnaire (CTSQ symptoms severity scale) NA
522
TABLE 135: SUMMARY OF FINDINGS PICO 7 PART 2 MINI (EARLY FOLLOW-UP (3 MONTHS UP TO 1
YEAR))
Favors treatment 1
Larsen,M.B., 2013 (3)
Capa-Grasa,A., 2014
Aslani,H.R., 2012 (3)
Cresswell,T.R., 2008
Suppaphol,S., 2012
Yucetas,S.C., 2013
Favors treatment 2
Tarallo,M., 2014
Jugovac,I., 2002
Faraj,A.A., 2012
Not significant
Zyluk,A., 2006
Meta-Analysis
Outcomes
Complications
Complications (general) NA
Symptom occurrence (scar length) NA
Function
Grip Strength NA
Percentage of contralateral hand NA
84 days NA
168 days NA
Key pinch strength NA
90 days NA
180 days NA
360 days NA
NCS (DML) NA
NCS (EMG) NA
NCS (SNCV) NA
Pinch Strength NA
Pinch Strength (three-point pinch)
90 days NA
180 days NA
360 days NA
Pinch Strength (two-point pinch) NA
Range of motion NA
Other
Questionnaire/Scale (Vancouver scale) NA
Pain
Symptom recurrence (general)
Night pain NA
Wrist pain NA
Quality Of Life
Return to normal activities NA
Return to work NA
Symptoms
Paresthesia (VAS scale) NA
Symptom recurrence (general weakness) NA
Symptom recurrence (general stiffness) NA
523
TABLE 136: SUMMARY OF FINDINGS PICO 7 PART 2 MINI (LATE FOLLOW-UP (> 1 YEAR))

Favors treatment 1
Cresswell,T.R., 2008
Favors treatment 2
Cellocco,P., 2005
Cellocco,P., 2009
Elsharif,M., 2014
Ucar,B.Y., 2012
Not significant
Meta-Analysis
Outcomes
Complications
Symptom occurrence (scar pain) NA
Function
Boston CTS Questionnaire (functional status scale)-Italian modified version
570 days NA
900 days NA
1800 days NA
Other
Subjective satisfaction with their scar
900 days NA
1800 days NA
Quality Of Life
Return to Work NA
Symptoms
Boston CTS Questionnaire (symptom severity scale)-Italian modified version
570 days NA
900 days NA
1800 days NA
524
TABLE 137: SUMMARY OF FINDINGS PICO 7 PART 3 OPEN (EARLY FOLLOW-UP (3 MONTHS UP TO 1
YEAR))
High Quality
Favors treatment 1
Favors treatment 2
Hamed,A.R., 2009
Castillo,T.N., 2014
Not significant
Meta-Analysis
Outcomes
Complications
Symptom occurrence (pillar pain)
90 days NA
180 days NA
Symptom occurrence (scar tenderness)
90 days NA
180 days NA
Function
Grip Strength NA
Pinch Strength NA
Questionnaire (BWCTQ-FSS) NA
Other
Symptoms
Questionnaire (BWCTQ-SSS) NA
525
TABLE 138: SUMMARY OF FINDINGS PICO 7 PART 4 SURGICAL VS. CONSERVATIVE (EARLY
FOLLOW-UP (3 MONTHS UP TO 1 YEAR))

Favors treatment 1
Gerritsen,A.A., 2002
Ismatullah,I., 2013
Favors treatment 2
Andreu,J.L., 2013
Jarvik,J.G., 2009
Ly,Pen D., 2005

Not significant
Hui,A.C., 2005
Meta-Analysis
Outcomes
Complications
Surgery Failure (success rate) NA
Treatment Failure
<20% VAS score improvement @ 3 months or worsening of symptoms NA
Function
Grip Strength NA
NCS (Motor amplitude) NA
NCS (DML) NA
NCS (DSL) NA
NCS (SA) NA
NCS (SNCV) NA
NCS( SNCV) NA
Vsual analog scale of functional impairment (100cm VAS)
90 days NA
180 days NA
360 days NA
Questionnaire (CTSAQ)
Function(1-5) NA
Questionnaire (Levine-FSS)
90 days NA
180 days NA
360 days NA
Other
Questionnaire (SF-36)
MCS NA
PCS
180 days NA
360 days NA
Pain
Questionnaire/Scale (VAS-pain 100cm)
90 days NA
180 days NA
360 days NA
Symptom recurrence (nocturanal pain)
Number of nights waking up due to symptoms
90 days NA
180 days NA
360 days NA
Pain intensity(1-10) NA
Pain interference(1-10) NA
Quality Of Life
Days of reduced work or housework
180 days NA
360 days NA
Symptoms
Paresthesia
Daytime paresthesia NA
Nighttime paresthesia NA
Nocturnal paresthesia (100mm VAS scale)
90 days NA
180 days NA
360 days NA
Questionnaire (CTSAQ)
Symptoms(1-5) NA
Questionnaire (Levine-SSS)
90 days NA
180 days NA
360 days NA
526
TABLE 139: SUMMARY OF FINDINGS PICO 7 PART 4 SURGICAL VS. CONSERVATIVE (LATE FOLLOW-
UP (> 1 YEAR))

Favors treatment 1
Gerritsen,A.A., 2002
Favors treatment 2
Ly-Pen,D., 2012
Not significant
Meta-Analysis
Outcomes
Complications
Discomfort caused by splint NA
Overall NA
Reflex sympathetic dystrophy NA
Scar pain NA
Skin irritation NA
Stiffness of wrist, hands, or fingers NA
Swelling of the wrist, hand or fingers NA
Complications (haematoma) NA
Complications (infection) NA
Surgery Failure (success rate) NA
Function
Reached 20% improvement in functional impairment on 100mm VAS scale NA
Pain
Symptom recurrence (nocturnal pain) NA
Reached 20% improvement in pain on VAS 100mm scale NA
Symptoms
Paresthesia
Daytime paresthesia NA
Reached 20% improvement in nocturnal parthesia on VAS 100mm scale NA
527
TABLE 140: PICO 7 PART 1- ENDOSCOPIC: COMPLICATIONS

Atroshi,I., High Surgery failure 5 years CT release 63 4.76% CT release 65 4.62% RR 1.03(0.22,4.92 Not
2009 Quality (reoperation)(Reoperat (endoscopic (open) (Open ) Significant
ion) ) (2-portal carpal tunnel (P-
endoscopic release) value>.05)
release)
528
Larsen,M.B., High Symptom occurrence 3 months CT release 30 . % CT release 30 . % Author NA Not
2013 Quality (pillar pain)( ) (endoscopic (open) (7 cm Reported Significant
) curved (P-
(Endoscopic incision just value>.05)
procedure ulnar to the
using the thenar crease
Linvatec and
system as angulated
described over the
by Menon flexion
(1993), crease of the
which is a wrist in
one-portal order to
technique release the
with a short flexor
transverse retinaculum
incision at and
the wrist antebrachial
using a fascia under
disposable direct vision)
set of
endoscopic
instruments
and a
conventiona
l 5 mm
arthroscope.
After trans-
section the
skin was
sutured and
a soft
dressing
without
splinting
applied)
529
2013 Quality (pillar pain)( ) (endoscopic (mini) (Short Reported Significant
) incision: an (P-
(Endoscopic incision of 3 value>.05)
procedure cm in the
using the mid-palm
Linvatec distal to the
system as flexion
described crease of the
by Menon wrist in order
(1993), to release the
which is a distal portion
one-portal of the flexor
technique retinaculum
with a short under direct
transverse vision, and
incision at the proximal
the wrist portion of the
using a flexor
disposable retinaculum
set of and
endoscopic antebrachial
instruments fascia were
and a then carefully
conventiona divided using
l 5 mm scissor
arthroscope. dissection in
After trans- a plane deep
section the to
skin was subcutaneous
sutured and fat and skin)
a soft
dressing
without
splinting
applied)
530
Larsen,M.B., High Symptom occurrence 5.5 CT release 30 . % CT release 30 . % Author NA Not
2013 Quality (pillar pain)( ) months (endoscopic (open) (7 cm Reported Significant
) curved (P-
(Endoscopic incision just value>.05)
procedure ulnar to the
using the thenar crease
Linvatec and
system as angulated
described over the
by Menon flexion
which is a wrist in
one-portal order to
with a short flexor
incision at and
the wrist antebrachial
using a fascia under
disposable direct vision)
set of
endoscopic
instruments
and a
conventiona
l 5 mm
arthroscope.
After trans-
section the
skin was
sutured and
a soft
dressing
without
splinting
applied)
531
2013 Quality (pillar pain)( ) months (endoscopic (mini) (Short Reported Significant
) incision: an (P-
(Endoscopic incision of 3 value>.05)
procedure cm in the
using the mid-palm
Linvatec distal to the
system as flexion
described crease of the
by Menon wrist in order
(1993), to release the
which is a distal portion
one-portal of the flexor
technique retinaculum
with a short under direct
transverse vision, and
incision at the proximal
the wrist portion of the
using a flexor
disposable retinaculum
set of and
endoscopic antebrachial
instruments fascia were
and a then carefully
conventiona divided using
l 5 mm scissor
arthroscope. dissection in
After trans- a plane deep
section the to
skin was subcutaneous
sutured and fat and skin)
a soft
dressing
without
splinting
applied)
532
Malhotra,R., High Symptom occurrence 5.9 CT release 30 0.00% CT release 31 29.03% RD -0.29(-0.45,- CT release
2007 Quality (scar tenderness)( ) months (endoscopic (open) (short 0.13) (endoscopic
) (single incision open ) (single
portal release) portal
endoscopic endoscopic
release) release)
(P-
value<.05)
Saw,N.L., High Symptom occurrence 3 months CT release 74 22(7.00) CT release 76 24(6.00) Mean -2(- Not
2003 Quality (scar (endoscopic (open) (Open Differenc 4.09,0.088891 Significant
tenderness)(Anterior ) CTR) e ) (P-
carpal tenderness) (Endoscopic value>.05)
release)
Trumble,T.E. High Symptom occurrence 12 months CT release 75 . % CT release 75 . % Author NA Not
, 2002 Quality (scar (endoscopic (open) (3- Reported Significant
tenderness)(Loads of ) (single 4cm incision) (P-
pressure (in kg) able portal value>.05)
to withstand) endoscopic
release)
Wong,K.C., High Symptom occurrence 1 years CT release 30 . % CT release 29 . % Author NA Not
2003 Quality (pillar pain)(Radial (endoscopic (open- Reported Significant
pillar pain) ) (two- limited) (P-
portal (limited-open value>.05)
endoscopic release)
release)
Wong,K.C., High Symptom occurrence 1 years CT release 30 . % CT release 29 . % Author NA Not
2003 Quality (pillar pain)(Ulnar (endoscopic (open- Reported Significant
pillar pain) ) (two- limited) (P-
portal (limited-open value>.05)
endoscopic release)
release)
533
Agee,J.M., Moderat Symptom occurrence 3 months CT release 72 . % CT release 55 . % Author NA Not
1992 e Quality (pillar pain)(Radial (endoscopic (open) Reported Significant
pillar pain (0=none to w/ 3M (Conventiona (P-
4=severe)) device) l open value>.05)
(Endoscopic surgery)
device
inserted into
incision at
wrist)
1992 e Quality (pillar pain)(Radial (endoscopic (open) Reported Significant
pillar pain (0=none to w/ 3M (Conventiona (P-
4=severe)) device) l open value>.05)
device
inserted into
incision at
wrist)
1992 e Quality (scar (endoscopic (open) Reported Significant
tenderness)(0=none to w/ 3M (Conventiona (P-
4=severe) device) l open value>.05)
device
inserted into
incision at
wrist)
1992 e Quality (scar (endoscopic (open) Reported Significant
tenderness)(0=none to w/ 3M (Conventiona (P-
4=severe) device) l open value>.05)
device
inserted into
incision at
wrist)
534
Tian,Y., Moderat Symptom occurrence 2 years CT release 30 . % CT release 32 . % Author NA CT release
2007 e Quality (scar tenderness)(Rate (endoscopic (open) Reported (endoscopic
of scar tenderness) ) (one- (traditional ) (one-
portal open release) portal
endoscopics endoscopics
release) release)
(P-
value<.05)
535
TABLE 141: PICO 7 PART 1- ENDOSCOPIC: OTHER QUESTIONNAIRE

Kang,H.J., 2013 High Questionnaire 3 months CT release 52 11(11.04) CT release (mini) 52 11(11.04) Mean 0(- Not
Quality (DASH)( ) (endoscopic) (1.5-cm incision Difference 4.24,4.24) Significant
(Endoscopic was made in the (P-
release using the prox-imal palm value>.05)
Agee technique) over the
transverse carpal
ligament)
MacDermid,J.C., High Questionnaire 3 months CT release 32 47(.) CT release 91 42(.) Author NA Not
2003 Quality (SF- (endoscopic) (2 (open) Reported Significant
36)(Physical portal Chow (traditional long (P-
health- SF-36) technique) incision open value>.05)
release)
536
TABLE 142: PICO 7 PART 1- ENDOSCOPIC: FUNCTION

Atroshi,I., High Grip strength(Units 3 months CT release 63 31.5(11.0 CT release 65 29.9(11.0 Mean 1.6(- Not
2006 Quality not reported) (endoscopic) 0) (open) 0) Differen 2.21,5.411770) Significant
(Endoscopic (Open ce (P-value>.05)
release carpal
injected tunnel
subcutaneous release
ly at the along the
proximal and length of the
distal portals) incision)
Atroshi,I., High Pinch 3 months CT release 63 6.7(2.20) CT release 65 6(1.80) Mean 0.7(0.00,1.3975 CT release
2006 Quality Strength(Units not (endoscopic) (open) Differen 82) (endoscopic)
reported) (Endoscopic (Open ce (Endoscopic
release carpal release
injected tunnel injected
subcutaneous release subcutaneous
ly at the along the ly at the
proximal and length of the proximal and
distal portals) incision) distal
portals)
(P-value<.05)
Atroshi,I., High Questionnaire 1 years CT release 63 1.25(0.50 CT release 65 1.19(0.40 Mean 0.06(- Not
2009 Quality (CTQ)(CTSQ (endoscopic) ) (open) ) Differen 0.10,0.217164) Significant
functional status (2-portal (Open ce (P-value>.05)
scale) endoscopic carpal
release) tunnel
release)
Atroshi,I., High Questionnaire 5 years CT release 63 1.3(0.50) CT release 63 1.29(0.50 Mean 0.01(- Not
2009 Quality (CTQ)(CTSQ (endoscopic) (open) ) Differen 0.16,0.184610) Significant
functional status (2-portal (Open ce (P-value>.05)
scale) endoscopic carpal
release) tunnel
release)
Ejiri,S., 2012 High Grip 3 months CT release 40 . % CT release 39 . % Author NA Not
Quality strength(Kilograms (endoscopic) (open) (3cm Reported Significant
) (Okutsu palmar (P-value>.05)
method) incision)
537
Ejiri,S., 2012 High Semmes Weinstein 3 months CT release 40 -0.49(.) CT release 39 -0.24(.) Author NA Not
Quality Monofilaments (endoscopic) (open) (3cm Reported Significant
Test (SW (Okutsu palmar (P-value>.05)
test)(lower method) incision)
scores=improveme
nt)
Ejiri,S., 2012 High Two-point 3 months CT release 40 -3.3(.) CT release 39 -1.7(.) Author NA Not
Quality discrimination(Mill (endoscopic) (open) (3cm Reported Significant
imeters) (Okutsu palmar (P-value>.05)
method) incision)
Kang,H.J., High Questionnaire 3 months CT release 52 1.5(0.37) CT release 52 1.7(-0.74) Mean -0.2(-0.42,0.02) Not
2013 Quality (Boston- (endoscopic) (mini) (1.5- Differen Significant
FSS)(Boston CTS (Endoscopic cm incision ce (P-value>.05)
Questionnaire release using was made in
(functional status the Agee the prox-
scale)) technique) imal palm
over the
transverse
carpal
ligament)
538
Larsen,M.B., High Grip 3 months CT release 30 . % CT release 30 . % Author NA Not
2013 Quality strength(Percentage (endoscopic) (open) (7 Reported Significant
of contralateral (Endoscopic cm curved (P-value>.05)
hand) procedure incision just
using the ulnar to the
Linvatec thenar
system as crease and
described by angulated
Menon over the
(1993), flexion
which is a crease of the
one-portal wrist in
technique order to
with a short release the
transverse flexor
incision at retinaculum
the wrist and
using a antebrachial
disposable fascia under
set of direct
endoscopic vision)
instruments
and a
conventional
5 mm
arthroscope.
After trans-
section the
skin was
sutured and a
soft dressing
without
splinting
applied)
539
Larsen,M.B., High Grip 3 months CT release 30 . % CT release 30 . % Author NA CT release
2013 Quality strength(Percentage (endoscopic) (mini) Reported (endoscopic)
of contralateral (Endoscopic (Short (Endoscopic
hand) procedure incision: an procedure
using the incision of 3 using the
Linvatec cm in the Linvatec
system as mid-palm system as
described by distal to the described by
Menon flexion Menon
(1993), crease of the (1993), which
which is a wrist in is a one-
one-portal order to portal
technique release the technique
with a short distal with a short
transverse portion of transverse
incision at the flexor incision at
the wrist retinaculum the wrist
using a under direct using a
disposable vision, and disposable
set of the proximal set of
endoscopic portion of endoscopic
instruments the flexor instruments
and a retinaculum and a
conventional and conventional
5 mm antebrachial 5 mm
arthroscope. fascia were arthroscope.
After trans- then After trans-
section the carefully section the
skin was divided skin was
sutured and a using sutured and
soft dressing scissor a soft
without dissection in dressing
splinting a plane deep without
applied) to splinting
subcutaneou applied)
s fat and (P-value<.05)
skin)
540
Larsen,M.B., High Grip 5.5 CT release 30 . % CT release 30 . % Author NA Not
2013 Quality strength(Percentage months (endoscopic) (mini) Reported Significant
of contralateral (Endoscopic (Short (P-value>.05)
hand) procedure incision: an
using the incision of 3
Linvatec cm in the
system as mid-palm
described by distal to the
Menon flexion
which is a wrist in
one-portal order to
with a short distal
transverse portion of
incision at the flexor
the wrist retinaculum
using a under direct
disposable vision, and
set of the proximal
endoscopic portion of
instruments the flexor
and a retinaculum
conventional and
5 mm antebrachial
arthroscope. fascia were
After trans- then
section the carefully
skin was divided
sutured and a using
soft dressing scissor
without dissection in
splinting a plane deep
applied) to
subcutaneou
s fat and
skin)
541
Larsen,M.B., High Grip 5.5 CT release 30 . % CT release 30 . % Author NA Not
2013 Quality strength(Percentage months (endoscopic) (open) (7 Reported Significant
of contralateral (Endoscopic cm curved (P-value>.05)
hand) procedure incision just
Linvatec thenar
Menon over the
(1993), flexion
one-portal wrist in
technique order to
transverse flexor
the wrist and
set of direct
endoscopic vision)
instruments
and a
conventional
5 mm
arthroscope.
After trans-
section the
skin was
sutured and a
soft dressing
without
splinting
applied)
542
Larsen,M.B., High Range of motion( ) 3 months CT release 30 . % CT release 30 . % Author NA Not
2013 Quality (endoscopic) (mini) Reported Significant
(Endoscopic (Short (P-value>.05)
procedure incision: an
Linvatec cm in the
system as mid-palm
Menon flexion
which is a wrist in
one-portal order to
with a short distal
set of the proximal
and a retinaculum
conventional and
5 mm antebrachial
After trans- then
skin was divided
sutured and a using
applied) to
subcutaneou
s fat and
skin)
543
Larsen,M.B., High Range of motion( ) 3 months CT release 30 . % CT release 30 . % Author NA Not
2013 Quality (endoscopic) (open) (7 Reported Significant
(Endoscopic cm curved (P-value>.05)
procedure incision just
Linvatec thenar
Menon over the
(1993), flexion
one-portal wrist in
technique order to
transverse flexor
the wrist and
set of direct
endoscopic vision)
instruments
and a
conventional
5 mm
arthroscope.
After trans-
section the
skin was
sutured and a
soft dressing
without
splinting
applied)
544
Larsen,M.B., High Range of motion( ) 5.5 CT release . . % CT release 30 . % Author NA Not
2013 Quality months (endoscopic) (open) (7 Reported Significant
(Endoscopic cm curved (P-value>.05)
Linvatec thenar
Menon over the
(1993), flexion
one-portal wrist in
technique order to
transverse flexor
the wrist and
set of direct
endoscopic vision)
instruments
and a
conventional
5 mm
arthroscope.
After trans-
section the
skin was
sutured and a
soft dressing
without
splinting
applied)
545
Larsen,M.B., High Range of motion( ) 5.5 CT release . . % CT release 30 . % Author NA Not
2013 Quality months (endoscopic) (mini) Reported Significant
(Endoscopic (Short (P-value>.05)
procedure incision: an
Linvatec cm in the
system as mid-palm
Menon flexion
which is a wrist in
one-portal order to
with a short distal
set of the proximal
and a retinaculum
conventional and
5 mm antebrachial
After trans- then
skin was divided
sutured and a using
applied) to
subcutaneou
s fat and
skin)
546
MacDermid,J. High Grip 3 months CT release 32 27(.) CT release 91 27(.) Author NA Not
C., 2003 Quality strength(Kilograms (endoscopic) (open) Reported Significant
) (2 portal (traditional (P-value>.05)
Chow long
technique) incision
open
release)
MacDermid,J. High Pinch Strength (key 3 months CT release 32 7(.) CT release 91 5.6(.) Author NA Not
C., 2003 Quality pinch)(Kilograms) (endoscopic) (open) Reported Significant
(2 portal (traditional (P-value>.05)
Chow long
technique) incision
open
release)
MacDermid,J. High Pinch Strength 3 months CT release 32 6.7(.) CT release 91 6.5(.) Author NA Not
C., 2003 Quality (tripod (endoscopic) (open) Reported Significant
pinch)(Kilograms) (2 portal (traditional (P-value>.05)
Chow long
technique) incision
open
release)
Malhotra,R., High NCS (DML)(Distal 5.9 CT release 30 . % CT release 31 . % Author NA Not
2007 Quality motor latency (ms)) months (endoscopic) (open) Reported Significant
(single portal (short (P-value>.05)
endoscopic incision
release) open
release)
Malhotra,R., High NCS (NCV)(Nerve 5.9 CT release 30 . % CT release 31 . % Author NA Not
2007 Quality conduction velocity months (endoscopic) (open) Reported Significant
(ms)) (single portal (short (P-value>.05)
endoscopic incision
release) open
release)
Saw,N.L., High Questionnaire 3 months CT release 74 . % CT release 76 . % Author NA Not
2003 Quality (Levine- (endoscopic) (open) Reported Significant
FSS)(Levine (Endoscopic (Open CTR) (P-value>.05)
functional score) release)
547
Sennwald,G.R. High Grip 3 months CT release 25 . % CT release 22 . % Author NA CT release
, 1995 Quality strength(Kilograms (endoscopic) (open) Reported (endoscopic)
) (two-portal (traditional (two-portal
Chow open Chow
technique) release) technique)
(P-value<.05)
Sennwald,G.R. High Key pinch 3 months CT release 25 . % CT release 22 . % Author NA Not
, 1995 Quality strength(Kilograms (endoscopic) (open) Reported Significant
) (two-portal (traditional (P-value>.05)
Chow open
technique) release)
Trumble,T.E., High Grip 3 months CT release 75 . % CT release 72 . % Author NA Not
2002 Quality strength(Kilograms (endoscopic) (open) (3- Reported Significant
) (single portal 4cm (P-value>.05)
endoscopic incision)
release)
Trumble,T.E., High Grip 12 months CT release 75 32(.) CT release 72 34(.) Author NA Not
2002 Quality strength(Kilograms (endoscopic) (open) (3- Reported Significant
release)
Trumble,T.E., High Hand 3 months CT release 75 44(.) CT release 72 44(.) Author NA Not
2002 Quality dexterity(Jebsen- (endoscopic) (open) (3- Reported Significant
Taylor test) (single portal 4cm (P-value>.05)
release)
Trumble,T.E., High Hand 3 months CT release 75 20(.) CT release 72 20(.) Author NA Not
2002 Quality dexterity(Purdue (endoscopic) (open) (3- Reported Significant
pegboard test) (single portal 4cm (P-value>.05)
release)
Trumble,T.E., High Pinch 3 months CT release 75 7.9(.) CT release 72 8.1(.) Author NA Not
2002 Quality Strength(Kilograms (endoscopic) (open) (3- Reported Significant
release)
548
Trumble,T.E., High Questionnaire 3 months CT release 75 1.7(0.10) CT release 72 2.4(0.10) Mean -0.7(-0.73,- CT release
2002 Quality (Levine-FSS)(CTS- (endoscopic) (open) (3- Differen 0.66766) (endoscopic)
FSS (1=least (single portal 4cm ce (single portal
functional endoscopic incision) endoscopic
difficulty, 5=svere release) release)
functional (P-value<.05)
difficulty))
Trumble,T.E., High Questionnaire 6 months CT release 75 1.8(0.13) CT release 72 1.8(0.09) Mean 0(- Not
2002 Quality (Levine-FSS)(CTS- (endoscopic) (open) (3- Differen 0.04,0.036025) Significant
FSS (1=least (single portal 4cm ce (P-value>.05)
functional endoscopic incision)
difficulty, 5=svere release)
functional
difficulty))
Trumble,T.E., High Questionnaire 12 months CT release 75 1.7(0.10) CT release 72 1.7(0.11) Mean 0(- Not
2002 Quality (Levine-FSS)(CTS- (endoscopic) (open) (3- Differen 0.03,0.034026) Significant
FSS (1=least (single portal 4cm ce (P-value>.05)
functional endoscopic incision)
difficulty, 5=svere release)
functional
difficulty))
Trumble,T.E., High Semmes-Weinstein 12 months CT release 75 3.26(.) CT release 72 3.2(.) Author NA Not
2002 Quality Monofilaments (endoscopic) (open) (3- Reported Significant
Test (SW test)( ) (single portal 4cm (P-value>.05)
release)
Wong,K.C., High Pinch Strength(% 1 years CT release 30 . % CT release 29 . % Author NA Not
2003 Quality improvement from (endoscopic) (open- Reported Significant
baseline (units not (two-portal limited) (P-value>.05)
reported)) endoscopic (limited-
release) open
release)
Wong,K.C., High Two-point 1 years CT release 30 . % CT release 29 . % Author NA Not
2003 Quality discrimination(Mill (endoscopic) (open- Reported Significant
imeters) (two-portal limited) (P-value>.05)
endoscopic (limited-
release) open
release)
549
Agee,J.M., Moderat Grip 3 months CT release 72 . % CT release 55 . % Author NA Not
1992 e strength(Jamar grip (endoscopic (open) Reported Significant
Quality (mean percent w/ 3M (Convention (P-value>.05)
change from device) al open
baseline)) (Endoscopic surgery)
device
inserted into
incision at
wrist)
Agee,J.M., Moderat Grip 6 months CT release 64 . % CT release 48 . % Author NA Not
1992 e strength(Jamar grip (endoscopic (open) Reported Significant
Quality (mean percent w/ 3M (Convention (P-value>.05)
change from device) al open
baseline)) (Endoscopic surgery)
device
inserted into
incision at
wrist)
Agee,J.M., Moderat Hand dexterity(fine 3 months CT release 74 14.86% CT release 55 12.73% RR 1.17(0.48,2.82) Not
1992 e dexterity loss) (endoscopic (open) Significant
Quality w/ 3M (Convention (P-value>.05)
device) al open
device
inserted into
incision at
wrist)
Agee,J.M., Moderat Hand dexterity(fine 6 months CT release 65 12.31% CT release 48 12.50% RR 0.98(0.37,2.65) Not
1992 e dexterity loss) (endoscopic (open) Significant
device) al open
device
inserted into
incision at
wrist)
550
Agee,J.M., Moderat Key pinch 1.1 weeks CT release 64 . % CT release 55 . % Author NA Not
1992 e strength(Mean % (endoscopic (open) Reported Significant
Quality change from w/ 3M (Convention (P-value>.05)
baseline) device) al open
device
inserted into
incision at
wrist)
Agee,J.M., Moderat Key pinch 3 months CT release 72 . % CT release 48 . % Author NA Not
1992 e strength(Mean % (endoscopic (open) Reported Significant
Quality change from w/ 3M (Convention (P-value>.05)
baseline) device) al open
device
inserted into
incision at
wrist)
Agee,J.M., Moderat Phalen's test 6 months CT release 64 92.19% CT release 46 93.48% RR 0.99(0.89,1.09) Not
1992 e score(% negative) (endoscopic (open) Significant
device) al open
device
inserted into
incision at
wrist)
Agee,J.M., Moderat Pinch strength 3 months CT release 72 . % CT release 55 . % Author NA Not
1992 e (pulp pinch)(Mean (endoscopic (open) Reported Significant
Quality % change from pre- w/ 3M (Convention (P-value>.05)
op value (units not device) al open
reported)) (Endoscopic surgery)
device
inserted into
incision at
wrist)
551
Agee,J.M., Moderat Pinch strength 6 months CT release 64 . % CT release 48 . % Author NA Not
1992 e (pulp pinch)(Mean (endoscopic (open) Reported Significant
Quality % change from pre- w/ 3M (Convention (P-value>.05)
op value (units not device) al open
reported)) (Endoscopic surgery)
device
inserted into
incision at
wrist)
Agee,J.M., Moderat Range of 3 months CT release 74 81.08% CT release 74 74.32% RR 1.09(0.92,1.30) Not
1992 e motion(Manual (endoscopic (open) Significant
Quality motor testing for w/ 3M (Convention (P-value>.05)
thumb abduction device) al open
(patients testing (Endoscopic surgery)
normal)) device
inserted into
incision at
wrist)
Agee,J.M., Moderat Range of 6 months CT release 63 80.95% CT release 83 83.13% RR 0.97(0.83,1.14) Not
1992 e motion(Manual (endoscopic (open) Significant
Quality motor testing for w/ 3M (Convention (P-value>.05)
thumb abduction device) al open
(patients testing (Endoscopic surgery)
normal)) device
inserted into
incision at
wrist)
Agee,J.M., Moderat Semmes-Weinstein 1.1 weeks CT release 57 71.93% CT release 27 48.15% RR 1.49(0.98,2.28) Not
1992 e Monofilaments (endoscopic (open) Significant
Quality Test (SW w/ 3M (Convention (P-value>.05)
test)(Thumb, device) al open
patients testing (Endoscopic surgery)
normal) device
inserted into
incision at
wrist)
552
Agee,J.M., Moderat Semmes-Weinstein 3 months CT release 37 62.16% CT release 27 51.85% RR 1.20(0.77,1.87) Not
test)(Index finger, device) al open
Patients testing (Endoscopic surgery)
normal) device
inserted into
incision at
wrist)
test)(Little finger, device) al open
normal) device
inserted into
incision at
wrist)
test)(Long finger, device) al open
normal) device
inserted into
incision at
wrist)
test)(Thumb, device) al open
patients testing (Endoscopic surgery)
normal) device
inserted into
incision at
wrist)
553
test)(Index finger, device) al open
normal) device
inserted into
incision at
wrist)
test)(Little finger, device) al open
normal) device
inserted into
incision at
wrist)
test)(Long finger, device) al open
normal) device
inserted into
incision at
wrist)
Agee,J.M., Moderat Tinel's Sign/Test(% 6 months CT release 64 87.50% CT release 46 82.61% RR 1.06(0.90,1.25) Not
1992 e negative) (endoscopic (open) Significant
device) al open
device
inserted into
incision at
wrist)
554
Aslani,H.R., Moderat Phalen's test 3.9 CT release 32 6.25% CT release 28 10.71% RR 0.58(0.10,3.24) Not
2012 e score(% positive) months (endoscopic) (mini) (Mini Significant
Quality (Endoscopic palmer (P-value>.05)
release) incision)
Aslani,H.R., Moderat Phalen's test 3.9 CT release 32 6.25% CT release 36 13.89% RR 0.46(0.10,2.22) Not
2012 e score(% positive) months (endoscopic) (open) Significant
Quality (Endoscopic (large open (P-value>.05)
release) incision)
Aslani,H.R., Moderat Tinel's Sign/Test(# 3.9 CT release 32 12.50% CT release 28 10.71% RR 1.17(0.29,4.77) Not
2012 e positive) months (endoscopic) (mini) (Mini Significant
Quality (Endoscopic palmer (P-value>.05)
release) incision)
Aslani,H.R., Moderat Tinel's Sign/Test(# 3.9 CT release 32 12.50% CT release 36 19.44% RR 0.64(0.21,1.99) Not
2012 e positive) months (endoscopic) (open) Significant
Quality (Endoscopic (large open (P-value>.05)
release) incision)
Dumontier,C., Moderat Grip 3 months CT release 28 . % CT release 30 . % Author NA CT release
1995 e strength(Kilograms (endoscopic) (open) Reported (endoscopic)
Quality ) (two-portal (Convention (two-portal
endoscopic al palmar endoscopic
release) open release)
release) (P-value<.05)
Ferdinand,R.D Moderat Grip 1 years CT release 25 . % CT release 25 . % Author NA Not
., 2002 e strength(Pounds) (endoscopic) (open) Reported Significant
Quality (single portal (traditional (P-value>.05)
endoscopic open
release) release)
Ferdinand,R.D Moderat Jebsen Taylor 1 years CT release 25 . % CT release 25 . % Author NA Not
., 2002 e score(Seconds) (endoscopic) (open) Reported Significant
Quality (single portal (traditional (P-value>.05)
endoscopic open
release) release)
555
Ferdinand,R.D Moderat Two-point 1 years CT release 25 . % CT release 25 . % Author NA Not
., 2002 e discrimination(Mill (endoscopic) (open) Reported Significant
Quality imeters) (single portal (traditional (P-value>.05)
endoscopic open
release) release)
Jacobsen,M.B. Moderat Two-point 5.9 CT release 16 2.94(0.56 CT release 16 3.25(1.30 Mean -0.31(- Not
, 1996 e discrimination(Mill months (endoscopic) ) (open) ) Differen 1.00,0.383588) Significant
Quality imeters) (two-portal (traditional ce (P-value>.05)
Chow open
technique) release)
Tian,Y., 2007 Moderat Two-point 2 years CT release 30 5.9(1.50) CT release 32 5.3(1.70) Mean 0.6(- Not
e discrimination(Unit (endoscopic) (open) Differen 0.20,1.396909) Significant
Quality s not specified) (one-portal (traditional ce (P-value>.05)
endoscopics open
release) release)
556
TABLE 143: PICO 7 PART 1- ENDOSCOPIC: OTHER

Atroshi,I., High Patient satisfaction 5 years CT release 63 85.71% CT release 63 82.54% RR 1.04(0.89,1.21) Not
2009 Quality (general)(Completely (endoscopic) (open) Significant
or very satisfied) (2-portal (Open (P-
endoscopic carpal value>.05)
release) tunnel
release)
Kang,H.J., High Patient satisfaction 3 months CT release 52 65.38% CT release 52 65.38% RR 1.00(0.76,1.32) Not
2013 Quality (general)(Preferred (endoscopic) (mini) Significant
Endoscopic CTR) (Endoscopic (1.5-cm (P-
release using incision value>.05)
the Agee was made
technique) in the
prox-imal
palm over
the
transverse
carpal
ligament)
Trumble,T.E., High Patient satisfaction 3 months CT release 75 4.4(0.13) CT release 72 4(0.14) Mean 0.4(0.36,0.443719) CT release
2002 Quality (general)(1=least (endoscopic) (open) (3- Difference (endoscopic)
satisfied to 5=most (single 4cm (single
satisfied) portal incision) portal
release) release)
(P-
value<.05)
Trumble,T.E., High Patient satisfaction 6 months CT release 75 4.5(0.12) CT release 72 4.5(0.12) Mean 0(-0.04,0.038806) Not
2002 Quality (general)(1=least (endoscopic) (open) (3- Difference Significant
satisfied to 5=most (single 4cm (P-
satisfied) portal incision) value>.05)
endoscopic
release)
557
Trumble,T.E., High Patient satisfaction 12 CT release 75 4.6(0.11) CT release 72 4.5(0.13) Mean 0.1(0.06,0.139006) CT release
2002 Quality (general)(1=least months (endoscopic) (open) (3- Difference (endoscopic)
satisfied to 5=most (single 4cm (single
satisfied) portal incision) portal
release) release)
(P-
value<.05)
558
TABLE 144: PICO 7 PART 1- ENDOSCOPIC: PAIN

Atroshi,I., 2009 High Symptom relief 5 years CT release 63 84.13% CT release 63 82.54% RR 1.02(0.87,1.19) Not
Quality (pain)(No scar or (endoscopic) (open) (Open Significant
palm pain) (2-portal carpal tunnel (P-
release)
Larsen,M.B., High Questionnaire/Scale 3 months CT release 30 . % CT release 30 . % Author NA Not
2013 Quality (VAS-pain)( ) (endoscopic) (open) (7 cm Reported Significant
(Endoscopic curved (P-
procedure incision just value>.05)
Linvatec thenar crease
system as and angulated
described by over the
Menon (1993), flexion crease
which is a one- of the wrist
portal in order to
technique with release the
a short flexor
incision at the and
wrist using a antebrachial
disposable set fascia under
of endoscopic direct vision)
instruments
and a
conventional 5
mm
arthroscope.
After trans-
section the
skin was
sutured and a
soft dressing
without
splinting
applied)
559
2013 Quality (VAS-pain)( ) (endoscopic) (mini) (Short Reported Significant
(Endoscopic incision: an (P-
procedure incision of 3 value>.05)
using the cm in the
Linvatec mid-palm
system as distal to the
described by flexion crease
Menon (1993), of the wrist in
which is a one- order to
portal release the
technique with distal portion
a short of the flexor
incision at the under direct
wrist using a vision, and
disposable set the proximal
of endoscopic portion of the
instruments flexor
and a retinaculum
conventional 5 and
mm antebrachial
After trans- then carefully
section the divided using
skin was scissor
sutured and a dissection in a
soft dressing plane deep to
without subcutaneous
splinting fat and skin)
applied)
560
Larsen,M.B., High Questionnaire/Scale 5.5 CT release 30 . % CT release 30 . % Author NA Not
2013 Quality (VAS-pain)( ) months (endoscopic) (mini) (Short Reported Significant
(Endoscopic incision: an (P-
procedure incision of 3 value>.05)
using the cm in the
Linvatec mid-palm
portal release the
instruments flexor
and a retinaculum
conventional 5 and
mm antebrachial
skin was scissor
applied)
561
2013 Quality (VAS-pain)( ) months (endoscopic) (open) (7 cm Reported Significant
(Endoscopic curved (P-
procedure incision just value>.05)
portal in order to
a short flexor
incision at the and
instruments
and a
conventional 5
mm
arthroscope.
After trans-
section the
skin was
sutured and a
soft dressing
without
splinting
applied)
MacDermid,J.C., High Symptom relief 3 months CT release 32 12(.) CT release 91 8(.) Author NA Not
2003 Quality (pain)(McGill pain (endoscopic) (open) Reported Significant
questionnaire) (2 portal Chow (traditional (P-
technique) long incision value>.05)
open release)
562
Malhotra,R., High Symptom 5.9 CT release 30 6.67% CT release 31 6.45% RR 1.03(0.16,6.87) Not
2007 Quality recurrence months (endoscopic) (open) (short Significant
(pain)(Patients (single portal incision open (P-
reporting pain in 4-6 endoscopic release) value>.05)
range on 10cm VAS release)
scale)
Malhotra,R., High Symptom relief 5.9 CT release 30 3.33% CT release 31 6.45% RR 0.52(0.05,5.40) Not
2007 Quality (pain)(50-75% months (endoscopic) (open) (short Significant
improvement) (single portal incision open (P-
release)
Malhotra,R., High Symptom relief 5.9 CT release 30 93.33% CT release 31 93.55% RR 1.00(0.87,1.14) Not
2007 Quality (pain)(Patients months (endoscopic) (open) (short Significant
reporting pain in 0-3 (single portal incision open (P-
range on 10cm VAS endoscopic release) value>.05)
scale) release)
Wong,K.C., High Questionnaire/Scale 1 years CT release 30 . % CT release 30 . % Author NA Not
2003 Quality (VAS-pain)( ) (endoscopic) (open- Reported Significant
(two-portal limited) (P-
endoscopic (limited-open value>.05)
release) release)
Aslani,H.R., Moderate Symptom 3.9 CT release 32 0.00% CT release 28 0.00% RD 0.00(0.00,0.00) Not
2012 Quality recurrence months (endoscopic) (mini) (Mini Significant
(general)(Night (Endoscopic palmer (P-
pain) release) incision) value>.05)
2012 Quality recurrence months (endoscopic) (open) (large Significant
(general)(Night (Endoscopic open incision) (P-
pain) release) value>.05)
Aslani,H.R., Moderate Symptom 3.9 CT release 32 12.50% CT release 28 14.29% RR 0.88(0.24,3.18) Not
2012 Quality recurrence months (endoscopic) (mini) (Mini Significant
(general)(Wrist (Endoscopic palmer (P-
pain) release) incision) value>.05)
563
Aslani,H.R., Moderate Symptom 3.9 CT release 32 12.50% CT release 36 0.00% RD 0.13(0.01,0.24) CT
2012 Quality recurrence months (endoscopic) (open) (large release
(general)(Wrist (Endoscopic open incision) (open)
pain) release) (large
open
incision)
(P-
value<.05)
Dumontier,C., Moderate Symptom 3 months CT release 28 39.29% CT release 30 43.33% RR 0.91(0.49,1.68) Not
1995 Quality recurrence (endoscopic) (open) Significant
(pain)(Patients still (two-portal (Conventional (P-
reporting pain) endoscopic palmar open value>.05)
release) release)
564
TABLE 145: PICO 7 PART 1- ENDOSCOPIC: POSTOPERATIVE PAIN CONTROL

Jacobsen,M.B., Moderate Analgesia 5.9 CT release 16 5.5(.) CT release 16 5.2(.) Author NA Not
1996 Quality (duration)(Postoperative months (endoscopic) (open) Reported Significant
analgesia use) (two-portal (traditional (P-
Chow open release) value>.05)
technique)
565
TABLE 146: PICO 7 PART 1- ENDOSCOPIC: QUALITY OF LIFE

Atroshi,I., High Activity of daily 3 months CT release 63 1.3(0.50) CT release 65 1.3(0.40) Mean 0(- Not
2006 Quality living (endoscopic) (open) Difference 0.16,0.157164) Significant
(ADL)(Carpal (Endoscopic (Open (P-
tunnel syndrome release carpal value>.05)
functional status) injected tunnel
subcutaneously release
at the proximal along the
and distal length of the
portals) incision)
Atroshi,I., High Activity of daily 11.8 CT release 63 1.3(0.50) CT release 65 1.2(0.40) Mean 0.1(- Not
2006 Quality living months (endoscopic) (open) Difference 0.06,0.257164) Significant
(ADL)(Carpal (Endoscopic (Open (P-
tunnel syndrome release carpal value>.05)
functional status) injected tunnel
subcutaneously release
at the proximal along the
and distal length of the
portals) incision)
Ejiri,S., 2012 High Activity of daily 3 months CT release 40 -23.7(.) CT release 39 -21.6(.) Author NA Not
Quality living (ADL)(Book (endoscopic) (open) (3cm Reported Significant
Holding (100mm (Okutsu palmar (P-
VAS)) method) incision) value>.05)
Quality living (endoscopic) (open) (3cm Reported Significant
(ADL)(Buttoning (Okutsu palmar (P-
(100mm VAS)) method) incision) value>.05)
(ADL)(Chopstick (Okutsu palmar (P-
use (100mm VAS)) method) incision) value>.05)
Ejiri,S., 2012 High Activity of daily 3 months CT release 40 -20.8(.) CT release 39 -22(.) Author NA Not
(ADL)(Receiver (Okutsu palmar (P-
holding (100mm method) incision) value>.05)
VAS))
566
(ADL)(Writing (Okutsu palmar (P-
(100mm VAS)) method) incision) value>.05)
Malhotra,R., High Patient satisfaction 5.9 CT release 30 83.33% CT release 31 67.74% RR 1.23(0.92,1.65) Not
2007 Quality (general)(Subjective months (endoscopic) (open) Significant
improvement- (single portal (short (P-
excellent endoscopic incision value>.05)
(Excellent, good, no release) open
improvement, or release)
worse))
Malhotra,R., High Patient satisfaction 5.9 CT release 30 16.67% CT release 31 29.03% RR 0.57(0.22,1.52) Not
2007 Quality (general)(Subjective months (endoscopic) (open) Significant
improvement-good (single portal (short (P-
(Excellent, good, no endoscopic incision value>.05)
improvement, or release) open
worse)) release)
Saw,N.L., High Return to 3 months CT release 74 18(11.00) CT release 76 26(14.00) Mean -8(-12.02,- CT release
2003 Quality Work(Days off (endoscopic) (open) Difference 3.97646) (endoscopic)
work) (Endoscopic (Open CTR) (Endoscopic
release) release)
(P-
value<.05)
Dumontier,C., Moderate Return to Work( ) 3 months CT release 30 . % CT release 28 . % Author NA Not
1995 Quality (open) (endoscopic) Reported Significant
(Conventional (two-portal (P-
palmar open endoscopic value>.05)
release) release)
567
TABLE 147: PICO 7 PART 1- ENDOSCOPIC: SYMPTOMS

Atroshi,I., 2006 High Symptom recurrence 3 months CT release 63 23.5(26.00) CT release 65 36.2(20.00) Mean -12.7(-20.75,- CT release
Quality (general)(Score range (endoscopic) (open) (Open Difference 4.64633) (endoscopic)
from 0 (no pain or (Endoscopic carpal tunnel (Endoscopic
tenderness in scar or release release along release
proximal palm and no injected the length of injected
activity limitation) to subcutaneously the incision) subcutaneously
100 (severe pain in scar at the proximal at the proximal
or proximal palm and and distal and distal
severe activity portals) portals) (P-
limitation because of value<.05)
pain or tenderness))
Atroshi,I., 2006 High Symptom recurrence 3 months CT release 1.5 .(0.50) CT release 65 1.5(0.50) Mean .(.,) Not Significant
Quality (general)(Score range; (endoscopic) (open) (Open Difference (P-value>.05)
carpal tunnel (Endoscopic carpal tunnel
syndrome, 1 (no release release along
symptoms or disability) injected the length of
to 5 (most severe subcutaneously the incision)
symptoms or at the proximal
disability)) and distal
portals)
Atroshi,I., 2006 High Symptom recurrence 11.8 CT release 63 8.7(21.00) CT release 65 13.9(22.00) Mean -5.2(- Not Significant
Quality (general)(Score range months (endoscopic) (open) (Open Difference 12.65,2.249586) (P-value>.05)
from 0 (no pain or (Endoscopic carpal tunnel
tenderness in scar or release release along
proximal palm and no injected the length of
activity limitation) to subcutaneously the incision)
100 (severe pain in scar at the proximal
or proximal palm and and distal
severe activity portals)
limitation because of
pain or tenderness))
568
Atroshi,I., 2006 High Symptom recurrence 11.8 CT release 63 1.4(0.60) CT release 65 1.4(0.50) Mean 0(- Not Significant
Quality (general)(Score range; months (endoscopic) (open) (Open Difference 0.19,0.191643) (P-value>.05)
carpal tunnel (Endoscopic carpal tunnel
syndrome, 1 (no release release along
symptoms or disability) injected the length of
to 5 (most severe subcutaneously the incision)
symptoms or at the proximal
disability)) and distal
portals)
Atroshi,I., 2009 High Questionnaire 1 years CT release 63 1.4(0.60) CT release 65 1.38(0.50) Mean 0.02(- Not Significant
Quality (CTQ)(CTSQ (endoscopic) (open) (Open Difference 0.17,0.211643) (P-value>.05)
symptoms severity (2-portal carpal tunnel
scale) endoscopic release)
release)
Atroshi,I., 2009 High Questionnaire 5 years CT release 63 1.45(0.70) CT release 63 1.42(0.70) Mean 0.03(- Not Significant
Quality (CTQ)(CTSQ (endoscopic) (open) (Open Difference 0.21,0.274454) (P-value>.05)
symptoms severity (2-portal carpal tunnel
scale) endoscopic release)
release)
Kang,H.J., 2013 High Questionnaire (Boston- 3 months CT release 52 1.5(0.37) CT release 52 1.4(0.74) Mean 0.1(-0.12,0.32) Not Significant
Quality SSS)(Boston CTS (endoscopic) (mini) (1.5- Difference (P-value>.05)
Questionnaire (Endoscopic cm incision
(symptom severity release using was made in
scale)) the Agee the prox-imal
technique) palm over the
transverse
carpal
ligament)
569
Larsen,M.B., High Paresthesia(Paresthesia 3 months CT release 30 . % CT release 30 . % Author NA Not Significant
2013 Quality (VAS scale)) (endoscopic) (open) (7 cm Reported (P-value>.05)
(Endoscopic curved
portal in order to
a short flexor
incision at the and
instruments
and a
conventional 5
mm
arthroscope.
After trans-
section the
skin was
sutured and a
soft dressing
without
splinting
applied)
570
Larsen,M.B., High Paresthesia(Paresthesia 3 months CT release 30 . % CT release 30 . % Author NA Not Significant
2013 Quality (VAS scale)) (endoscopic) (mini) (Short Reported (P-value>.05)
(Endoscopic incision: an
procedure incision of 3
using the cm in the
Linvatec mid-palm
portal release the
instruments flexor
and a retinaculum
conventional 5 and
mm antebrachial
skin was scissor
applied)
571
Larsen,M.B., High Paresthesia(Paresthesia 5.5 CT release 30 . % CT release 30 . % Author NA Not Significant
2013 Quality (VAS scale)) months (endoscopic) (mini) (Short Reported (P-value>.05)
(Endoscopic incision: an
procedure incision of 3
using the cm in the
Linvatec mid-palm
portal release the
instruments flexor
and a retinaculum
conventional 5 and
mm antebrachial
skin was scissor
applied)
572
Larsen,M.B., High Paresthesia(Paresthesia 5.5 CT release 30 . % CT release 30 . % Author NA Not Significant
2013 Quality (VAS scale)) months (endoscopic) (open) (7 cm Reported (P-value>.05)
(Endoscopic curved
portal in order to
a short flexor
incision at the and
instruments
and a
conventional 5
mm
arthroscope.
After trans-
section the
skin was
sutured and a
soft dressing
without
splinting
applied)
MacDermid,J.C., High Questionnaire (Levine- 3 months CT release 91 1.8(.) CT release 32 2(.) Author NA Not Significant
2003 Quality SSS)(Levines (endoscopic) (open) Reported (P-value>.05)
symptom severity (2 portal Chow (traditional
score) technique) long incision
open release)
573
Malhotra,R., High Symptom recurrence 5.9 CT release 30 6.67% CT release 31 12.90% RR 0.52(0.10,2.61) Not Significant
2007 Quality (numbness)( ) months (endoscopic) (open) (short (P-value>.05)
(single portal incision open
endoscopic release)
release)
Malhotra,R., High Symptom recurrence 5.9 CT release 30 6.67% CT release 31 16.13% RR 0.41(0.09,1.97) Not Significant
2007 Quality (weakness)( ) months (endoscopic) (open) (short (P-value>.05)
(single portal incision open
endoscopic release)
release)
Malhotra,R., High Symptom relief 5.9 CT release 30 20.00% CT release 31 25.81% RR 0.78(0.31,1.97) Not Significant
2007 Quality (general)(>75% months (endoscopic) (open) (short (P-value>.05)
improvement) (single portal incision open
endoscopic release)
release)
Malhotra,R., High Symptom relief 5.9 CT release 30 76.67% CT release 31 64.52% RR 1.19(0.86,1.65) Not Significant
2007 Quality (general)(100% months (endoscopic) (open) (short (P-value>.05)
improvement) (single portal incision open
endoscopic release)
release)
Saw,N.L., 2003 High Questionnaire (Levine- 3 months CT release 74 . % CT release 76 . % Author NA Not Significant
Quality SSS)( ) (endoscopic) (open) (Open Reported (P-value>.05)
(Endoscopic CTR)
release)
Trumble,T.E., High Questionnaire (Levine- 3 months CT release 75 1.8(0.14) CT release 72 1.8(0.11) Mean 0(- Not Significant
2002 Quality SSS)(CTS-SSS (endoscopic) (open) (3- Difference 0.04,0.040614) (P-value>.05)
(1=fewest symptoms, (single portal 4cm incision)
5=severe)) endoscopic
release)
Trumble,T.E., High Questionnaire (Levine- 6 months CT release 75 1.7(0.13) CT release 72 1.8(0.10) Mean -0.1(-0.14,- CT release
2002 Quality SSS)(CTS-SSS (endoscopic) (open) (3- Difference 0.06259) (endoscopic)
(1=fewest symptoms, (single portal 4cm incision) (single portal
5=severe)) endoscopic endoscopic
release) release)
(P-value<.05)
574
Trumble,T.E., High Questionnaire (Levine- 12 CT release 75 1.8(0.15) CT release 72 1.8(0.10) Mean 0(- Not Significant
2002 Quality SSS)(CTS-SSS months (endoscopic) (open) (3- Difference 0.04,0.041061) (P-value>.05)
(1=fewest symptoms, (single portal 4cm incision)
5=severe)) endoscopic
release)
Wong,K.C., High Symptom relief 1 years CT release 30 56.67% CT release 29 65.52% RR 0.86(0.57,1.30) Not Significant
2003 Quality (general)(complete (endoscopic) (open- (P-value>.05)
relief of symptoms) (two-portal limited)
endoscopic (limited-open
release) release)
Agee,J.M., 1992 Moderate Symptom recurrence 3 months CT release 74 21.62% CT release 55 12.73% RR 1.70(0.75,3.84) Not Significant
Quality (numbness)(Patients (endoscopic w/ (open) (P-value>.05)
with symptoms still 3M device) (Conventional
present) (Endoscopic open surgery)
device inserted
into incision at
wrist)
Quality (numbness)(Patients (endoscopic w/ (open) (P-value>.05)
device inserted
into incision at
wrist)
Quality (pain)(Nocturnal pain, (endoscopic w/ (open) (P-value>.05)
patients with symptoms 3M device) (Conventional
still present) (Endoscopic open surgery)
device inserted
into incision at
wrist)
Quality (pain)(Nocturnal pain, (endoscopic w/ (open) (P-value>.05)
patients with symptoms 3M device) (Conventional
still present) (Endoscopic open surgery)
device inserted
into incision at
wrist)
575
Quality (tingling)(Patients with (endoscopic w/ (open) (P-value>.05)
symptoms still present) 3M device) (Conventional
(Endoscopic open surgery)
device inserted
into incision at
wrist)
Quality (tingling)(Patients with (endoscopic w/ (open) (P-value>.05)
symptoms still present) 3M device) (Conventional
(Endoscopic open surgery)
device inserted
into incision at
wrist)
Quality (weakness)(Patients (endoscopic w/ (open) (P-value>.05)
device inserted
into incision at
wrist)
Quality (weakness)(Patients (endoscopic w/ (open) (P-value>.05)
device inserted
into incision at
wrist)
Aslani,H.R., Moderate Symptom recurrence 3.9 CT release 32 12.50% CT release 28 0.00% RD 0.13(0.01,0.24) CT release
2012 Quality (general)(Stiffness) months (endoscopic) (mini) (Mini (mini) (Mini
(Endoscopic palmer palmer
release) incision) incision)
(P-value<.05)
Aslani,H.R., Moderate Symptom recurrence 3.9 CT release 32 12.50% CT release 36 5.56% RR 2.25(0.44,11.48) Not Significant
2012 Quality (general)(Stiffness) months (endoscopic) (open) (large (P-value>.05)
(Endoscopic open incision)
release)
576
Aslani,H.R., Moderate Symptom recurrence 3.9 CT release 32 6.25% CT release 28 0.00% RD 0.06(-0.02,0.15) Not Significant
2012 Quality (general)(Weakness) months (endoscopic) (mini) (Mini (P-value>.05)
(Endoscopic palmer
release) incision)
Aslani,H.R., Moderate Symptom recurrence 3.9 CT release 32 6.25% CT release 36 11.11% RR 0.56(0.11,2.87) Not Significant
2012 Quality (general)(Weakness) months (endoscopic) (open) (large (P-value>.05)
release)
Aslani,H.R., Moderate Symptom recurrence 3.9 CT release 32 0.00% CT release 28 0.00% RD 0.00(0.00,0.00) Not Significant
2012 Quality (numbness)(Numbness) months (endoscopic) (mini) (Mini (P-value>.05)
(Endoscopic palmer
release) incision)
Aslani,H.R., Moderate Symptom recurrence 3.9 CT release 32 0.00% CT release 36 0.00% RD 0.00(0.00,0.00) Not Significant
2012 Quality (numbness)(Numbness) months (endoscopic) (open) (large (P-value>.05)
release)
Ferdinand,R.D., Moderate Symptom relief 1 years CT release 25 . % CT release 25 . % Author NA Not Significant
2002 Quality (general)( ) (endoscopic) (open) Reported (P-value>.05)
(single portal (traditional
endoscopic open release)
release)
Tian,Y., 2007 Moderate Symptom relief 2 years CT release 30 93.33% CT release 32 90.63% RR 1.03(0.89,1.19) Not Significant
Quality (general)(Patient (endoscopic) (open) (P-value>.05)
satisfaction: excellent (one-portal (traditional
to good) endoscopics open release)
release)
577
TABLE 148: PICO 7 PART 2- MINI: COMPLICATIONS

Cresswell,T.R., High Complications 3 months CT release 100 2.00% CT release 95 9.47% RR 0.21(0.05,0.95) CT release
2008 Quality (general)(Rate of (open) (mini- (open)
complications) (Standard Indiana (Standard
limited Tome) limited
open (Indiana open
palmer Tome) palmer
release) release)
(P-
value<.05)
Cresswell,T.R., High Symptom occurrence 3 months CT release 88 1.9(.) CT release 88 1.7(.) Author NA Not
2008 Quality (scar tenderness)( ) (open) (mini- Reported Significant
(Standard Indiana (P-
limited Tome) value>.05)
open (Indiana
palmer Tome)
release)
Jugovac,I., High Symptom occurrence 3 months CT release 36 22.22% CT release 36 8.33% RR 2.67(0.77,9.25) Not
2002 Quality (scar (open) (mini-limited Significant
tenderness)(Tenderness) (Traditional incision) (P-
technique) (limited value>.05)
palmer
incision)
578
2013 Quality (pillar pain)( ) (open) (7 (mini) (Short Reported Significant
cm curved incision: an (P-
incision just incision of 3 value>.05)
ulnar to the cm in the
thenar mid-palm
crease and distal to the
angulated flexion
over the crease of the
flexion wrist in order
crease of to release the
the wrist in distal portion
order to of the flexor
release the retinaculum
flexor under direct
retinaculum vision, and
and the proximal
antebrachial portion of
fascia under the flexor
direct retinaculum
vision) and
antebrachial
fascia were
then
carefully
divided
using scissor
dissection in
a plane deep
to
subcutaneous
fat and skin)
579
2013 Quality (pillar pain)( ) months (open) (7 (mini) (Short Reported Significant
ulnar to the cm in the
thenar mid-palm
crease and distal to the
angulated flexion
over the crease of the
flexion wrist in order
crease of to release the
the wrist in distal portion
order to of the flexor
release the retinaculum
flexor under direct
retinaculum vision, and
and the proximal
antebrachial portion of
fascia under the flexor
direct retinaculum
vision) and
antebrachial
fascia were
then
carefully
divided
using scissor
dissection in
a plane deep
to
subcutaneous
fat and skin)
Yucetas,S.C., High Complications 5.9 CT release 37 18.92% CT release 38 5.26% RR 3.59(0.80,16.19) Not
2013 Quality (general)(Complications months (open) (mini-open Significant
or reoperation within 6 (Standard KnifeLight) (P-
months) open CTR) (mini open value>.05)
KnifeLight
instrument
assisted)
580
Faraj,A.A., Moderate Symptom occurrence 3 months CT release 20 5.15(0.26) CT release 20 1.4(0.17) Mean 3.75(3.61,3.886145) CT release
2012 Quality (scar length)(Length of (open) (mini) (mini- Difference (mini)
scar (cm)) (traditional transverse (mini-
open wrist transverse
release) incisions) wrist
incisions)
(P-
value<.05)
Ucar,B.Y., Moderate Symptom occurrence 2.5 years CT release 45 24.44% CT release 45 6.67% RR 3.67(1.10,12.27) CT release
2012 Quality (scar pain)( ) (Mini- (Mini- (Mini-
incision incision incision
distal to proximal to proximal to
flexor flexor crease flexor
crease (group 2)) crease
(group 1)) (2cm (group 2))
(2cm longitudinal (2cm
longitudinal incision longitudinal
incision made incision
made distal proximal to made
to flexor flexor proximal to
crease) crease) flexor
crease)
(P-
value<.05)
581
TABLE 149: PICO 7 PART 2- MINI: FUNCTION
Treatment Group Mean1/P Treatment Group Effect Result

Reference Outcome Duratio 1 1 1 2 2 Mean2/P2 Measur (95% Favored
Title Quality Details n (Details) N (SD1) (Details) N (SD2) e CI) Treatment
Cellocco,P., High Questionnaire 1.6 years CT release 123 2.53(.) CT release 99 2.02(.) Author NA CT release
2005 Quality (Boston-FSS)(Boston (open- (mini-open Reported (mini-open
CTS Questionnaire limited blind blind
(functional status open) technique) technique)
scale)-Italian modified (limited (mini-open (mini-open
version) open CTR) blind blind
technique) technique)
(P-value<.05)
Cellocco,P., High Questionnaire 2.5 years CT release 123 1.73(.) CT release 99 1.87(.) Author NA Not Significant
2005 Quality (Boston-FSS)(Boston (open- (mini-open Reported (P-value>.05)
CTS Questionnaire limited blind
(functional status open) technique)
scale)-Italian modified (limited (mini-open
version) open CTR) blind
technique)
Cellocco,P., High Two-point 2.5 years CT release 123 4.3(.) CT release 99 4.7(.) Author NA Not Significant
2005 Quality discrimination(Millim (open- (mini-open Reported (P-value>.05)
eters) limited blind
open) technique)
(limited (mini-open
open CTR) blind
technique)
Cellocco,P., High Questionnaire 1.6 years CT release 123 2.05(0.82 CT release 99 3.85(0.75) Mean -1.8(-2.01,- CT release
2009 Quality (Boston-FSS)(Boston (open) (3- ) (mini- Differen 1.59305) (open) (3-4cm
CTS Questionnaire 4cm long knifelight) ce long limited-
(functional status limited-open (Knifelight open palmar
scale)-Italian modified palmar surgery) incision)
version) incision) (P-value<.05)
Cellocco,P., High Questionnaire 2.5 years CT release 123 1.39(0.72 CT release 99 1.28(0.52) Mean 0.11(- Not Significant
2009 Quality (Boston-FSS)(Boston (open) (3- ) (mini- Differen 0.05,0.273351) (P-value>.05)
CTS Questionnaire 4cm long knifelight) ce
(functional status limited-open (Knifelight
scale)-Italian modified palmar surgery)
version) incision)
582
Cellocco,P., High Questionnaire 4.9 years CT release 123 1.38(0.83 CT release 99 1.33(0.64) Mean 0.05(- Not Significant
2009 Quality (Boston-FSS)(Boston (open) (3- ) (mini- Differen 0.14,0.243417) (P-value>.05)
CTS Questionnaire 4cm long knifelight) ce
(functional status limited-open (Knifelight
scale)-Italian modified palmar surgery)
version) incision)
Cellocco,P., High Two-point 4.9 years CT release 99 4.5(.) CT release 99 4.6(.) Author NA CT release
2009 Quality discrimination(Millim (open) (3- (mini- Reported (mini-
eters) 4cm long knifelight) knifelight)
limited-open (Knifelight (Knifelight
palmar surgery) surgery)
incision) (P-value<.05)
Cresswell,T. High Grip 3 months CT release 88 . % CT release 88 . % Author NA Not Significant
R., 2008 Quality strength(Percentage of (open) (mini-Indiana Reported (P-value>.05)
pre-op value) (Standard Tome)
limited open (Indiana
palmer Tome)
release)
Cresswell,T. High Pinch Strength(% 3 months CT release 88 . % CT release 88 . % Author NA Not Significant
R., 2008 Quality improvement from (open) (mini-Indiana Reported (P-value>.05)
baseline (units not (Standard Tome)
reported)) limited open (Indiana
palmer Tome)
release)
Jugovac,I., High NCS (DML)(Distal 3 months CT release 36 4.08(0.80 CT release 36 4.12(0.90) Mean -0.04(- Not Significant
2002 Quality motor latency (ms)) (open) ) (mini-limited Differen 0.43,0.353358) (P-value>.05)
(Traditional incision) ce
technique) (limited
palmer
incision)
Jugovac,I., High NCS (SNCV)(Sensory 3 months CT release 36 43.67(9.0 CT release 36 41.86(8.50 Mean 1.81(- Not Significant
2002 Quality nerve conduction (open) 0) (mini-limited ) Differen 2.23,5.853943) (P-value>.05)
velocity (m/s)) (Traditional incision) ce
technique) (limited
palmer
incision)
583
Larsen,M.B., High Grip 3 months CT release 30 . % CT release 30 . % Author NA CT release
2013 Quality strength(Percentage of (open) (7 cm (mini) (Short Reported (open) (7 cm
contralateral hand) curved incision: an curved
incision just incision of 3 incision just
ulnar to the cm in the mid- ulnar to the
thenar palm distal to thenar crease
crease and the flexion and angulated
angulated crease of the over the
over the wrist in order flexion crease
flexion to release the of the wrist in
crease of the distal portion order to
wrist in of the flexor release the
order to retinaculum flexor
release the under direct retinaculum
flexor vision, and the and
retinaculum proximal antebrachial
and portion of the fascia under
antebrachial flexor direct vision)
fascia under retinaculum (P-value<.05)
direct and
vision) antebrachial
fascia were
then carefully
divided using
scissor
dissection in a
plane deep to
subcutaneous
fat and skin)
584
Larsen,M.B., High Grip 5.5 CT release 30 . % CT release 30 . % Author NA Not Significant
2013 Quality strength(Percentage of months (open) (7 cm (mini) (Short Reported (P-value>.05)
contralateral hand) curved incision: an
incision just incision of 3
ulnar to the cm in the mid-
thenar palm distal to
crease and the flexion
angulated crease of the
over the wrist in order
flexion to release the
crease of the distal portion
wrist in of the flexor
order to retinaculum
release the under direct
flexor vision, and the
retinaculum proximal
and portion of the
antebrachial flexor
fascia under retinaculum
direct and
fascia were
then carefully
divided using
scissor
dissection in a
plane deep to
subcutaneous
fat and skin)
585
Larsen,M.B., High Range of motion( ) 3 months CT release 30 . % CT release 30 . % Author NA Not Significant
2013 Quality (open) (7 cm (mini) (Short Reported (P-value>.05)
curved incision: an
and portion of the
antebrachial flexor
direct and
fascia were
then carefully
divided using
scissor
dissection in a
plane deep to
subcutaneous
fat and skin)
586
Larsen,M.B., High Range of motion( ) 5.5 CT release 30 . % CT release 30 . % Author NA Not Significant
2013 Quality months (open) (7 cm (mini) (Short Reported (P-value>.05)
curved incision: an
and portion of the
antebrachial flexor
direct and
fascia were
then carefully
divided using
scissor
dissection in a
plane deep to
subcutaneous
fat and skin)
587
Suppaphol,S. High Grip strength(Pounds) 3 months CT release 15 55.67(6.5 CT release 15 62.67(5.62 Mean -7(-11.35,- CT release
, 2012 Quality (open) 1) (mini) ) Differen 2.64766) (mini)
(Standard (Limited open ce (Limited open
open carpal carpal tunnel carpal tunnel
tunnel release direct release direct
release) vision and vision and
tunneling tunneling
technique; 1.5 technique; 1.5
cm incision is cm incision is
made over the made over the
distal edge of distal edge of
transverse transverse
carpal carpal
ligament) ligament) (P-
value<.05)
Suppaphol,S. High Pinch 3 months CT release 15 12.47(1.5 CT release 15 13.6(1.84) Mean -1.13(- Not Significant
, 2012 Quality Strength(Pounds) (open) 5) (mini) Differen 2.35,0.087526) (P-value>.05)
(Standard (Limited open ce
open carpal carpal tunnel
tunnel release direct
release) vision and
tunneling
technique; 1.5
cm incision is
made over the
distal edge of
transverse
carpal
ligament)
588
Suppaphol,S. High Questionnaire 3 months CT release 15 1.45(0.50 CT release 15 1.28(0.31) Mean 0.17(- Not Significant
, 2012 Quality (Levine- (open) ) (mini) Differen 0.13,0.467722) (P-value>.05)
FSS)(Levines (Standard (Limited open ce
functional score) open carpal carpal tunnel
release) vision and
tunneling
technique; 1.5
cm incision is
made over the
distal edge of
transverse
carpal
ligament)
Suppaphol,S. High Two-point 3 months CT release 15 2.63(0.69 CT release 15 2.75(0.62) Mean -0.12(- Not Significant
, 2012 Quality discrimination(Millim (open) ) (mini) Differen 0.59,0.349446) (P-value>.05)
eters) (Standard (Limited open ce
open carpal carpal tunnel
release) vision and
tunneling
technique; 1.5
cm incision is
made over the
distal edge of
transverse
carpal
ligament)
Yucetas,S.C. High NCS (EMG)( 3 months CT release 37 3.73(0.26 CT release 38 3.67(0.30) Mean 0.06(- Not Significant
, 2013 Quality Electromyographical (open) ) (mini-open Differen 0.07,0.186953) (P-value>.05)
motor latency (ms)) (Standard KnifeLight) ce
open CTR) (mini open
KnifeLight
instrument
assisted)
589
Yucetas,S.C. High NCS 5.9 CT release 37 3.75(0.26 CT release 38 3.65(0.30) Mean 0.1(- Not Significant
, 2013 Quality (EMG)(Electromyogr months (open) ) (mini-open Differen 0.03,0.226953) (P-value>.05)
aphical motor latency (Standard KnifeLight) ce
(ms)) open CTR) (mini open
KnifeLight
instrument
assisted)
Yucetas,S.C. High Questionnaire 3 months CT release 37 2.22(0.63 CT release 38 2.15(0.56) Mean 0.07(- Not Significant
, 2013 Quality (Boston-FSS)(Boston (open) ) (mini-open Differen 0.20,0.340022) (P-value>.05)
CTS Questionnaire (Standard KnifeLight) ce
(functional status open CTR) (mini open
scale)) KnifeLight
instrument
assisted)
Yucetas,S.C. High Questionnaire 5.9 CT release 37 2.22(0.62 CT release 38 2.15(0.56) Mean 0.07(- Not Significant
, 2013 Quality (Boston-FSS)(Boston months (open) ) (mini-open Differen 0.20,0.337608) (P-value>.05)
CTS Questionnaire (Standard KnifeLight) ce
(functional status open CTR) (mini open
scale)) KnifeLight
instrument
assisted)
Zyluk,A., High Grip 3 months CT release 33 . % CT release 40 . % Author NA CT release
2006 Quality strength(Kilograms) (mini- (mini-single Reported (mini-single
double incision) incision)
incision) (Mini-open (Mini-open
(Mini-open single incision single incision
double release) release)
incision (P-value<.05)
release)
Zyluk,A., High Grip 5.9 CT release 33 . % CT release 40 . % Author NA CT release
2006 Quality strength(Kilograms) months (mini- (mini-single Reported (mini-single
release)
590
Zyluk,A., High Grip 11.8 CT release 33 . % CT release 40 . % Author NA CT release
2006 Quality strength(Kilograms) months (mini- (mini-single Reported (mini-single
release)
Zyluk,A., High Key pinch 3 months CT release 33 . % CT release 40 . % Author NA CT release
2006 Quality strength(Kilograms) (mini- (mini-single Reported (mini-single
release)
Zyluk,A., High Key pinch 5.9 CT release 33 . % CT release 40 . % Author NA Not Significant
2006 Quality strength(Kilograms) months (mini- (mini-single Reported (P-value>.05)
double incision)
incision) (Mini-open
(Mini-open single incision
double release)
incision
release)
Zyluk,A., High Key pinch 11.8 CT release 33 . % CT release 40 . % Author NA Not Significant
2006 Quality strength(Kilograms) months (mini- (mini-single Reported (P-value>.05)
double incision)
double release)
incision
release)
591
Zyluk,A., High Pinch Strength (three- 3 months CT release 33 . % CT release 40 . % Author NA CT release
2006 Quality point (mini- (mini-single Reported (mini-single
pinch)(Kilograms) double incision) incision)
release)
Zyluk,A., High Pinch Strength (three- 5.9 CT release 33 . % CT release 40 . % Author NA CT release
2006 Quality point months (mini- (mini-single Reported (mini-single
release)
Zyluk,A., High Pinch Strength (three- 11.8 CT release 33 . % CT release 40 . % Author NA Not Significant
2006 Quality point months (mini- (mini-single Reported (P-value>.05)
pinch)(Kilograms) double incision)
double release)
incision
release)
Zyluk,A., High Pinch Strength (two- 3 months CT release 33 . % CT release 40 . % Author NA CT release
2006 Quality point (mini- (mini-single Reported (mini-single
release)
592
Zyluk,A., High Pinch Strength (two- 5.9 CT release 33 . % CT release 40 . % Author NA CT release
release)
Zyluk,A., High Pinch Strength (two- 11.8 CT release 33 . % CT release 40 . % Author NA CT release
release)
Zyluk,A., High Questionnaire 11.8 CT release 33 1.2(.) CT release 40 1.2(.) Author NA Not Significant
2006 Quality (Levine-FSS)( ) months (mini- (mini-single Reported (P-value>.05)
double incision)
double release)
incision
release)
Zyluk,A., High Semmes Weinstein 11.8 CT release 33 1.4(.) CT release 40 1.3(.) Author NA Not Significant
2006 Quality Monofilaments Test months (mini- (mini-single Reported (P-value>.05)
(SW test)( ) double incision)
double release)
incision
release)
593
Zyluk,A., High Two-point 11.8 CT release 33 1.3(.) CT release 40 1.2(.) Author NA Not Significant
2006 Quality discrimination(Millim months (mini- (mini-single Reported (P-value>.05)
eters) double incision)
double release)
incision
release)
Aslani,H.R., Modera Phalen's test score(% 3.9 CT release 36 13.89% CT release 28 10.71% RR 1.26(0.33,4.84) Not Significant
2012 te positive) months (open) (large (mini) (Mini (P-value>.05)
Quality open palmer
incision) incision)
Aslani,H.R., Modera Tinel's Sign/Test(# 3.9 CT release 36 19.44% CT release 28 10.71% RR 1.81(0.52,6.39) Not Significant
2012 te positive) months (open) (large (mini) (Mini (P-value>.05)
Quality open palmer
incision) incision)
Capa- Modera Grip strength(Grip 3 months CT release 20 86.17(5.5 CT release 20 87.22(4.76 Mean -1.05(- Not Significant
Grasa,A., te strength rate (units not (mini-open) 0) (Ultra- ) Differen 4.24,2.137866) (P-value>.05)
2014 Quality reported)) (Mini- minimally ce
OCTR invasive)
respectively (Sonographica
performed lly guided
through a 1 technique for
mm or a 2 ultra-
cm minimally-
incision.) invasive
(Ultra-MIS)
CT release 1
mm or cm
incision)
594
Capa- Modera Questionnaire 3 months CT release 20 14.54(3.1 CT release 20 7.39(1.84) Mean 7.15(5.56,8.7374 CT release
Grasa,A., te (DASH-Quick (mini-open) 2) (Ultra- Differen 79) (Ultra-
2014 Quality DASH)( ) (Mini- minimally ce minimally
OCTR invasive) invasive)
respectively (Sonographica (Sonographica
performed lly guided lly guided
through a 1 technique for technique for
mm or a 2 ultra- ultra-
cm minimally- minimally-
incision.) invasive invasive
(Ultra-MIS) (Ultra-MIS)
CT release 1 CT release 1
mm or cm mm or cm
incision) incision)
(P-value<.05)
Elsharif,M., Modera Questionnaire 10 years CT release . 34.1(23.2 CT release . 13.22(13.6 Mean 20.88(.,) CT release
2014 te (DASH-Quick (open) ( ) 7) (knifelight) ( ) 2) Differen (knifelight)
Quality DASH)( ) ce (P-value<.05)
Faraj,A.A., Modera NCS (DML)(Distal 3 months CT release 20 4.08(0.80 CT release 20 4.6(0.90) Mean -0.52(- Not Significant
2012 te motor latency (ms)) (open) ) (mini) (mini- Differen 1.05,0.007746) (P-value>.05)
Quality (traditional transverse ce
open wrist
release) incisions)
Faraj,A.A., Modera NCS (SNCV)(Sensory 3 months CT release 20 44.6(7.50 CT release 20 42.52(8.70 Mean 2.08(- Not Significant
2012 te nerve conduction (open) ) (mini) (mini- ) Differen 2.95,7.114186) (P-value>.05)
Quality velocity (m/s)) (traditional transverse ce
open wrist
release) incisions)
Tarallo,M., Modera Questionnaire 5.9 CT release 60 2.3(0.60) CT release 60 1.4(0.40) Mean 0.9(0.72,1.08246 CT release
2014 te (Boston-FSS)(Boston months (open) (mini) (2 cm Differen 6) (mini) (2 cm
Quality CTS Questionnaire (Traditional) long incision) ce long incision)
(functional status (P-value<.05)
scale))
595
Tarallo,M., Modera Questionnaire 11.8 CT release 60 1.5(0.20) CT release 60 1.1(0.10) Mean 0.4(0.34,0.45658 CT release
2014 te (Boston-FSS)(Boston months (open) (mini) (2 cm Differen 0) (mini) (2 cm
Quality CTS Questionnaire (Traditional) long incision) ce long incision)
(functional status (P-value<.05)
scale))
Tarallo,M., Modera Two-point 11.8 CT release 60 . % CT release 60 . % Author NA Not Significant
2014 te discrimination (2PD)( months (open) (mini) (2 cm Reported (P-value>.05)
Quality ) (Traditional) long incision)
Ucar,B.Y., Modera Questionnaire 2.5 years CT release 45 2.16(0.68 CT release 45 2.21(0.73) Mean -0.05(- Not Significant
2012 te (Boston-FSS)(Boston (Mini- ) (Mini- Differen 0.34,0.241492) (P-value>.05)
Quality CTS Questionnaire incision incision ce
(functional status distal to proximal to
scale)) flexor crease flexor crease
(group 1)) (group 2))
(2cm (2cm
longitudinal longitudinal
incision incision made
made distal proximal to
to flexor flexor crease)
crease)
596
TABLE 150: PICO 7 PART 2- MINI: OTHER

Cellocco,P., High Patient satisfaction 2.5 years CT release 123 74.80% CT release 99 100.00% RR .(.,.) CT release
2005 Quality (general)(Patients (open-limited (mini-open (mini-open
satisfied results at open) (limited blind blind
final follow-up) open CTR) technique) technique)
(mini-open (mini-open
blind blind
(P-
value<.05)
Cellocco,P., High Patient satisfaction 2.5 years CT release 96 85.42% CT release 99 77.78% RR 1.10(0.96,1.26) Not
2009 Quality (general)(Subjective (open) (3- (mini- Significant
satisfaction with their 4cm long knifelight) (P-
scar) limited-open (Knifelight value>.05)
palmar surgery)
incision)
Cellocco,P., High Patient satisfaction 4.9 years CT release 95 85.26% CT release 99 100.00% RR .(.,.) CT release
2009 Quality (general)(Subjective (open) (3- (mini- (mini-
satisfaction with their 4cm long knifelight) knifelight)
scar) limited-open (Knifelight (Knifelight
palmar surgery) surgery)
incision) (P-
value<.05)
Faraj,A.A., Moderate Patient satisfaction 3 months CT release 20 80.00% CT release 20 60.00% RR 1.33(0.88,2.03) Not
2012 Quality (general)(Satisfaction (open) (mini) Significant
of patients with (traditional (mini- (P-
postoperative open release) transverse value>.05)
symptomatic relieve: wrist
Good) incisions)
Tarallo,M., Moderate Questionnaire/Scale 11.8 CT release 60 30.00% CT release 60 53.33% RR 0.56(0.36,0.89) CT release
2014 Quality (Vancouver months (open) (mini) (2 (mini) (2
scale)(Patient (Traditional) cm long cm long
satisfaction with scar incision) incision)
- Good) (P-
value<.05)
597
- Satisfactory) (P-
value<.05)
- Unsatisfactory) (P-
value<.05)
- Very good) (P-
value<.05)
598
TABLE 151: PICO 7 PART 2- MINI: PAIN

Cresswell,T.R., High Questionnaire/Scale 3 months CT release 88 2(.) CT release 88 1.9(.) Author NA Not
2008 Quality (VAS-pain)(visual (open) (mini-Indiana Reported Significant
analogue scale of 0 (Standard Tome) (Indiana (P-
to 10) limited open Tome) value>.05)
palmer
release)
2013 Quality (VAS-pain)( ) (open) (7 (mini) (Short Reported Significant
crease of distal portion
the wrist in of the flexor
and portion of the
antebrachial flexor
direct and
fascia were
then carefully
divided using
scissor
dissection in a
plane deep to
subcutaneous
fat and skin)
599
2013 Quality (VAS-pain)( ) months (open) (7 (mini) (Short Reported Significant
crease of distal portion
the wrist in of the flexor
and portion of the
antebrachial flexor
direct and
fascia were
then carefully
divided using
scissor
dissection in a
plane deep to
subcutaneous
fat and skin)
Yucetas,S.C., High Questionnaire/Scale 3 months CT release 37 3.35(1.74) CT release 38 3.11(1.80) Mean 0.24(- Not
2013 Quality (VAS-pain)( ) (open) (mini-open Difference 0.56,1.041182) Significant
(Standard KnifeLight) (P-
open CTR) (mini open value>.05)
KnifeLight
instrument
assisted)
600
Yucetas,S.C., High Questionnaire/Scale 5.9 CT release 37 3.16(1.48) CT release 38 2.84(1.53) Mean 0.32(- Not
2013 Quality (VAS-pain)( ) months (open) (mini-open Difference 0.36,1.001230) Significant
(Standard KnifeLight) (P-
open CTR) (mini open value>.05)
KnifeLight
instrument
assisted)
2012 Quality recurrence months (open) (mini) (Mini Significant
(general)(Night (large open palmer (P-
pain) incision) incision) value>.05)
Aslani,H.R., Moderate Symptom 3.9 CT release 36 0.00% CT release 28 14.29% RD -0.14(-0.27,- CT
2012 Quality recurrence months (open) (mini) (Mini 0.01) release
(general)(Wrist (large open palmer (open)
pain) incision) incision) (large
open
incision)
(P-
value<.05)
601
TABLE 152: PICO 7 PART 2- MINI: QUALITY OF LIFE

Cellocco,P., High Return to Work( 4.9 years CT release . . % CT release 99 . % Author NA CT release
2009 Quality ) (open) (3-4cm (mini- Reported (mini-
long limited- knifelight) knifelight)
open palmar (Knifelight (Knifelight
incision) surgery) surgery)
(P-
value<.05)
Jugovac,I., High Return to 3 months CT release 36 86.11% CT release 36 . % RR .(.,.) CT release
2002 Quality Normal (open) (mini- (open)
Activities(Return (Traditional limited (Traditional
to daily activities technique) incision) technique)
days) (limited (P-
palmer value<.05)
incision)
Jugovac,I., High Return to 3 months CT release 36 . % CT release 36 . % Author NA CT release
2002 Quality Work(Return to (open) (mini- Reported (mini-
work days) (Traditional limited limited
technique) incision) incision)
(limited (limited
palmer palmer
incision) incision) (P-
value<.05)
Faraj,A.A., Moderate Return to 3 months CT release 20 12.55(4.03) CT release 20 3.95(1.82) Mean 8.6(6.66,10.53798) CT release
2012 Quality Normal (open) (mini) Difference (mini)
Activities(Days) (traditional (mini- (mini-
open release) transverse transverse
wrist wrist
incisions) incisions)
(P-
value<.05)
602
TABLE 153: PICO 7 PART 2- MINI: SYMPTOMS
Treatment Group Mean1/P Treatment Group Mean2/P Result Favored

Reference Outcome Duratio 1 1 1 2 2 2 Effect (95% Treatmen
Title Quality Details n (Details) N (SD1) (Details) N (SD2) Measure CI) t
Cellocco,P., High Questionnaire 1.6 years CT release 123 2.04(.) CT release 99 1.46(.) Author NA CT
2005 Quality (Boston-SSS)(Boston (open- (mini-open Reported release
CTS Questionnaire limited blind (mini-
(symptom severity open) technique) open
scale)-Italian modified (limited (mini-open blind
version) open CTR) blind technique)
technique) (mini-
open
blind
technique)
(P-
value<.05)
Cellocco,P., High Questionnaire 2.5 years CT release 123 1.39(.) CT release 99 1.28(.) Author NA Not
2005 Quality (Boston-SSS)(Boston (open- (mini-open Reported Significant
CTS Questionnaire limited blind (P-
(symptom severity open) technique) value>.05)
scale)-Italian modified (limited (mini-open
version) open CTR) blind
technique)
Cellocco,P., High Questionnaire 1.6 years CT release 123 2.54(0.88) CT release 99 2.02(0.82) Mean 0.52(0.30,0.744228 CT
2009 Quality (Boston-SSS)(Boston (open) (3- (mini- Differenc ) release
CTS Questionnaire 4cm long knifelight) e (mini-
(symptom severity limited- (Knifelight knifelight)
scale)-Italian modified open surgery) (Knifeligh
version) palmar t surgery)
incision) (P-
value<.05)
Cellocco,P., High Questionnaire 2.5 years CT release 123 1.73(0.83) CT release 99 1.88(0.75) Mean -0.15(- Not
2009 Quality (Boston-SSS)(Boston (open) (3- (mini- Differenc 0.36,0.058190) Significant
CTS Questionnaire 4cm long knifelight) e (P-
(symptom severity limited- (Knifelight value>.05)
scale)-Italian modified open surgery)
version) palmar
incision)
603
Cellocco,P., High Questionnaire 4.9 years CT release 123 1.75(0.97) CT release 99 1.8(0.78) Mean -0.05(- Not
2009 Quality (Boston-SSS)(Boston (open) (3- (mini- Differenc 0.28,0.180206) Significant
CTS Questionnaire 4cm long knifelight) e (P-
(symptom severity limited- (Knifelight value>.05)
scale)-Italian modified open surgery)
version) palmar
incision)
Cellocco,P., High Symptom recurrence 4.9 years CT release 123 3.25% CT release 99 6.06% RR 0.54(0.16,1.85) Not
2009 Quality (general)(Recurrent (open) (3- (mini- Significant
CTS) 4cm long knifelight) (P-
limited- (Knifelight value>.05)
open surgery)
palmar
incision)
Cresswell,T.R. High Questionnaire 3 months CT release 88 17.1(.) CT release 88 18.5(.) Author NA Not
, 2008 Quality (Levine-SSS)( ) (open) (mini- Reported Significant
(Standard Indiana (P-
limited Tome) value>.05)
open (Indiana
palmer Tome)
release)
Cresswell,T.R. High Questionnaire 7 years CT release 62 13(.) CT release 53 16(.) Author NA CT
, 2008 Quality (Levine-SSS)( ) (open) (mini- Reported release
(Standard Indiana (mini-
limited Tome) Indiana
open (Indiana Tome)
palmer Tome) (Indiana
release) Tome) (P-
value<.05)
Jugovac,I., High Symptom relief 3 months CT release 36 86.11% CT release 36 86.11% RR 1.00(0.83,1.20) Not
2002 Quality (general)(Complete (open) (mini- Significant
symptomatic relief (Traditional limited (P-
after the procedure) technique) incision) value>.05)
(limited
palmer
incision)
604
Larsen,M.B., High Paresthesia(Paresthesi 3 months CT release 30 . % CT release 30 . % Author NA Not
2013 Quality a (VAS scale)) (open) (7 (mini) Reported Significant
cm curved (Short (P-
incision just incision: an value>.05)
ulnar to the incision of 3
thenar cm in the
crease and mid-palm
angulated distal to the
over the flexion
flexion crease of the
crease of wrist in
the wrist in order to
order to release the
release the distal
flexor portion of
retinaculum the flexor
and retinaculum
antebrachial under direct
fascia under vision, and
direct the proximal
vision) portion of
the flexor
retinaculum
and
antebrachial
fascia were
then
carefully
divided
using scissor
dissection in
a plane deep
to
subcutaneou
s fat and
skin)
605
Larsen,M.B., High Paresthesia(Paresthesi 5.5 CT release 30 . % CT release 30 . % Author NA Not
2013 Quality a (VAS scale)) months (open) (7 (mini) Reported Significant
cm curved (Short (P-
incision just incision: an value>.05)
ulnar to the incision of 3
thenar cm in the
crease and mid-palm
angulated distal to the
over the flexion
flexion crease of the
crease of wrist in
the wrist in order to
order to release the
release the distal
flexor portion of
retinaculum the flexor
and retinaculum
antebrachial under direct
fascia under vision, and
direct the proximal
vision) portion of
the flexor
retinaculum
and
antebrachial
fascia were
then
carefully
divided
using scissor
dissection in
a plane deep
to
subcutaneou
s fat and
skin)
606
Suppaphol,S., High Questionnaire 3 months CT release 15 1.23(0.50) CT release 15 1.17(0.17) Mean 0.06(- Not
2012 Quality (Levine- (open) (mini) Differenc 0.21,0.327260) Significant
SSS)(Levines (Standard (Limited e (P-
symptom severity open carpal open carpal value>.05)
score) tunnel tunnel
release) release
direct vision
and
tunneling
technique;
1.5 cm
incision is
made over
the distal
edge of
transverse
carpal
ligament)
Yucetas,S.C., High Questionnaire 3 months CT release 37 1.89(0.33) CT release 38 1.95(0.42) Mean -0.06(- Not
2013 Quality (Boston-SSS)(Boston (open) (mini-open Differenc 0.23,0.110704) Significant
CTS Questionnaire (Standard KnifeLight) e (P-
(symptom severity open CTR) (mini open value>.05)
scale)) KnifeLight
instrument
assisted)
Yucetas,S.C., High Questionnaire 5.9 CT release 37 1.87(0.35) CT release 38 1.95(0.41) Mean -0.08(- Not
2013 Quality (Boston-SSS)(Boston months (open) (mini-open Differenc 0.25,0.092374) Significant
CTS Questionnaire (Standard KnifeLight) e (P-
(symptom severity open CTR) (mini open value>.05)
scale)) KnifeLight
instrument
assisted)
607
Zyluk,A., High Questionnaire 11.8 CT release 33 1.2(.) CT release 40 1.1(.) Author NA Not
2006 Quality (Levine-SSS)( ) months (mini- (mini-single Reported Significant
double incision) (P-
incision) (Mini-open value>.05)
(Mini-open single
double incision
incision release)
release)
Aslani,H.R., Moderat Symptom recurrence 3.9 CT release 36 5.56% CT release 28 0.00% RD 0.06(-0.02,0.13) Not
2012 e Quality (general)(Stiffness) months (open) (mini) (Mini Significant
(large open palmer (P-
incision) incision) value>.05)
Aslani,H.R., Moderat Symptom recurrence 3.9 CT release 36 11.11% CT release 28 0.00% RD 0.11(0.01,0.21) CT
2012 e Quality (general)(Weakness) months (open) (mini) (Mini release
(large open palmer (mini)
incision) incision) (Mini
palmer
incision)
(P-
value<.05)
Aslani,H.R., Moderat Symptom recurrence 3.9 CT release 36 0.00% CT release 28 0.00% RD 0.00(0.00,0.00) Not
2012 e Quality (numbness)(Numbnes months (open) (mini) (Mini Significant
s) (large open palmer (P-
Tarallo,M., Moderat Questionnaire 5.9 CT release 60 2.7(0.60) CT release 60 1.4(0.30) Mean 1.3(1.13,1.469740) CT
2014 e Quality (Boston-SSS)(Boston months (open) (mini) (2 cm Differenc release
CTS Questionnaire (Traditional long e (mini) (2
(symptom severity ) incision) cm long
scale)) incision)
(P-
value<.05)
Tarallo,M., Moderat Questionnaire 11.8 CT release 60 1.6(0.40) CT release 60 1.1(0.10) Mean 0.5(0.40,0.604328) CT
2014 e Quality (Boston-SSS)(Boston months (open) (mini) (2 cm Differenc release
CTS Questionnaire (Traditional long e (mini) (2
(symptom severity ) incision) cm long
scale)) incision)
(P-
value<.05)
608
Ucar,B.Y., Moderat Questionnaire 2.5 years CT release 45 2.42(0.75) CT release 45 2.66(0.74) Mean -0.24(- Not
2012 e Quality (Boston-SSS)(Boston (Mini- (Mini- Differenc 0.55,0.067844) Significant
CTS Questionnaire incision incision e (P-
(symptom severity distal to proximal to value>.05)
scale)) flexor flexor crease
crease (group 2))
(group 1)) (2cm
(2cm longitudinal
longitudinal incision
incision made
made distal proximal to
to flexor flexor
crease) crease)
609
TABLE 154: PICO 7 PART 3- OPEN: COMPLICATIONS

Castillo,T.N., High Symptom 5.9 CT release (open- 13 . % CT release 11 . % Author NA Not
2014 Quality occurrence months single incision) (open-double Reported Significant
(pillar pain)( (Open single incision) (Two- (P-
) incision CTR) incision CTR) value>.05)
2014 Quality occurrence months double incision) (open-single Reported Significant
(pillar pain)( (Two-incision incision) (Open (P-
) CTR) single incision value>.05)
CTR)
2014 Quality occurrence months single incision) (open-double Reported Significant
(scar (Open single incision) (Two- (P-
tenderness)( ) incision CTR) incision CTR) value>.05)
2014 Quality occurrence months double incision) (open-single Reported Significant
(scar (Two-incision incision) (Open (P-
tenderness)( ) CTR) single incision value>.05)
CTR)
Hamed,A.R., High Symptom 3 months CT release (open- 19 21.05% CT release 21 57.14% RR 0.37(0.14,0.95) CT release
2009 Quality occurrence double incision) (open-single (open-
(pillar pain)( (Open double- incision) double
) incision (Standard single- incision)
technique) incision (Open
technique) double-
incision
technique)
(P-
value<.05)
Hamed,A.R., High Symptom 5.9 CT release (open- 19 5.26% CT release 21 38.10% RR 0.14(0.02,1.00) Not
2009 Quality occurrence months double incision) (open-single Significant
(pillar pain)( (Open double- incision) (P-
) incision (Standard single- value>.05)
technique) incision
technique)
610
Hamed,A.R., High Symptom 3 months CT release (open- 19 10.53% CT release 21 47.62% RR 0.22(0.06,0.88) CT release
2009 Quality occurrence double incision) (open-single (open-
(scar (Open double- incision) double
tenderness)( ) incision (Standard single- incision)
technique) incision (Open
technique) double-
incision
technique)
(P-
value<.05)
Hamed,A.R., High Symptom 5.9 CT release (open- 19 5.26% CT release 21 23.81% RR 0.22(0.03,1.73) Not
2009 Quality occurrence months double incision) (open-single Significant
(scar (Open double- incision) (P-
tenderness)( ) incision (Standard single- value>.05)
technique) incision
technique)
611
TABLE 155: PICO 7 PART 3- OPEN: OTHER QUESTIONNAIRE

Castillo,T.N., High Questionnaire 5.9 CT release 11 13.5(22.46) CT release 13 13.22(20.63) Mean 0.28(- Not
2014 Quality (DASH)( ) months (open-double (open-single Difference 17.10,17.65642) Significant
incision) (Two- incision) (Open (P-
incision CTR) single incision value>.05)
CTR)
612
TABLE 156: PICO 7 PART 3- OPEN: FUNCTION

Castillo,T.N., High Grip 5.9 CT release 11 43.6(14.15) CT release 13 42.81(22.15) Mean 0.79(- Not
2014 Quality strength(Pounds) months (open- (open- Difference 13.87,15.44973) Significant
double single (P-
(Two- (Open
incision single
CTR) incision
CTR)
Castillo,T.N., High Pinch 5.9 CT release 11 16.6(3.27) CT release 13 12.25(6.04) Mean 4.35(0.54,8.159848) CT release
2014 Quality Strength(Pounds) months (open- (open- Difference (open-
double single double
incision) incision) incision)
(Two- (Open (Two-
incision single incision
CTR) incision CTR) (P-
CTR) value<.05)
Castillo,T.N., High Questionnaire 5.9 CT release 11 1.6(0.87) CT release 13 1.57(0.88) Mean 0.03(- Not
2014 Quality (BWCTQ-FSS)( ) months (open- (open- Difference 0.67,0.732266) Significant
double single (P-
(Two- (Open
incision single
CTR) incision
CTR)
Hamed,A.R., High Grip 3 months CT release 19 65(12.00) CT release 21 61(10.00) Mean 4(-2.89,10.88539) Not
2009 Quality strength(Pounds) (open- (open- Difference Significant
double single (P-
(Open (Standard
double- single-
incision incision
613
Hamed,A.R., High Grip 5.9 CT release 19 70(16.00) CT release 21 65(16.00) Mean 5(-4.93,14.92932) Not
2009 Quality strength(Pounds) months (open- (open- Difference Significant
double single (P-
(Open (Standard
double- single-
incision incision
614
TABLE 157: PICO 7 PART 3- OPEN: SYMPTOMS

Castillo,T.N., High Questionnaire 5.9 CT release 11 1.33(0.53) CT release 13 1.33(0.36) Mean 0(- Not
2014 Quality (BWCTQ- months (open-double (open-single Difference 0.37,0.369321) Significant
SSS)( ) incision) (Two- incision) (Open (P-
incision CTR) single incision value>.05)
CTR)
615
TABLE 158: PICO 7 PART 4- SURGICAL VERSUS CONSERVATIVE: COMPLICATIONS

Gerritsen,A.A., High Complications 1.5 years Open CTR 68 0.00% Splinting 79 7.59% RD -0.08(-0.13,-0.02) Open CTR
2002 Quality (general)(Discomfort (traditional (instructed (traditional
caused by splint) open to wear open
release) splint release)
during the (P-
night for 6 value<.05)
weeks)
Gerritsen,A.A., High Complications 1.5 years Open CTR 68 85.29% Splinting 79 58.23% RR 1.46(1.19,1.81) Splinting
2002 Quality (general)(Overall) (traditional (instructed (instructed
open to wear to wear
release) splint splint
during the during the
night for 6 night for 6
weeks) weeks)
(P-
value<.05)
Gerritsen,A.A., High Complications 1.5 years Open CTR 68 1.47% Splinting 79 0.00% RD 0.01(-0.01,0.04) Not
2002 Quality (general)(Reflex (traditional (instructed Significant
sympathetic open to wear (P-
dystrophy) release) splint value>.05)
during the
night for 6
weeks)
2002 Quality (general)(Scar pain) (traditional (instructed (instructed
open to wear to wear
weeks) weeks)
(P-
value<.05)
616
2002 Quality (general)(skin (traditional (instructed (instructed
irritation) open to wear to wear
weeks) weeks)
(P-
value<.05)
Gerritsen,A.A., High Complications 1.5 years Open CTR 68 35.29% Splinting 79 39.24% RR 0.90(0.59,1.37) Not
2002 Quality (general)(stiffness of (traditional (instructed Significant
wrist, hands, or open to wear (P-
fingers) release) splint value>.05)
during the
night for 6
weeks)
Gerritsen,A.A., High Complications 1.5 years Open CTR 68 0.00% Splinting 79 5.06% RD -0.05(-0.10,-0.00) Open CTR
2002 Quality (general)(Swelling of (traditional (instructed (traditional
the wrist, hand or open to wear open
fingers) release) splint release)
during the (P-
weeks)
2002 Quality (hematoma)(wound (traditional (instructed (instructed
hematoma) open to wear to wear
weeks) weeks)
(P-
value<.05)
617
Gerritsen,A.A., High Complications 1.5 years Open CTR 68 7.35% Splinting 79 2.53% RR 2.90(0.58,14.49) Not
2002 Quality (infection)(wound (traditional (instructed Significant
infection) open to wear (P-
release) splint value>.05)
during the
night for 6
weeks)
Gerritsen,A.A., High Surgery 3 months Open CTR 78 79.49% Splinting 86 53.49% RR 1.49(1.18,1.86) Open CTR
2002 Quality Failure(Success Rate) (traditional (instructed (traditional
open to wear open
during the (P-
weeks)
Gerritsen,A.A., High Surgery 5.9 Open CTR 77 93.51% Splinting 84 67.86% RR 1.38(1.18,1.61) Open CTR
2002 Quality Failure(Success Rate) months (traditional (instructed (traditional
open to wear open
during the (P-
weeks)
Gerritsen,A.A., High Surgery 11.8 Open CTR 73 91.78% Splinting 83 72.29% RR 1.27(1.09,1.47) Open CTR
2002 Quality Failure(Success Rate) months (traditional (instructed (traditional
open to wear open
during the (P-
weeks)
Gerritsen,A.A., High Surgery 1.5 years Open CTR 68 89.71% Splinting 79 74.68% RR 1.20(1.03,1.40) Open CTR
2002 Quality Failure(Success Rate) (traditional (instructed (traditional
open to wear open
during the (P-
weeks)
618
Gerritsen,A.A., High Symptom occurrence 1.5 years Open CTR 68 2.94% Splinting 79 0.00% RD 0.03(-0.01,0.07) Not
2002 Quality (pillar pain)(severe (traditional (instructed Significant
pillar pain) open to wear (P-
release) splint value>.05)
during the
night for 6
weeks)
Ly,Pen D., Moderate Treatment 3 months CT release 69 2.90% Steroid 82 1.22% RR 2.38(0.22,25.66) Not
2005 Quality Failure(<20% VAS (mini) (injection) Significant
score improvement @ (Limited (22-gauge (P-
3 months or palmar needle value>.05)
worsening of incision used)
symptoms) technique)
Ly,Pen D., Moderate Treatment 5.9 CT release 67 4.48% Steroid 80 3.75% RR 1.19(0.25,5.72) Not
2005 Quality Failure(<20% VAS months (mini) (injection) Significant
Ly,Pen D., Moderate Treatment 11.8 CT release 63 3.17% Steroid 77 10.39% RR 0.31(0.07,1.39) Not
2005 Quality Failure(<20% VAS months (mini) (injection) Significant
619
TABLE 159: PICO 7 PART 4- SURGICAL VERSUS CONSERVATIVE: OTHER QUESTIONNAIRE

Jarvik,J.G., High Questionnaire 5.9 CT release 50 47(16.00) No surgery 54 47(14.00) Mean 0(- Not
2009 Quality (SF- months (Open/Endoscopic) (NSAIDs w/ Difference 5.80,5.797635) Significant (P-
36)(MCS) (Open or hand therapy) value>.05)
Endoscopic CTR (Non-steroidal
based on surgeon anti-
preference) inflammatory
drugs and 6
hand therapy
sessions over 6
weeks)
Jarvik,J.G., High Questionnaire 5.9 CT release 50 39(12.00) No surgery 54 47(14.00) Mean -8(-13.00,- No surgery
2009 Quality (SF-36)(PCS) months (Open/Endoscopic) (NSAIDs w/ Difference 2.99926) (NSAIDs w/
(Open or hand therapy) hand
Endoscopic CTR (Non-steroidal therapy)
based on surgeon anti- (Non-
preference) inflammatory steroidal
drugs and 6 anti-
hand therapy inflammatory
sessions over 6 drugs and 6
weeks) hand therapy
sessions over
6 weeks)
(P-value<.05)
Jarvik,J.G., High Questionnaire 11.8 CT release 49 45(15.00) No surgery 52 47(15.00) Mean -2(- Not
2009 Quality (SF- months (Open/Endoscopic) (NSAIDs w/ Difference 7.85,3.853401) Significant (P-
36)(MCS) (Open or hand therapy) value>.05)
drugs and 6
hand therapy
sessions over 6
weeks)
620
Jarvik,J.G., High Questionnaire 11.8 CT release 49 39(14.00) No surgery 52 37(12.00) Mean 2(- Not
2009 Quality (SF-36)(PCS) months (Open/Endoscopic) (NSAIDs w/ Difference 3.10,7.099478) Significant (P-
(Open or hand therapy) value>.05)
drugs and 6
hand therapy
sessions over 6
weeks)
621
TABLE 160: PICO 7 PART 4- SURGICAL VERSUS CONSERVATIVE: FUNCTION
Treatment Treatment Mean2/P Result

Reference Outcome 1 Group1 Mean1/P1 2 Group2 2 Effect (95% Favored
Gerritsen,A High NCS (DSL)( ) 11.8 Open CTR 56 1(1.00) Splinting 59 0.7(0.80) Mean 0.3(- Not Significant
.A., 2002 Quality months (traditional (instructed to Difference 0.03,0.632071) (P-value>.05)
open release) wear splint
during the
night for 6
weeks)
Gerritsen,A High Questionnaire 3 months Open CTR 78 0.6(0.90) Splinting 86 0.4(0.70) Mean 0.2(- Not Significant
.A., 2002 Quality (Levine- (traditional (instructed to Difference 0.05,0.448559) (P-value>.05)
FSS)(Functional open release) wear splint
status scale) during the
night for 6
weeks)
Gerritsen,A High Questionnaire 5.9 Open CTR 77 1(0.90) Splinting 84 0.5(0.80) Mean 0.5(0.24,0.7639 Open CTR
.A., 2002 Quality (Levine- months (traditional (instructed to Difference 71) (traditional
FSS)(Functional open release) wear splint open release)
status scale) during the (P-value<.05)
night for 6
weeks)
Gerritsen,A High Questionnaire 11.8 Open CTR 73 1(0.90) Splinting 83 0.7(0.80) Mean 0.3(0.03,0.5687 Open CTR
.A., 2002 Quality (Levine- months (traditional (instructed to Difference 89) (traditional
FSS)(Functional open release) wear splint open release)
status scale) during the (P-value<.05)
night for 6
weeks)
Gerritsen,A High Questionnaire 1.5 years Open CTR 68 0.9(0.90) Splinting 79 0.7(0.80) Mean 0.2(- Not Significant
.A., 2002 Quality (Levine- (traditional (instructed to Difference 0.08,0.477276) (P-value>.05)
FSS)(Functional open release) wear splint
status scale) during the
night for 6
weeks)
622
Hui,A.C., High Grip 4.6 CT release 25 21.8(7.90) No surgery 25 26.6(7.40 Mean -4.8(-9.04,- No surgery
2005 Quality strength(Kilograms) months (open) (steroid ) Difference 0.55679) (steroid
(traditional injection) (15 injection) (15
open release) mg of mg of
methylpredniso methylprednis
lone acetate olone acetate
injected into injected into
carpal tunnel) carpal tunnel)
(P-value<.05)
Hui,A.C., High NCS (DML)(Distal 4.6 CT release 25 4.2(0.90) No surgery 25 4.4(0.90) Mean -0.2(- Not Significant
2005 Quality motor latency (ms)) months (open) (steroid Difference 0.70,0.298934) (P-value>.05)
(traditional injection) (15
open release) mg of
methylpredniso
lone acetate
injected into
carpal tunnel)
Hui,A.C., High NCS 4.6 CT release 25 42.2(8.00) No surgery 25 40.5(6.30 Mean 1.7(- Not Significant
2005 Quality (SNCV)(Sensory months (open) (steroid ) Difference 2.29,5.691668) (P-value>.05)
nerve conduction (traditional injection) (15
velocity (m/s)) open release) mg of
methylpredniso
lone acetate
injected into
carpal tunnel)
Jarvik,J.G., High Questionnaire 5.9 CT release 50 1.91(0.88) No surgery 54 2.44(0.87 Mean -0.53(-0.87,- CT release
2009 Quality (CTSAQ)(Function(1 months (Open/Endosc (NSAIDs w/ ) Difference 0.19333) (Open/Endosco
-5)) opic) (Open or hand therapy) pic) (Open or
Endoscopic (Non-steroidal Endoscopic
CTR based on anti- CTR based on
surgeon inflammatory surgeon
preference) drugs and 6 preference)
hand therapy (P-value<.05)
sessions over 6
weeks)
623
Jarvik,J.G., High Questionnaire 11.8 CT release 49 1.74(0.79) No surgery 52 2.17(0.96 Mean -0.43(-0.77,- CT release
2009 Quality (CTSAQ)(Function(1 months (Open/Endosc (NSAIDs w/ ) Difference 0.08792) (Open/Endosco
-5)) opic) (Open or hand therapy) pic) (Open or
sessions over 6
weeks)
Andreu,J.L. Moderat NCS(Motor 11.8 CT release 45 8.06(3.80) No surgery 50 9.75(9.62 Mean -1.69(- Not Significant
, 2013 e amplitude) months (open) ( ) (steroid ) Difference 4.58,1.198442) (P-value>.05)
Quality injection) ( )
Andreu,J.L. Moderat NCS (DML)( ) 11.8 CT release 45 4.74(1.30) No surgery 50 5.39(1.67 Mean -0.65(-1.25,- CT release
, 2013 e months (open) ( ) (steroid ) Difference 0.05120) (open) (P-
Quality injection) ( ) value<.05)
Andreu,J.L. Moderat NCS (SA)( ) 11.8 CT release 45 32.28(17.44 No surgery 50 28.72(18. Mean 3.56(- Not Significant
, 2013 e months (open) ( ) ) (steroid 82) Difference 3.73,10.85236) (P-value>.05)
Quality injection) ( )
Andreu,J.L. Moderat NCS( SNCV)( ) 11.8 CT release 45 43.74(7.64) No surgery 50 36.9(11.7 Mean 6.84(2.89,10.78 No surgery
, 2013 e months (open) ( ) (steroid 4) Difference 620) (steroid
Quality injection) ( ) injection)
(P-value<.05)
Andreu,J.L. Moderat Questionnaire 3 months CT release 67 17(23.00) No surgery 80 6(13.00) Mean 11(4.80,17.200 No surgery
, 2013 e (General/undefined)( (open) ( ) (steroid Difference 54) (steroid
Quality Vsual analog scale of injection) ( ) injection)
functional (P-value<.05)
impairment (100cm
VAS))
Andreu,J.L. Moderat Questionnaire 5.9 CT release 63 7(15.00) No surgery 77 8(15.00) Mean -1(- Not Significant
, 2013 e (General/undefined)( months (open) ( ) (steroid Difference 5.99,3.994542) (P-value>.05)
Quality Vsual analog scale of injection) ( )
functional
impairment (100cm
VAS))
624
Andreu,J.L. Moderat Questionnaire 11.8 CT release 45 3(11.00) No surgery 50 9(15.00) Mean -6(-11.26,- CT release
, 2013 e (General/undefined)( months (open) ( ) (steroid Difference 0.74482) (open) (P-
Quality Vsual analog scale of injection) ( ) value<.05)
functional
impairment (100cm
VAS))
Ly-Pen,D., Moderat Questionnaire 2 years CT release 80 65.00% No surgery 83 53.01% RR 1.23(0.95,1.59) Not Significant
2012 e (General/undefined)( (mini) (limited (Steroid (P-value>.05)
Quality Reached 20% palmar injection)
improvement in incision) (paramethason
functional e acetonide,
impairment on 20mg in 1 ml)
100mm VAS scale)
100mm VAS scale)
100mm VAS scale)
625
TABLE 161: PICO 7 PART 4- SURGICAL VERSUS CONSERVATIVE: PAIN

Gerritsen,A.A., High Symptom 3 months Open CTR 78 2.6(3.50) Splinting 86 2.2(3.10) Mean 0.4(- Not
2002 Quality recurrence (traditional open (instructed to Difference 0.62,1.416171) Significant
(nocturnal release) wear splint (P-
pain)(Number of during the value>.05)
nights waking up night for 6
due to symptoms) weeks)
Gerritsen,A.A., High Symptom 5.9 Open CTR 77 3.6(2.80) Splinting 84 2.6(3.10) Mean 1(0.09,1.911395) Open CTR
2002 Quality recurrence months (traditional open (instructed to Difference (traditional
(nocturnal release) wear splint open
pain)(Number of during the release)
nights waking up night for 6 (P-
due to symptoms) weeks) value<.05)
Gerritsen,A.A., High Symptom 11.8 Open CTR 73 3.6(2.90) Splinting 83 2.9(3.00) Mean 0.7(- Not
2002 Quality recurrence months (traditional open (instructed to Difference 0.23,1.626893) Significant
Gerritsen,A.A., High Symptom 1.5 years Open CTR 68 3.6(2.90) Splinting 79 3.2(3.10) Mean 0.4(- Not
2002 Quality recurrence (traditional open (instructed to Difference 0.57,1.370787) Significant
Jarvik,J.G., High Symptom 5.9 CT release 50 4.7(3.20) No surgery 54 5.7(3.10) Mean -1(- Not
2009 Quality recurrence months (Open/Endoscopic) (NSAIDs w/ Difference 2.21,0.212609) Significant
(pain)(Pain (Open or hand therapy) (P-
intensity(1-10)) Endoscopic CTR (Non-steroidal value>.05)
drugs and 6
hand therapy
sessions over 6
weeks)
626
Jarvik,J.G., High Symptom 5.9 CT release 50 2.8(3.00) No surgery 54 3.4(3.20) Mean -0.6(- Not
interference(1-10)) Endoscopic CTR (Non-steroidal value>.05)
drugs and 6
hand therapy
sessions over 6
weeks)
Jarvik,J.G., High Symptom 11.8 CT release 49 3.5(3.00) No surgery 52 4.3(3.30) Mean -0.8(- Not
intensity(1-10)) Endoscopic CTR (Non-steroidal value>.05)
drugs and 6
hand therapy
sessions over 6
weeks)
Jarvik,J.G., High Symptom 11.8 CT release 49 2.1(6.90) No surgery 52 3.1(3.30) Mean -1(- Not
interference(1-10)) Endoscopic CTR (Non-steroidal value>.05)
drugs and 6
hand therapy
sessions over 6
weeks)
Andreu,J.L., Moderate Questionnaire/Scale 3 months CT release (open) ( 67 15(22.00) No surgery 80 6(15.00) Mean 9(2.79,15.20932) No surgery
2013 Quality (VAS- ) (steroid Difference (steroid
pain)(100cm) injection) ( ) injection)
(P-
value<.05)
627
Andreu,J.L., Moderate Questionnaire/Scale 5.9 CT release (open) ( 63 5(16.00) No surgery 77 8(18.00) Mean -3(- Not
2013 Quality (VAS- months ) (steroid Difference 8.64,2.636928) Significant
pain)(100cm) injection) ( ) (P-
value>.05)
Andreu,J.L., Moderate Questionnaire/Scale 11.8 CT release (open) ( 45 2(10.00) No surgery 50 8(15.00) Mean -6(-11.08,- CT release
2013 Quality (VAS- months ) (steroid Difference 0.91825) (open) (P-
pain)(100cm) injection) ( ) value<.05)
Ly-Pen,D., Moderate Symptom relief 2 years CT release (mini) 80 65.00% No surgery 83 60.24% RR 1.08(0.85,1.37) Not
2012 Quality (pain)(Reached (limited palmar (Steroid Significant
20% improvement incision) injection) (P-
in pain on VAS (paramethasone value>.05)
100mm scale) acetonide,
20mg in 1 ml)
20mg in 1 ml)
20mg in 1 ml)
628
TABLE 162: PICO 7 PART 4- SURGICAL VERSUS CONSERVATIVE: QUALITY OF LIFE

Jarvik,J.G., High Activity of 5.9 CT release 50 4.3(8.80) No surgery 54 6.3(9.40) Mean -2(- Not Significant (P-
2009 Quality daily living months (Open/Endoscopic) (NSAIDs w/ Difference 5.50,1.497980) value>.05)
(ADL)(Days (Open or hand
of reduced Endoscopic CTR therapy)
work or based on surgeon (Non-
housework) preference) steroidal
anti-
inflammatory
drugs and 6
hand therapy
sessions over
6 weeks)
Jarvik,J.G., High Activity of 11.8 CT release 49 2.2(5.60) No surgery 52 5.2(8.80) Mean -3(-5.86,- CT release
2009 Quality daily living months (Open/Endoscopic) (NSAIDs w/ Difference 0.13999) (Open/Endoscopic)
(ADL)(Days (Open or hand (Open or
of reduced Endoscopic CTR therapy) Endoscopic CTR
work or based on surgeon (Non- based on surgeon
housework) preference) steroidal preference)
anti- (P-value<.05)
inflammatory
drugs and 6
hand therapy
sessions over
6 weeks)
629
TABLE 163: PICO 7 PART 4- SURGICAL VERSUS CONSERVATIVE: SYMPTOMS
Treatment Grou Mean1/ Treatment Grou Mean2/P Effect Result

Reference Outcome 1 p1 P1 2 p2 2 Measur (95% Favored
Gerritsen,A. High Paresthesia(Daytime 3 months Open CTR 78 4.8(3.20 Splinting 86 2.2(3.20) Mean 2.6(1.62,3.5806 Open CTR
A., 2002 Quality paresthesia) (traditional ) (instructed to Differen 89) (traditional
open release) wear splint ce open release)
during the night (P-value<.05)
for 6 weeks)
Gerritsen,A. High Paresthesia(Nighttime 3 months Open CTR 78 4.6(3.80 Splinting 86 3.5(3.30) Mean 1.1(0.01,2.1943 Open CTR
for 6 weeks)
Gerritsen,A. High Paresthesia(Daytime 5.9 Open CTR 77 5.5(2.90 Splinting 84 3.7(3.20) Mean 1.8(0.86,2.7422 Open CTR
A., 2002 Quality paresthesia) months (traditional ) (instructed to Differen 80) (traditional
for 6 weeks)
Gerritsen,A. High Paresthesia(Nighttime 5.9 Open CTR 77 5.4(3.50 Splinting 84 4.1(3.70) Mean 1.3(0.19,2.4123 Open CTR
for 6 weeks)
Gerritsen,A. High Paresthesia(Daytime 11.8 Open CTR 73 5.5(2.90 Splinting 83 4(3.40) Mean 1.5(0.51,2.4887 Open CTR
for 6 weeks)
Gerritsen,A. High Paresthesia(Daytime 1.5 years Open CTR 68 5.3(3.00 Splinting 79 4(3.60) Mean 1.3(0.23,2.3670 Open CTR
for 6 weeks)
Gerritsen,A. High Questionnaire 3 months Open CTR 78 1(0.90) Splinting 83 0.9(0.90) Mean 0.1(- Not Significant
A., 2002 Quality (Levine- (traditional (instructed to Differen 0.18,0.378179) (P-value>.05)
SSS)(Symptom open release) wear splint ce
severity scale) during the night
for 6 weeks)
630
Gerritsen,A. High Questionnaire 5.9 Open CTR 77 1.3(0.80 Splinting 86 0.6(0.70) Mean 0.7(0.47,0.9319 Open CTR
A., 2002 Quality (Levine- months (traditional ) (instructed to Differen 87) (traditional
SSS)(Symptom open release) wear splint ce open release)
severity scale) during the night (P-value<.05)
for 6 weeks)
Gerritsen,A. High Questionnaire 11.8 Open CTR 73 1.3(0.80 Splinting 84 0.9(0.80) Mean 0.4(0.15,0.6508 Open CTR
A., 2002 Quality (Levine- months (traditional ) (instructed to Differen 96) (traditional
for 6 weeks)
Gerritsen,A. High Questionnaire 1.5 years Open CTR 68 1.3(0.80 Splinting 79 0.9(0.90) Mean 0.4(0.13,0.6748 Open CTR
A., 2002 Quality (Levine- (traditional ) (instructed to Differen 54) (traditional
for 6 weeks)
Hui,A.C., High Questionnaire/Scale 4.6 CT release 25 4.3(5.60 No surgery 25 16.6(12.3 Mean -12.3(-17.60,- CT release
2005 Quality (GSS)(0 (no months (open) ) (steroid 0) Differen 7.00219) (open)
symptoms) to 50 (traditional injection) (15 ce (traditional
(most severe)) open release) mg of open release)
methylprednisol (P-value<.05)
one acetate
injected into
carpal tunnel)
Ismatullah,I. High Questionnaire/Scale 3 months CT release 20 5.45(6.9 No surgery 20 22.1(6.90 Mean -16.65(-20.93,- CT release
, 2013 Quality (GSS)( ) (open) 0) (Steroid ) Differen 12.3738) (open)
(traditional injection) (local ce (traditional
open release) steroid open release)
injection) (P-value<.05)
Jarvik,J.G., High Questionnaire 5.9 CT release 50 2.02(1.0 No surgery 54 2.42(0.80 Mean -0.4(-0.76,- CT release
2009 Quality (CTSAQ)(Symptoms( months (Open/Endosco 3) (NSAIDs w/ ) Differen 0.04357) (Open/Endosco
1-5)) pic) (Open or hand therapy) ce pic) (Open or
sessions over 6
weeks)
631
Jarvik,J.G., High Questionnaire 11.8 CT release 49 1.74(0.7 No surgery 52 2.07(0.88 Mean -0.33(-0.65,- CT release
2009 Quality (CTSAQ)(Symptoms( months (Open/Endosco 6) (NSAIDs w/ ) Differen 0.00985) (Open/Endosco
1-5)) pic) (Open or hand therapy) ce pic) (Open or
sessions over 6
weeks)
Andreu,J.L., Moderate Paresthesia(Nocturnal 3 months CT release 67 16(25.0 No surgery 80 8(17.00) Mean 8(0.95,15.0507 No surgery
2013 Quality paresthesia (100mm (open) ( ) 0) (steroid Differen 8) (steroid
VAS scale)) injection) ( ) ce injection)
(P-value<.05)
Andreu,J.L., Moderate Paresthesia(Nocturnal 5.9 CT release 63 7(17.00) No surgery 77 13(21.00 Mean -6(- Not Significant
2013 Quality paresthesia (100mm months (open) ( ) (steroid ) Differen 12.29,0.294796 (P-value>.05)
VAS scale)) injection) ( ) ce )
Andreu,J.L., Moderate Paresthesia(Nocturnal 11.8 CT release 45 3(11.00) No surgery 50 12(19.00 Mean -9(-15.17,- CT release
2013 Quality paresthesia (100mm months (open) ( ) (steroid ) Differen 2.83023) (open) (P-
VAS scale)) injection) ( ) ce value<.05)
Ly-Pen,D., Moderate Paresthesia(Reached 2 years CT release 80 68.75% No surgery 83 60.24% RR 1.14(0.91,1.43) Not Significant
2012 Quality 20% improvement in (mini) (limited (Steroid (P-value>.05)
nocturnal parthesia on palmar injection)
VAS 100mm scale) incision) (paramethasone
acetonide,
20mg in 1 ml)
Ly-Pen,D., Moderate Paresthesia(Reached 2 years CT release 80 67.50% No surgery 83 56.63% RR 1.19(0.94,1.52) Not Significant
2012 Quality 50% improvement in (mini) (limited (Steroid (P-value>.05)
nocturnal parthesia on palmar injection)
VAS 100mm scale) incision) (paramethasone
acetonide,
20mg in 1 ml)
632
Ly-Pen,D., Moderate Paresthesia(Reached 2 years CT release 80 67.50% No surgery 83 50.60% RR 1.33(1.03,1.73) CT release
2012 Quality 70% improvement in (mini) (limited (Steroid (mini) (limited
nocturnal parthesia on palmar injection) palmar
VAS 100mm scale) incision) (paramethasone incision)
acetonide, (P-value<.05)
20mg in 1 ml)
633
META-ANALYSES
FIGURE 13: PICO 7 PART 1 ENDOSCOPIC VERSUS OPEN: SYMPTOM RECURRENCE: PAIN
634
ADJUNCTIVE TECHNIQUES
Moderate evidence supports that there is no benefit to routine inclusion of the
following adjunctive techniques: epineurotomy, neurolysis, flexor
tenosynovectomy, and lengthening/reconstruction of the flexor retinaculum
(transverse carpal ligament).
Rationale
Epineurotomy: There are two high quality studies (Leinberry 1997and Crnkovic 2012) and one
moderate quality study (Blair 1996) that evaluated carpal tunnel release alone versus the addition
of epineurotomy of the median nerve. The Leinberry (1997) evaluated patients at 11.8 months
after surgery. There was no significant difference found in clinical evaluation (Boston
Questionnaire, APB strength, Phalens, Tinels, or two-point discrimination) or in symptom
recurrence. Crnkovic (2012) studied nerve volume measured by MRI as an index of nerve
recovery. Patients were evaluated at 3 and 6 months after surgery and no significant differences
was noted at either time point. There were also no differences found for the symptoms of pain
between the groups. Blair (1996) found no differences in post-operative two-point
discrimination, pain, or ability to complete activities of daily living at a minimum of two years
following surgery. There were also no differences electrodiagnostic parameters.
Neurolysis: There was one high quality study (Mackinnon 1991) and one moderate quality study
(Lowry 1988) which evaluated the addition of neurolysis of the median nerve to a standard
carpal tunnel release. The Mackinnon study focused on internal neurolysis and found no
differences in thenar atrophy, muscle strength, pressure threshold, vibration threshold and static
two-point discrimination at 12 months after surgery. No difference was noted in pinch or grip
strength. The Lowry study evaluated the NCS findings at 3 months after surgery and did not find
a difference in nerve conduction velocity or distal motor and sensory latency. Neither study
found a difference in symptom relief or recurrence.
Flexor Tenosynovectomy: There was one high quality study (Shum 2002) evaluating flexor
tenosynovectomy as an adjunct to carpal tunnel release. There was no difference in surgical site
infection, scar sensitivity, wrist motion, finger motion, or Boston Carpal Tunnel Questionnaire at
12 months following surgery.
Flexor Retinaculum Reconstruction/Lengthening: There was one high quality study (Dias
2004) that evaluated flexor retinaculum lengthening/reconstruction. Six months following
surgery there were no differences in grip strength, Jebsen Taylor score, Phalen test, pinch
strength, Boston Carpal Tunnel Questionnaire score or symptom recurrence.

There are no known harms with implementation of this recommendation
635
Future Research
Future research should be directed on conducting studies with larger sample sizes. There may
also be certain subsets of patients who would benefit from regular inclusion of these adjunctive
procedures, and future research can focus on such subsets.
636
STUDY QUALITY TABLE OF ADJUNCTIVE SURGICAL TECHNIQUES
TABLE 164: OBSERVATIONAL STUDY QUALITY
Other Bias? (If Is there a
Follow- Influence of All Dose-
Participant Confounding retrospective large
Study Design Allocation Up Plausible Residual Response Inclusion Strength
Recruitment Variables comparative, magnitude of
Length Confounding Gradient
mark Yes) effect?
Shiota,E., Low
Include
2001 Quality
TABLE 165: RANDOMIZED TRIAL QUALITY

Is there a
of effect?
Crnkovi?-T, High
Include
2012 Quality
Blair,W.F., Moderate
Include
1996 Quality
High
Dias,J.J., 2004 Include
Quality
Kharwadkar,N., High
Include
2005 Quality
Leinberry,C.F., High
Include
1997 Quality
Lowry,W.E.,Jr., Moderate
Include
1988 Quality
Mackinnon,S.E., High
Include
1991 Quality
High
Shum,C., 2002 Include
Quality
637
RESULTS
TABLE 166: SUMMARY OF FINDINGS PICO 8 ADJUNCTIVE/ALTERNATIVE SURGICAL TECHNIQUES (EARLY FOLLOW-UP (3 MONTHS
UP TO 6 MONTHS))

Favors treatment 1
Kharwadkar,N., 2005
Lowry,W.E.,Jr., 1988
Favors treatment 2
-Crnkovi?-T, 2012
Not significant
Shiota,E., 2001
Dias,J.J., 2004
Meta-Analysis
Outcomes
Complications
Function
Grip Strength NA
Jebsen Taylor score NA
NCS (DML) NA
NCS (DSL) NA
NCS (NCV) NA
Pinch Strength NA
Pain
Questionnaire/Scale (VAS-pain)
VAS for pillar pain (SD not provided for all subgroups) NA
Symptoms
638
TABLE 167: SUMMARY OF FINDINGS PICO 8 ADJUNCTIVE/ALTERNATIVE SURGICAL TECHNIQUES (LATEFOLLOW-UP (> 6 MONTHS))

Favors treatment 1
Favors treatment 2
Mackinnon,S.E., 1991
Leinberry,C.F., 1997
Not significant
Blair,W.F., 1996
Meta-Analysis
Shiota,E., 2001
Shum,C., 2002
Outcomes
Complications
Surgical site infection NA
Function
Grip Strength NA
Improvement of strength
Average strength of the abductor pollicis brevis muscle NA
NCS (motor conduction latency) NA
NCS (DML) NA
NCS (motor amplitude) NA
Thenar Atrophy NA
Pain
General pain (non-questionnaire) NA
Quality Of Life
Difficulty in lifting NA
Symptoms
639
TABLE 168: PICO 8 PART 1- ADJUNCTIVE/ALTERNATIVE SURGICAL TECHNIQUES: COMPLICATIONS

Kharwadkar,N., High Symptom 3 months CT release-open 18 33.33% CT release-open 18 44.44% RR 0.75(0.33,1.72) Not
2005 Quality occurrence (scar (w/ absorbable (w/ non- Significant
tenderness)(Mild, sutures) (CT absorbable (P-
moderate, or release (w/ sutures) (CT value>.05)
severe) absorbable release (w/ non-
sutures)) absorbable
sutures))
Shum,C., 2002 High Surgical site 11.8 CT release (w/ no 44 0.00% CT release (w/ 44 0.00% RD 0.00(0.00,0.00) Not
Quality infection( ) months flexor flexor Significant
tenosynovectomy) tenosynovectomy) (P-
(Wrists treated by (Wrists treated by value>.05)
open CT release open CT release
w/ no flexor with a flexor
tenosynovectomy) tenosynovectomy)
640
TABLE 169: PICO 8 PART 1- ADJUNCTIVE/ALTERNATIVE SURGICAL TECHNIQUES: FUNCTION

Crnkovi-T, 2012 High NCS (DML)(Distal motor 3 months CT release (w/ no 25 32.00% CT release (w/ 25 24.00% RR 1.33(0.54,3.29) Not Significant
Quality latency (ms) (# of patients epineurotomy)- epineurotomy)- (P-value>.05)
not improved)) control (Open- test (Open-field
field release surgical carpal
without tunnel release
epineurotomy) followed by a
longitudinal
epineurotomy of
the nerve)
Crnkovi-T, 2012 High NCS (DML)(Distal motor 5.9 CT release (w/ no 25 32.00% CT release (w/ 25 16.00% RR 2.00(0.69,5.80) Not Significant
Quality latency (ms) (# of patients months epineurotomy)- epineurotomy)- (P-value>.05)
longitudinal
epineurotomy of
the nerve)
Crnkovi-T, 2012 High NCS (DSL)(Distal sensory 3 months CT release (w/ no 25 52.00% CT release (w/ 24 54.17% RR 0.96(0.57,1.63) Not Significant
Quality latency (ms) (# of patients epineurotomy)- epineurotomy)- (P-value>.05)
longitudinal
epineurotomy of
the nerve)
Crnkovi-T, 2012 High NCS (DSL)(Distal sensory 5.9 CT release (w/ no 25 36.00% CT release (w/ 24 41.67% RR 0.86(0.43,1.75) Not Significant
Quality latency (ms) (# of patients months epineurotomy)- epineurotomy)- (P-value>.05)
longitudinal
epineurotomy of
the nerve)
Dias,J.J., 2004 High Grip strength(Kilograms) 5.8 CT release-open 26 21.2(8.85) CT release-open 26 21.5(9.11) Mean -0.3(-5.18,4.58) Not Significant
Quality months (divide) (CT (lengthen) ( ) Difference (P-value>.05)
release (flexor
retinaculum
divided))
641
Dias,J.J., 2004 High Jebsen Taylor 3 months CT release-open 26 67.6(22.37) CT release-open 26 66.3(21.85) Mean 1.3(- Not Significant
Quality score(Seconds) (divide) (CT (lengthen) ( ) Difference 10.72,13.32) (P-value>.05)
release (flexor
retinaculum
divided))
Dias,J.J., 2004 High Phalen's test score(# 5.8 CT release-open 26 3.85% CT release-open 26 3.85% RR 1.00(0.07,15.15) Not Significant
Quality positive) months (divide) (CT (lengthen) ( ) (P-value>.05)
release (flexor
retinaculum
divided))
Dias,J.J., 2004 High Pinch Strength(Kilograms) 5.8 CT release-open 26 6.4(1.82) CT release-open 26 6.5(1.82) Mean -0.1(-1.09,0.89) Not Significant
Quality months (divide) (CT (lengthen) ( ) Difference (P-value>.05)
release (flexor
retinaculum
divided))
Dias,J.J., 2004 High Questionnaire (Levine- 5.8 CT release-open 26 1.2(0.26) CT release-open 26 1.3(0.52) Mean -0.1(-0.32,0.12) Not Significant
Quality FSS)( ) months (divide) (CT (lengthen) ( ) Difference (P-value>.05)
release (flexor
retinaculum
divided))
Kharwadkar,N., High Questionnaire (Boston- 3 months CT release-open 18 1.1(0.39) CT release-open 18 1.1(0.69) Mean 0(- Not Significant
2005 Quality FSS)(Boston CTS (w/ absorbable (w/ non- Difference 0.37,0.366158) (P-value>.05)
Questionnaire (functional sutures) (CT absorbable
status scale)) release (w/ sutures) (CT
absorbable release (w/ non-
sutures))
Leinberry,C.F., High Improvement of 11.8 CT release (w/ no 25 4.3(.) CT release (w/ 25 4.2(.) Author NA Not Significant
1997 Quality strength(Average strength months epineurotomy) epineurotomy) Reported (P-value>.05)
of the abductor pollicis (release of the (release and
brevis muscle) transverse carpal adjuvant
ligament alone,) epineurotomy of
the median
nerve.)
Leinberry,C.F., High Phalen's test score(% 11.8 CT release (w/ no 25 8.00% CT release (w/ 25 16.00% RR 0.50(0.10,2.49) Not Significant
1997 Quality positive) months epineurotomy) epineurotomy) (P-value>.05)
(release of the (release and
transverse carpal adjuvant
the median
nerve.)
642
Leinberry,C.F., High Tinel's Sign/Test(% 11.8 CT release (w/ no 25 24.00% CT release (w/ 25 44.00% RR 0.55(0.24,1.25) Not Significant
1997 Quality positive) months epineurotomy) epineurotomy) (P-value>.05)
the median
nerve.)
Leinberry,C.F., High Two-point 11.8 CT release (w/ no 25 5.1(.) CT release (w/ 25 4.7(.) Author NA Not Significant
1997 Quality discrimination(Millimeters) months epineurotomy) epineurotomy) Reported (P-value>.05)
the median
nerve.)
Mackinnon,S.E., High Thenar Atrophy((0-5 11.8 CT release (w/ no 32 40.63% CT release (w/ 31 35.48% RR 1.14(0.61,2.16) Not Significant
1991 Quality scale)) months neurolysis) ( ) neurolysis) ( ) (P-value>.05)
Mackinnon,S.E., High Two-point 11.8 CT release (w/ no 32 28.13% CT release (w/ 31 25.81% RR 1.09(0.48,2.46) Not Significant
1991 Quality discrimination(>3 months neurolysis) ( ) neurolysis) ( ) (P-value>.05)
millimeters)
Shum,C., 2002 High Questionnaire (Levine- 11.8 CT release (w/ no 44 1.6(0.62) CT release (w/ 44 1.7(0.71) Mean -0.1(- Not Significant
Quality FSS)(Mean functional months flexor flexor Difference 0.38,0.178521) (P-value>.05)
status score) tenosynovectomy) tenosynovectomy)
(Wrists treated by (Wrists treated by
open CT release open CT release
w/ no flexor with a flexor
tenosynovectomy) tenosynovectomy)
Blair,W.F., Moderate NCS (DML)(Wrist motor 2 years CT release (w/ no 27 . % CT release (w/ 48 . % Author NA CT release (w/
1996 Quality latency) Epineurotomy) Epineurotomy) Reported Epineurotomy)
(CT release (w/o (CT release (w/ (CT release (w/
epineurotomy)) epineurotomy)) epineurotomy))
(P-value<.05)
Blair,W.F., Moderate NCS (MA)(Motor 2 years CT release (w/ no 24 . % CT release (w/ 48 . % Author NA CT release (w/
1996 Quality amplitude) Epineurotomy) Epineurotomy) Reported Epineurotomy)
(CT release (w/o (CT release (w/ (CT release (w/
epineurotomy)) epineurotomy)) epineurotomy))
(P-value<.05)
Lowry,W.E.,Jr., Moderate NCS (DML)(Distal motor 3 months CT release (w/ no 23 5(1.10) CT release (w/ 23 4.8(0.90) Mean 0.2(- Not Significant
1988 Quality latency (ms)) neurolysis) neurolysis) Difference 0.38,0.780855) (P-value>.05)
(Standard (Standard
ligament release ligament release
w/ no neurolysis) w/ neurolysis)
643
Lowry,W.E.,Jr., Moderate NCS (DSL)(Distal sensory 3 months CT release (w/ no 23 . % CT release (w/ 24 . % Author NA Not Significant
1988 Quality latency (ms)) neurolysis) neurolysis) Reported (P-value>.05)
(Standard (Standard
Lowry,W.E.,Jr., Moderate NCS (NCV)(Nerve 3 months CT release (w/ no 23 48(6.50) CT release (w/ 23 50(6.60) Mean -2(- Not Significant
1988 Quality conduction velocity) neurolysis) neurolysis) Difference 5.79,1.785829) (P-value>.05)
(Standard (Standard
Shiota,E., 2001 Low Grip strength(Kilograms) 3.9 CT release (w/ no 43 . % CT release (w/ 70 . % Author NA CT release (w/
Quality months synovectomy) synovectomy) Reported synovectomy)
(CT release alone) (Enlargement (Enlargement
reconstruction of reconstruction
the flexor of the flexor
retinaculum with retinaculum
synovectomy) with
synovectomy)
(P-value<.05)
Shiota,E., 2001 Low Grip strength(Kilograms) 6 months CT release (w/ no 43 13.5(.) CT release (w/ 70 15(.) Author NA Not Significant
Quality synovectomy) synovectomy) Reported (P-value>.05)
(CT release alone) (Enlargement
reconstruction of
the flexor
retinaculum with
synovectomy)
Shiota,E., 2001 Low NCS(Motor conduction 2 years CT release (w/ no 43 3.7(1.60) CT release (w/ 70 4.6(1.50) Mean -0.9(-1.49,- CT release (w/
Quality latency (msec)) synovectomy) synovectomy) Difference 0.30654) no
(CT release alone) (Enlargement synovectomy)
reconstruction of (CT release
the flexor alone)
retinaculum with (P-value<.05)
synovectomy)
644
TABLE 170: PICO 8 PART 1- ADJUNCTIVE/ALTERNATIVE SURGICAL TECHNIQUES: PAIN

Kharwadkar,N., High Questionnaire/Scale (VAS- 3 months CT release-open 18 0(.) CT release- 18 0.67(0.50) Author NA Not
2005 Quality pain)(VAS for pillar pain (SD (w/ absorbable open (w/ non- Reported Significant
not provided for all sutures) (CT absorbable (P-
subgroups)) release (w/ sutures) (CT value>.05)
absorbable release (w/ non-
sutures))
Blair,W.F., Moderate Questionnaire 2 years CT release (w/ no 27 29.63% CT release (w/ 48 12.50% RR 2.37(0.92,6.12) Not
1996 Quality (General/undefined)(General Epineurotomy) Epineurotomy) Significant
pain (non-questionnaire)) (CT release (w/o (CT release (w/ (P-
epineurotomy)) epineurotomy)) value>.05)
645
TABLE 171: PICO 8 PART 1- ADJUNCTIVE/ALTERNATIVE SURGICAL TECHNIQUES: QUALITY OF LIFE

Blair,W.F., Moderate Activity of daily 2 years CT release (w/ no 27 25.93% CT release (w/ 48 18.75% RR 1.38(0.58,3.29) Not
1996 Quality living Epineurotomy) Epineurotomy) Significant
(ADL)(Difficulty (CT release (w/o (CT release (w/ (P-
in lifting) epineurotomy)) epineurotomy)) value>.05)
646
TABLE 172: PICO 8 PART 1- ADJUNCTIVE/ALTERNATIVE SURGICAL TECHNIQUES: SYMPTOMS

Dias,J.J., 2004 High Questionnaire 5.8 CT release-open 26 1.3(0.52) CT release-open 26 1.3(0.52) Mean 0(-0.28,0.28) Not
Quality (Levine-SSS)( ) months (divide) (CT (lengthen) ( ) Differen Significant (P-
release (flexor ce value>.05)
retinaculum
divided))
Dias,J.J., 2004 High Symptom 5.8 CT release-open 26 3.85% CT release-open 26 0.00% RD 0.04(- Not
Quality recurrence months (divide) (CT (lengthen) ( ) 0.04,0.11) Significant (P-
(general)(Wrist release (flexor value>.05)
stiffness (mild or retinaculum
moderate)) divided))
Kharwadkar,N High Questionnaire 3 months CT release-open 18 1.1(0.25) CT release-open 18 1.1(0.21) Mean 0(- Not
., 2005 Quality (Boston- (w/ absorbable (w/ non- Differen 0.15,0.150833 Significant (P-
SSS)(Boston CTS sutures) (CT absorbable ce ) value>.05)
Questionnaire release (w/ sutures) (CT
(symptom severity absorbable release (w/ non-
scale)) sutures)) absorbable
sutures))
Leinberry,C.F. High Symptom 11.8 CT release (w/ 25 40.00% CT release (w/ 25 44.00% RR 0.91(0.47,1.75 Not
, 1997 Quality recurrence months no epineurotomy) ) Significant (P-
(general)(@ 12 epineurotomy) (release and value>.05)
month post-op) (release of the adjuvant
transverse epineurotomy
carpal ligament of the median
alone,) nerve.)
Mackinnon,S. High Symptom relief 11.8 CT release (w/ 32 12.50% CT release (w/ 31 19.35% RR 0.65(0.20,2.07 Not
E., 1991 Quality (general)(# of months no neurolysis) ( neurolysis) ( ) ) Significant (P-
events=patients' ) value>.05)
symptoms not
relieving)
647
Shum,C., 2002 High Questionnaire 11.8 CT release (w/ 44 1.6(0.70) CT release (w/ 44 1.6(0.68) Mean 0(- Not
Quality (Levine- months no flexor flexor Differen 0.29,0.288362 Significant (P-
SSS)(Mean tenosynovectom tenosynovectom ce ) value>.05)
symptom-severity y) (Wrists y) (Wrists
score) treated by open treated by open
CT release w/ CT release with
no flexor a flexor
tenosynovectom tenosynovectom
y) y)
Blair,W.F., Moderat Symptom 2 years CT release (w/ 27 44.44% CT release (w/ 48 20.83% RR 2.13(1.07,4.27 CT release
1996 e recurrence no Epineurotomy) ) (w/
Quality (numbness)(Numbn Epineurotomy) (CT release (w/ Epineurotom
ess (pre-op (CT release epineurotomy)) y) (CT
numbness, and (w/o release (w/
post-op numbness)) epineurotomy)) epineurotom
y)) (P-
value<.05)
Lowry,W.E.,Jr Moderat Symptom 3 months CT release (w/ 23 8.70% CT release (w/ 24 4.17% RR 2.09(0.20,21.4 Not
., 1988 e recurrence no neurolysis) neurolysis) 8) Significant (P-
Quality (general)( ) (Standard (Standard value>.05)
w/ no w/ neurolysis)
neurolysis)
Shiota,E., Low Symptom 2 years CT release (w/ 43 25.58% CT release (w/ 70 10.00% RR 2.56(1.07,6.10 CT release
2001 Quality recurrence no synovectomy) ) (w/
(general)(With synovectomy) (Enlargement synovectomy)
mean follow-up of (CT release reconstruction (Enlargement
1.6 years) alone) of the flexor reconstructio
retinaculum n of the
with flexor
synovectomy) retinaculum
with
synovectomy)
(P-value<.05)
648
BILATERAL VERSUS STAGED CARPAL TUNNEL RELEASE
Limited evidence supports that simultaneous bilateral or staged endoscopic carpal
tunnel release might be performed based on patient and surgeon preference. No
evidence meeting the inclusion criteria was found addressing bilateral
simultaneous open carpal tunnel release.

Rationale
There were two low strength studies (Fehringer 2002, Nesbitt 2006) which looked at
simultaneous and staged endoscopic carpal tunnel releases. There were no studies that met our
inclusion criteria which evaluated open release. The results of these studies were conflicting. For
example, grip strength in short term follow-up was better in the staged group, but return to work
was faster in the simultaneous group. Patient-specific factors, such as quality of life, non-
employment work, care-giving, family and community responsibilities were not addressed. Both
studies were limited in that there was no randomization of treatment protocols. Patients selected
simultaneous or staged procedures, and both groups were satisfied with their choices. At 6
month follow up, there was no difference between the two groups.
Because no studies comparing simultaneous versus staged procedures for open release were
considered, there are no data to support concurrent or sequential bilateral open carpal tunnel
releases. This does not constitute a mandate that bilateral simultaneous carpal tunnel releases
should be performed endoscopically.
Implications of two versus one surgical experience such as two anesthetics, total analgesic
consumption, costs of two OR and perioperative nursing unit visits were not addressed.

There are no known harms associated with implementing this recommendation.
Future Research
Studies of simultaneous versus staged open carpal tunnel releases with adequate follow up would
be helpful in elucidating whether simultaneous open release should be considered as a treatment
option.
Studies which define return to work status by rigorous, objective criteria would be helpful to
define the strength of the recommendation regarding simultaneous releases.
649
STUDY QUALITY TABLE OF BILATERAL CARPAL TUNNEL RELEASE
TABLE 173. INTERVENTION QUALITY EVALUATIONS
Other Bias? (If Is there a Influence of All

Follow- Dose-
Participant Confounding retrospective large Plausible
Study Design Allocation Up Response Inclusion Strength
Recruitment Variables comparative, magnitude Residual
Length Gradient
mark Yes) of effect? Confounding
Fehringer,E.V., Low
Include
2002 Quality
Nesbitt,K.S., Low
Include
2006 Quality
650
RESULTS
TABLE 174: SUMMARY OF FINDINGS PICO 9 SIMULTANEOUS BI-LATERAL RELEASE

(EARLY FOLLOW-UP (3 MONTHS UP TO 6 MONTHS))
Low Quality
Favors treatment 1
Nesbitt,K.S., 2006 (1)

Favors treatment 2
Not significant
Meta-Analysis
Outcomes
Function
Grip Strength NA
Pinch Strength NA
Functional severity NA
Quality Of Life
Return to Work (weeks) NA
Symptoms
Symptom severity NA
651
TABLE 175: SUMMARY OF FINDINGS PICO 9 SIMULTANEOUS BI-LATERAL RELEASE
TECHNIQUES (LATEFOLLOW-UP (> 6 MONTHS))
Low Quality
Favors treatment 1
Fehringer,E.V., 2002
Favors treatment 2
Not significant
Meta-Analysis
Outcomes
Quality Of Life
Return to normal activities
Average number of days before return to light duty NA
Average number of days before return to return to Regular Duty NA
652
TABLE 176: PICO 9- CT RELEASE (SIMULTANEOUS VERSUS STAGED): FUNCTION

Nesbitt,K.S., Low Grip strength(Kilograms) 5.9 CT release 12 32(.) CT release 31 27(.) Author NA CT release
2006 Quality months (simultaneous- (staged- Reported (staged-
endoscopic) endoscopic endoscopic
(12 (24 [1-3 weeks [1-3 weeks
hands)) apart]) (31 apart]) (31
(62 (62
hands)) hands))
(P-
value<.05)
2006 Quality months (simultaneous- (staged- Reported (staged-
endoscopic) endoscopic endoscopic
(12 (24 [>3weeks [>3weeks
hands)) apart]) (28 apart]) (28
(56 (56
hands)) hands))
(P-
value<.05)
2006 Quality months (staged- (staged- Reported (staged-
endoscopic [1- endoscopic endoscopic
3 weeks [>3weeks [1-3 weeks
apart]) (31 (62 apart]) (28 apart]) (31
hands)) (56 (62
hands)) hands))
(P-
value<.05)
Nesbitt,K.S., Low Phalen's test score(% positive) 5.9 CT release 12 8.33% CT release 28 3.57% RR 2.33(0.16,34.31) Not
2006 Quality months (simultaneous- (staged- Significant
endoscopic) endoscopic (P-
(12 (24 [>3weeks value>.05)
hands)) apart]) (28
(56
hands))
653
Nesbitt,K.S., Low Phalen's test score(% positive) 5.9 CT release 12 8.33% CT release 31 0.00% RD 0.08(-0.07,0.24) Not
(12 (24 [1-3 weeks value>.05)
hands)) apart]) (31
(62
hands))
Nesbitt,K.S., Low Phalen's test score(% positive) 5.9 CT release 31 0.00% CT release 28 3.57% RD -0.04(- Not
2006 Quality months (staged- (staged- 0.10,0.03) Significant
endoscopic [1- endoscopic (P-
3 weeks [>3weeks value>.05)
apart]) (31 (62 apart]) (28
hands)) (56
hands))
Nesbitt,K.S., Low Pinch Strength(Kilograms) 5.9 CT release 12 8.1(.) CT release 31 7.6(.) Author NA Not
2006 Quality months (simultaneous- (staged- Reported Significant
(12 (24 [1-3 weeks value>.05)
hands)) apart]) (31
(62
hands))
2006 Quality months (simultaneous- (staged- Reported Significant
(12 (24 [>3weeks value>.05)
hands)) apart]) (28
(56
hands))
2006 Quality months (staged- (staged- Reported Significant
apart]) (31 (62 apart]) (28
hands)) (56
hands))
654
Nesbitt,K.S., Low Questionnaire 5.9 CT release 12 1.3(.) CT release 31 1.3(.) Author NA Not
2006 Quality (General/undefined)(Functional months (simultaneous- (staged- Reported Significant
severity) endoscopic) endoscopic (P-
(12 (24 [1-3 weeks value>.05)
hands)) apart]) (31
(62
hands))
2006 Quality (General/undefined)(Functional months (simultaneous- (staged- Reported Significant
severity) endoscopic) endoscopic (P-
(12 (24 [>3weeks value>.05)
hands)) apart]) (28
(56
hands))
2006 Quality (General/undefined)(Functional months (staged- (staged- Reported Significant
severity) endoscopic [1- endoscopic (P-
apart]) (31 (62 apart]) (28
hands)) (56
hands))
Nesbitt,K.S., Low Semmes Weinstein 5.9 CT release 12 1.7(.) CT release 31 1.8(.) Author NA Not
2006 Quality Monofilaments Test (SW test)( months (simultaneous- (staged- Reported Significant
) endoscopic) endoscopic (P-
(12 (24 [1-3 weeks value>.05)
hands)) apart]) (31
(62
hands))
2006 Quality Monofilaments Test (SW test)( months (simultaneous- (staged- Reported Significant
) endoscopic) endoscopic (P-
(12 (24 [>3weeks value>.05)
hands)) apart]) (28
(56
hands))
655
2006 Quality Monofilaments Test (SW test)( months (staged- (staged- Reported Significant
) endoscopic [1- endoscopic (P-
apart]) (31 (62 apart]) (28
hands)) (56
hands))
Nesbitt,K.S., Low Tinel's Sign/Test(% positive) 5.9 CT release 12 8.33% CT release 28 3.57% RR 2.33(0.16,34.31) Not
(12 (24 [>3weeks value>.05)
hands)) apart]) (28
(56
hands))
(12 (24 [1-3 weeks value>.05)
hands)) apart]) (31
(62
hands))
2006 Quality months (staged- (staged- Significant
apart]) (31 (62 apart]) (28
hands)) (56
hands))
656
TABLE 177: PICO 9- CT RELEASE (SIMULTANEOUS VERSUS STAGED): QUALITY OF LIFE

Fehringer,E.V., Low Patient 11.8 CT release 48 4.17% CT release 48 10.42% RR 0.40(0.08,1.96) Not Significant
2002 Quality satisfaction months (simultaneous- (staged- (P-value>.05)
(general)(Patient endoscopic) endoscopic)
satisfaction (Group 2) (Group 1)
(event=those who
were not
satisfied)
Fehringer,E.V., Low Return to Normal 11.8 CT release 48 17.8(.) CT release 48 33.7(.) Author NA Not Significant
2002 Quality Activities(average months (simultaneous- (staged- Reported (P-value>.05)
number of days endoscopic) endoscopic)
before return to (Group 2) (Group 1)
light duty)
Fehringer,E.V., Low Return to Normal 11.8 CT release 48 82.2(.) CT release 48 112.6(.) Author NA Not Significant
2002 Quality Activities(average months (simultaneous- (staged- Reported (P-value>.05)
number of days endoscopic) endoscopic)
before return to (Group 2) (Group 1)
return to Regular
Duty)
Nesbitt,K.S., Low Return to 5.9 CT release 12 2.25(.) CT release 31 8(.) Author NA CT release
2006 Quality Work(weeks) months (simultaneous- (staged- Reported (simultaneous-
endoscopic) endoscopic [1- endoscopic)
(12 (24 3 weeks (12 (24
hands)) apart]) (31 (62 hands))
hands)) (P-value<.05)
Nesbitt,K.S., Low Return to 5.9 CT release 12 2.25(.) CT release 28 6(.) Author NA CT release
2006 Quality Work(weeks) months (simultaneous- (staged- Reported (simultaneous-
endoscopic) endoscopic endoscopic)
(12 (24 [>3weeks (12 (24
hands)) apart]) (28 (56 hands))
hands)) (P-value<.05)
657
Nesbitt,K.S., Low Return to 5.9 CT release 31 8(.) CT release 28 6(.) Author NA CT release
2006 Quality Work(weeks) months (staged- (staged- Reported (staged-
endoscopic [1- endoscopic endoscopic
3 weeks [>3weeks [>3weeks
apart]) (31 (62 apart]) (28 (56 apart]) (28 (56
hands)) hands)) hands))
(P-value<.05)
658
TABLE 178: PICO 9- CT RELEASE (SIMULTANEOUS VERSUS STAGED): SYMPTOMS

2006 Quality (General/undefined)(Symptom months (simultaneous- (staged- Reported Significant
severity) endoscopic) (12 endoscopic [1-3 (P-
(24 hands)) weeks apart]) value>.05)
(31 (62 hands))
2006 Quality (General/undefined)(Symptom months (simultaneous- (staged- Reported Significant
severity) endoscopic) (12 endoscopic (P-
(24 hands)) [>3weeks value>.05)
apart]) (28 (56
hands))
2006 Quality (General/undefined)(Symptom months (staged- (staged- Reported Significant
severity) endoscopic [1-3 endoscopic (P-
weeks apart]) [>3weeks value>.05)
(31 (62 hands)) apart]) (28 (56
hands))
659
ANESTHESIA GUIDELINE RECOMMENDATIONS
A. LOCAL VERSUS INTRAVENOUS (IV) REGIONAL ANESTHESIA

Limited evidence supports the use of local anesthesia rather than intravenous
regional anesthesia (Bier block) because it might offer longer pain relief after
carpal tunnel release; no evidence meeting our inclusion criteria was found
comparing general anesthesia to either regional or local anesthesia for carpal tunnel
surgery.

RATIONALE
There were two moderate quality studies comparing local anesthesia to intravenous regional
anesthesia. Nabhan (2011) studied 43 patients randomized to receive either local anesthesia or
intravenous regional anesthesia using prilocaine. Three patients in the intravenous regional
anesthesia group and one patient in the local anesthesia group required supplementation with
additional local infiltration at the surgery site. The tourniquet was inflated longer in the
intravenous regional anesthesia group but the operating time was the same in both groups. There
were no other differences between the groups.
Sorensen et al (2013) randomized 38 patients to have endoscopic carpal tunnel release under
either local anesthesia with ropivicaine or intravenous regional anesthesia with mepivicaine. The
group treated with local anesthesia had less pain at the end of the procedure as well as two hours
after surgery was completed although pain during the procedure was equal in the two groups.

The main concern with the local infiltration of anesthetic agents is the well-documented
cardiotoxicity of bupivacaine3.
FUTURE RESEARCH STATEMENT

No evidence meeting our inclusion criteria was found specifically comparing local anesthesia to
either general anesthesia or regional anesthesia using brachial plexus blocks. Studies evaluating
the role of regional anesthesia administered via brachial plexus block might be valuable given
the post-operative analgesia conferred by these methods. In the existing literature the main
advantage of local infiltration compared with intravenous regional anesthesia was post-operative
pain relief for up to two hours.
B. BUFFERED VERSUS PLAIN LIDOCAINE

Moderate evidence supports the use of buffered lidocaine rather than plain
lidocaine for local anesthesia because it could result in less injection pain.
660
RATIONALE
There were two high quality studies evaluating the use of buffered lidocaine for local anesthesia.
Vossinakis et al (2004) studied 21 patients undergoing sequential, bilateral carpal tunnel release
under local anesthesia. In each case one hand was anesthetized with lidocaine buffered with
sodium bicarbonate and the other hand with plain lidocaine. Following infiltration the patients
reported pain on a 100 mm visual analog scale. Those receiving the buffered solution reported
less pain and the difference between the groups was statistically significant.
Watts et al (2004) randomized 64 patients to have a carpal tunnel release under local anesthesia
using either plain lidocaine or lidocaine buffered with sodium bicarbonate. One minute after
infiltration, and before application of a tourniquet, pain was measured on a 100 mm visual
analog scale. Although patients who received buffered lidocaine reported less pain, the
difference from those receiving the plain lidocaine was not statistically significant.

The main concern with the local infiltration of anesthetic agents is the well-documented
cardiotoxicity of bupivacaine.
FUTURE RESEARCH STATEMENT

No evidence meeting our inclusion criteria was found specifically comparing local anesthesia to
either general anesthesia or regional anesthesia using brachial plexus blocks. Studies evaluating
the role of regional anesthesia administered via brachial plexus block might be valuable given
the post-operative analgesia conferred by these methods. In the existing literature the main
advantage of local infiltration compared with intravenous regional anesthesia was post-operative
pain relief for up to two hours.
661
STUDY QUALITY TABLE OF SURGICAL ANESTHETIC
TABLE 179: OBSERVATIONAL STUDY QUALITY

Other Bias? (If Is there a Influence of
Follow- Dose-
Participant Confounding retrospective large All Plausible
Length Gradient
Tomaino,M.M., Low
Include
2001 Quality
TABLE 180: RANDOMIZED TRIAL QUALITY

Is there a
Concealment Reporting Bias magnitude of
effect?
Moderate
Nabhan,A., 2011 Include
Quality
Sorensen,A.M., Moderate
Include
2013 Quality
Vossinakis,I.C., High
Include
2004 Quality
Watts,A.C., High
Include
2004 Quality
662
RESULTS
TABLE 181: SUMMARY OF FINDINGS PICO 11 PART 1 MODES OF ANALGESIA: LOCAL VS LOCAL
(EARLY FOLLOW-UP (PRE-OP/INTRA-OP))
High Quality
Favors treatment 1
Favors treatment 2
Not significant
Meta-Analysis
Vossinakis,I.C., 2004
Watts,A.C., 2004
Outcomes
Pain
0-10 (at 0.5 minutes) NA
Burning pain, 0-10 (at 0.5 minutes) NA
Pain 1 minute after injection, (0-100) (at 2 minutes) NA
Stinging pain, 0-10 (at 0.5 minutes) NA
Tension pain, 0-10 (at 0.5 minutes) NA
663
TABLE 182: SUMMARY OF FINDINGS PICO 11 PART 2 MODES OF ANALGESIA: LOCAL VS REGIONAL
(EARLY FOLLOW-UP (PRE-OP/INTRA-OP))

Favors treatment 1
Favors treatment 2
Tomaino,M.M., 2001
Sorensen,A.M., 2013
Not significant
Nabhan,A., 2011
Meta-Analysis
Outcomes
Function
Questionnaire (MHQ-hand function)
Hand function (Michigan Hand Outcomes Questionnaire, 0-100)
0 NA
Other
Anxiety
Anxiety during anesthetic administration, 0-10
0 NA
Pain
Questionnaire (MHQ-pain)
Pain (Michigan Hand Outcomes Questionnaire, 0-100)
0 NA
0-10
0min NA
20min NA
Pain during anesthetic administration, 0-10
0 NA
Pain during surgery, 0-10
30min NA
Pain related to tourniquet, 0-10
0 NA
Quality Of Life
Questionnaire (MHQ-activity of daily living)
Activity of daily living (Michigan Hand Outcomes Questionnaire, 0-100)
0 NA
Questionnaire (MHQ-patient satisfaction)
Patient satisfaction (Michigan Hand Outcomes Questionnaire, 0-100)
0 NA
Questionnaire (MHQ-work performance)
Work performance (Michigan Hand Outcomes Questionnaire, 0-100)
0 NA
664
TABLE 183: SUMMARY OF FINDINGS PICO 11 PART 2 MODES OF ANALGESIA: LOCAL VS REGIONAL
(LATE FOLLOW-UP (POST-OP))

Favors treatment 1
Favors treatment 2
Tomaino,M.M., 2001
Sorensen,A.M., 2013
Not significant
Nabhan,A., 2011
Meta-Analysis
Outcomes
Function
Questionnaire (MHQ-hand function)
Hand function (Michigan Hand Outcomes Questionnaire, 0-100)
14 days NA
180 days NA
Pain
Questionnaire (MHQ-pain)
Pain (Michigan Hand Outcomes Questionnaire, 0-100)
14 days NA
180 days NA
0-10
40mins NA
2hrs NA
24hrs NA
Quality Of Life
Questionnaire (MHQ-activity of daily living)
Activity of daily living (Michigan Hand Outcomes Questionnaire, 0-100)
14 days NA
180 days NA
Questionnaire (MHQ-patient satisfaction)
Patient satisfaction (Michigan Hand Outcomes Questionnaire, 0-100)
14 days NA
180 days NA
Questionnaire (MHQ-work performance)
Work performance (Michigan Hand Outcomes Questionnaire, 0-100)
14 days NA
180 days NA
Questionnaire/Scale (VAS-patient satisfaction)
Patient satisfaction with anesthesia
90 days NA
665
TABLE 184: PICO 11 PART 1- LOCAL VERSUS LOCAL: PAIN

Vossinakis,I.C., High Questionnaire/Scale 0.5 min Local 21 7.6(0.80) Local 21 3.6(0.50) Mean 4(3.60,4.403498) Local
2004 Quality (VAS-pain)(0-10) (Intra- (lidocaine) (lidocaine- Difference (lidocaine-
Op) (15mL 1% buffered) buffered)
lidocaine + (15mL 1% (15mL 1%
adrenaline lidocaine + lidocaine +
1:200,000) adrenaline adrenaline
1:200,000 1:200,000
buffered buffered
8.4% 8.4%
sodium sodium
bicarbonate) bicarbonate)
(P-
value<.05)
Vossinakis,I.C., High Questionnaire/Scale 0.5 min Local 21 7.5(2.30) Local 21 2.3(1.30) Mean 5.2(4.07,6.329988) Local
2004 Quality (VAS- (Intra- (lidocaine) (lidocaine- Difference (lidocaine-
pain)(burning pain, Op) (15mL 1% buffered) buffered)
0-10) lidocaine + (15mL 1% (15mL 1%
adrenaline lidocaine + lidocaine +
1:200,000) adrenaline adrenaline
1:200,000 1:200,000
buffered buffered
8.4% 8.4%
sodium sodium
bicarbonate) bicarbonate)
(P-
value<.05)
666
Vossinakis,I.C., High Questionnaire/Scale 0.5 min Local 21 2.3(1.00) Local 21 2.4(0.80) Mean -0.1(- Not
2004 Quality (VAS- (Intra- (lidocaine) (lidocaine- Difference 0.65,0.447732) Significant
pain)(stinging pain, Op) (15mL 1% buffered) (P-
0-10) lidocaine + (15mL 1% value>.05)
adrenaline lidocaine +
1:200,000) adrenaline
1:200,000
buffered
8.4%
sodium
bicarbonate)
Vossinakis,I.C., High Questionnaire/Scale 0.5 min Local 21 3.6(0.70) Local 21 3.5(0.50) Mean 0.1(- Not
2004 Quality (VAS- (Intra- (lidocaine) (lidocaine- Difference 0.27,0.467927) Significant
pain)(Tension pain, Op) (15mL 1% buffered) (P-
0-10) lidocaine + (15mL 1% value>.05)
adrenaline lidocaine +
1:200,000) adrenaline
1:200,000
buffered
8.4%
sodium
bicarbonate)
Watts,A.C., High Questionnaire/Scale 2 min Local 32 17.3(2.70) Local 32 20(2.30) Mean -2.7(-3.93,- Local
2004 Quality (VAS-pain)(Pain 1 (Intra- (lidocaine- (lidocaine- Difference 1.47108) (lidocaine-
minute after Op) buffered) not buffered)
injection, (0-100)) (2% buffered) (2%
lidocaine (2% plain lidocaine
buffered lidocaine + buffered
with sodium sodium with sodium
bicarbonate) chloride) bicarbonate)
(P-
value<.05)
667
TABLE 185: PICO 11 PART 2- LOCAL VERSUS REGIONAL: FUNCTION

Nabhan,A., Moderate Questionnaire NA (Pre- Local (10ml of 1% 22 58(.) Regional (30 ml of 21 56(.) Author NA Not
2011 Quality (MHQ-hand Op) prilocaine) (LA- 1% prilocaine) Reported Significant (P-
function)(Hand 20ml prilocaine) (IVRA-30mL 1% value>.05)
function prilocaine)
(Michigan
Hand
Outcomes
Questionnaire,
0-100))
Nabhan,A., Moderate Questionnaire 2 weeks Local (10ml of 1% 22 75(.) Regional (30 ml of 21 74(.) Author NA Not
2011 Quality (MHQ-hand (Post- prilocaine) (LA- 1% prilocaine) Reported Significant (P-
function)(Hand Op) 20ml prilocaine) (IVRA-30mL 1% value>.05)
(Michigan
Hand
Outcomes
Questionnaire,
0-100))
Nabhan,A., Moderate Questionnaire 6 months Local (10ml of 1% 22 94(.) Regional (30 ml of 21 91(.) Author NA Not
2011 Quality (MHQ-hand (Post- prilocaine) (LA- 1% prilocaine) Reported Significant (P-
function)(Hand Op) 20ml prilocaine) (IVRA-30mL 1% value>.05)
(Michigan
Hand
Outcomes
Questionnaire,
0-100))
668
TABLE 186: PICO 11 PART 2- LOCAL VERSUS REGIONAL: OTHER

Tomaino,M.M., Low Anxiety(Anxiety 0 (Pre- Regional 15 1(.) Local (lidocaine) 15 0(.) Author NA Not
2001 Quality during Op) (lidocaine) (IVRA (LA with lidocaine) Reported Significant (P-
anesthetic with lidocaine) value>.05)
administration,
0-10)
669
TABLE 187: PICO 11 PART 2- LOCAL VERSUS REGIONAL: PAIN

Nabhan,A., Moderate Questionnaire NA (Pre- Local (10ml 22 56(.) Regional (30 21 66(.) Author NA Not
2011 Quality (MHQ-pain)(Pain Op) of 1% ml of 1% Reported Significant
(Michigan Hand prilocaine) prilocaine) (P-
Outcomes (LA-20ml (IVRA-30mL value>.05)
Questionnaire, 0- prilocaine) 1%
100)) prilocaine)
Nabhan,A., Moderate Questionnaire 2 weeks Local (10ml 22 15(.) Regional (30 21 17(.) Author NA Not
2011 Quality (MHQ-pain)(Pain (Post- of 1% ml of 1% Reported Significant
(Michigan Hand Op) prilocaine) prilocaine) (P-
100)) prilocaine)
Nabhan,A., Moderate Questionnaire 6 months Local (10ml 22 11(.) Regional (30 21 15(.) Author NA Not
2011 Quality (MHQ-pain)(Pain (Post- of 1% ml of 1% Reported Significant
(Michigan Hand Op) prilocaine) prilocaine) (P-
100)) prilocaine)
Nabhan,A., Moderate Questionnaire/Scale Intra-Op Local (10ml 22 4.6(0.90) Regional (30 21 4.5(1.60) Mean 0.1(- Not
2011 Quality (VAS-pain)(pain of 1% ml of 1% Difference 0.68,0.880864) Significant
related to prilocaine) prilocaine) (P-
tourniquet, 0-10) (LA-20ml (IVRA-30mL value>.05)
prilocaine) 1%
prilocaine)
Sorensen,A.M., Moderate Questionnaire/Scale 0 min Local 19 1.2(2.00) Regional 19 1.4(2.30) Mean -0.2(- Not
2013 Quality (VAS-pain)(0-10) (Intra- (ropivacain) (mepivacaine) Difference 1.57,1.170525) Significant
Op) (7.5mg/ml (1% (P-
Ropivacaine Mepivacaine) value>.05)
10ml total)
Sorensen,A.M., Moderate Questionnaire/Scale 40 min Local 19 0.2(0.60) Regional 19 1.4(1.80) Mean -1.2(-2.05,- Local
2013 Quality (VAS-pain)(0-10) (Post- (ropivacain) (mepivacaine) Difference 0.34683) (ropivacain)
Op) (7.5mg/ml (1% (7.5mg/ml
Ropivacaine Mepivacaine) Ropivacaine
10ml total) 10ml total)
(P-
value<.05)
670
Sorensen,A.M., Moderate Questionnaire/Scale 20 min Local 19 2.9(1.40) Regional 19 3.6(2.70) Mean -0.7(- Not
2013 Quality (VAS-pain)(0-10) (Peri-Op) (ropivacain) (mepivacaine) Difference 2.07,0.667571) Significant
(7.5mg/ml (1% (P-
10ml total)
Sorensen,A.M., Moderate Questionnaire/Scale 2 hours Local 19 0.2(0.50) Regional 19 1.4(1.80) Mean -1.2(-2.04,- Local
2013 Quality (VAS-pain)(0-10) (Post- (ropivacain) (mepivacaine) Difference 0.35997) (ropivacain)
Op) (7.5mg/ml (1% (7.5mg/ml
Ropivacaine Mepivacaine) Ropivacaine
10ml total) 10ml total)
(P-
value<.05)
Sorensen,A.M., Moderate Questionnaire/Scale 24 hours Local 19 1.3(2.30) Regional 19 1.1(1.70) Mean 0.2(- Not
2013 Quality (VAS-pain)(0-10) (Post- (ropivacain) (mepivacaine) Difference 1.09,1.486044) Significant
Op) (7.5mg/ml (1% (P-
10ml total)
Tomaino,M.M., Low Questionnaire/Scale 0 (Pre- Regional 15 1(.) Local 15 2(.) Author NA Not
2001 Quality (VAS-pain)(pain Op) (lidocaine) (lidocaine) Reported Significant
during anesthetic (IVRA with (LA with (P-
administration, 0- lidocaine) lidocaine) value>.05)
10)
Tomaino,M.M., Low Questionnaire/Scale 30 min Regional 15 1(.) Local 15 3(.) Author NA Not
2001 Quality (VAS-pain)(Pain (Intra- (lidocaine) (lidocaine) Reported Significant
during surgery, 0- Op) (IVRA with (LA with (P-
10) lidocaine) lidocaine) value>.05)
671
TABLE 188: PICO 11 PART 2- LOCAL VERSUS REGIONAL: QUALITY OF LIFE

Nabhan,A., Moderate Questionnaire NA (Pre- Local (10ml of 1% 22 67(.) Regional (30 ml 21 63(.) Author NA Not
2011 Quality (MHQ-activity of Op) prilocaine) (LA- of 1% prilocaine) Reported Significant
daily 20ml prilocaine) (IVRA-30mL 1% (P-
living)(Activity of prilocaine) value>.05)
daily living
(Michigan Hand
Outcomes
Questionnaire, 0-
100))
Nabhan,A., Moderate Questionnaire 2 weeks Local (10ml of 1% 22 85(.) Regional (30 ml 21 89(.) Author NA Not
2011 Quality (MHQ-activity of (Post- prilocaine) (LA- of 1% prilocaine) Reported Significant
daily Op) 20ml prilocaine) (IVRA-30mL 1% (P-
daily living
(Michigan Hand
Outcomes
Questionnaire, 0-
100))
Nabhan,A., Moderate Questionnaire 6 months Local (10ml of 1% 22 95(.) Regional (30 ml 21 95(.) Author NA Not
2011 Quality (MHQ-activity of (Post- prilocaine) (LA- of 1% prilocaine) Reported Significant
daily Op) 20ml prilocaine) (IVRA-30mL 1% (P-
daily living
(Michigan Hand
Outcomes
Questionnaire, 0-
100))
2011 Quality (MHQ-patient Op) prilocaine) (LA- of 1% prilocaine) Reported Significant
satisfaction)(Patient 20ml prilocaine) (IVRA-30mL 1% (P-
satisfaction prilocaine) value>.05)
(Michigan Hand
Outcomes
Questionnaire, 0-
100))
672
2011 Quality (MHQ-patient (Post- prilocaine) (LA- of 1% prilocaine) Reported Significant
satisfaction)(Patient Op) 20ml prilocaine) (IVRA-30mL 1% (P-
(Michigan Hand
Outcomes
Questionnaire, 0-
100))
2011 Quality (MHQ-patient (Post- prilocaine) (LA- of 1% prilocaine) Reported Significant
satisfaction)(Patient Op) 20ml prilocaine) (IVRA-30mL 1% (P-
(Michigan Hand
Outcomes
Questionnaire, 0-
100))
2011 Quality (MHQ-work Op) prilocaine) (LA- of 1% prilocaine) Reported Significant
performance)(Work 20ml prilocaine) (IVRA-30mL 1% (P-
performance prilocaine) value>.05)
(Michigan Hand
Outcomes
Questionnaire, 0-
100))
2011 Quality (MHQ-work (Post- prilocaine) (LA- of 1% prilocaine) Reported Significant
performance)(Work Op) 20ml prilocaine) (IVRA-30mL 1% (P-
(Michigan Hand
Outcomes
Questionnaire, 0-
100))
673
2011 Quality (MHQ-work (Post- prilocaine) (LA- of 1% prilocaine) Reported Significant
performance)(Work Op) 20ml prilocaine) (IVRA-30mL 1% (P-
(Michigan Hand
Outcomes
Questionnaire, 0-
100))
Tomaino,M.M., Low Questionnaire/Scale 90 days Regional 15 1(.) Local (lidocaine) 15 3(.) Author NA Not
2001 Quality (VAS-patient (Post- (lidocaine) (IVRA (LA with Reported Significant
satisfaction)(patient Op) with lidocaine) lidocaine) (P-
satisfaction with value>.05)
anesthesia)
674
ASPIRIN USE
Limited evidence supports that the patient might continue the use of aspirin
perioperatively; no evidence meeting our inclusion criteria addressed other
anticoagulants.

Rationale
One low quality study (Brunetti 2013) met our inclusion criteria. This study examined only
aspirin use that was either continued or stopped five days before surgery and resumed three days
postoperatively. Compared with controls that were not on aspirin, there were no differences in
either hematoma formation or other general complications. There is no evidence meeting our
criteria on any other anticoagulant therapies.

There is a potential risk of bleeding in patients who undergo surgical procedures while on
anticoagulants.
Future Research
Investigate anticoagulant use in carpal tunnel surgery using different types of anesthesia and with
and without the use of a tourniquet as well. More data is needed on other anticoagulant types
including NSAIDs.
675
STUDY QUALITY TABLE OF PERI-OPERATIVE ANTICOAGULATION CESSATION
Other Bias? (If Is there a

Follow- Influence of All Dose-
Participant Confounding retrospective large
Study Design Allocation Up Plausible Residual Response Inclusion Strength
Recruitment Variables comparative, magnitude of
Length Confounding Gradient
mark Yes) effect?
Brunetti,S., Low
Include
2013 Quality
676
RESULTS
TABLE 190: SUMMARY OF FINDINGS PICO 12 PERI-OPERATIVE ANTICOAGULATION
CESSATION
Low Quality
Favors treatment 1
Favors treatment 2
Brunetti,S., 2013 (1)

Not significant
Meta-Analysis
Outcomes
Complications
Complications (general) NA
Complications (haematoma) NA
677
TABLE 191: PICO 12- ANTICOAGULATION: COMPLICATIONS

Brunetti,S., Low Complications 3 months Group 2 (stop 50 2.00% Group 3 (never 50 2.00% RR 1.00(0.06,15.55) Not
2013 Quality (general)(Combination of aspirin) antiaggregated) Significant
major+minor (Aspirin (Patients did (P-
complications) stopped at least not take value>.05)
5 d before aspirin)
surgery and
resumed 3 d
after)
Brunetti,S., Low Complications 3 months Anticoagulation 50 2.00% Anticoagulation 50 2.00% RR 1.00(0.06,15.55) Not
2013 Quality (general)(Combination of (continued) (cessation) Significant
major+minor (Non-stop (Aspirin (P-
complications) Aspirin for 1 stopped at least value>.05)
year) 5 d before
surgery and
resumed 3 d
after)
Brunetti,S., Low Complications 3 months Anticoagulation 50 2.00% No 50 2.00% RR 1.00(0.06,15.55) Not
2013 Quality (general)(Combination of (continued) anticoagulation Significant
major+minor (Non-stop (Patients did (P-
complications) Aspirin for 1 not take value>.05)
year) aspirin)
Brunetti,S., Low Complications 3 months Group 2 (stop 50 18.00% Group 3 (never 50 16.00% RR 1.13(0.47,2.68) Not
2013 Quality (haematoma)(Major+minor aspirin) antiaggregated) Significant
Haematoma combined) (Aspirin (Patients did (P-
stopped at least not take value>.05)
5 d before aspirin)
surgery and
resumed 3 d
after)
678
Brunetti,S., Low Complications 3 months Anticoagulation 50 20.00% Anticoagulation 50 18.00% RR 1.11(0.49,2.50) Not
2013 Quality (haematoma)(Major+minor (continued) (cessation) Significant
Haematoma combined) (Non-stop (Aspirin (P-
Aspirin for 1 stopped at least value>.05)
year) 5 d before
surgery and
resumed 3 d
after)
Brunetti,S., Low Complications 3 months Anticoagulation 50 20.00% No 50 16.00% RR 1.25(0.54,2.90) Not
2013 Quality (haematoma)(Major+minor (continued) anticoagulation Significant
Haematoma combined) (Non-stop (Patients did (P-
Aspirin for 1 not take value>.05)
year) aspirin)
679
PREOPERATIVE ANTIBIOTICS
Limited evidence supports that there is no benefit for routine use of prophylactic
antibiotics prior to carpal tunnel release because there is no demonstrated reduction
in postoperative surgical site infection.

Rationale
There were two low quality studies (Harness, Tosti) which evaluated the use of prophylactic
antibiotics in carpal tunnel release. Neither study showed a statistically significant difference
between the groups receiving prophylactic antibiotics and those not receiving antibiotics. There
is insufficient evidence to support the routine use of prophylactic antibiotics to prevent surgical
site infections in carpal tunnel release.

Routine use of prophylactic antibiotics is not without consequence. Financial cost, anaphylaxis,
development of antibiotic resistance, and changes in microbiome population are all factors
Future Research
Future research should consider reporting on the associated cost, value, and quality of life as they
relate to antibiotics. Future research should also focus on the efficacy of preoperative antibiotic
treatment in diabetics and/or other immunocompromised populations.
680
STUDY QUALITY TABLE OF PREOPERATIVE ANTIBIOTICS
Other Bias? (If Is there a Influence of All

Follow- Dose-
Participant Confounding retrospective large Plausible
Length Gradient
Harness,N.G., Low
Include
2010 Quality
Tosti,R., Low
Include
2012 Quality
681
RESULTS
TABLE 193: SUMMARY OF FINDINGS PICO 13 PROPHYLACTIC ANTIBIOTICS
Low Quality
Favors treatment 1
Favors treatment 2
Harness,N.G., 2010
Not significant
Meta-Analysis
Tosti,R., 2012
Outcomes
Complications
Surgical site infection NA
682
TABLE 194: PICO 13- PROPHYLACTIC ANTIBIOTICS: COMPLICATIONS

Harness,N.G., Low Surgical site 1 month Patients Without 917 0.65% Patients With 1419 0.35% RR 1.86(0.57,6.07) Not
2010 Quality infection( ) Prophylactic Prophylactic Significant
Antibiotics (No Antibiotics (P-
prophylactic (Prophylactic value>.05)
antibiotics) antibiotics)
Tosti,R., Low Surgical site 1 month Patients Without 198 1.01% Patients With 102 0.98% RR 1.03(0.09,11.23) Not
2012 Quality infection( ) Prophylactic Prophylactic Significant
Antibiotics ( ) Antibiotics ( ) (P-
value>.05)
683
SUPERVISED VERSUS HOME THERAPY
Moderate evidence supports no additional benefit to routine supervised therapy
over home programs in the immediate postoperative period. No evidence meeting
the inclusion criteria was found comparing the potential benefit of exercise versus
no exercise after surgery.

Rationale
Routine post-operative therapy after carpal tunnel release was examined in 6 high quality studies.
From these, two studies (Hochberg 2001 and Jerosch-Herold 2012) addressed interventions not
relevant to current core practices of postoperative rehabilitation. The remaining four studies
(Alves 2011, Fagan 2004, Pomerance 2007, and Provinciali 2000) addressed the need for
supervised therapy in addition to a home program in the early postoperative period, the early use
of laser, or the role of sensory reeducation in the later stages of recovery.
One high quality study (Alves 2011) evaluated the use of laser administered to the carpal tunnel
in 10 daily consecutive sessions at a 3J dosage and found no difference in pain/symptom
reoccurrence in comparison to placebo.
Two moderate quality studies (Pomerance 2007 and Provinciali 2000) compared in-clinic or
therapist supervised exercise programs in addition to a home program to a home program alone.
The studies were somewhat limited by an incomplete description of who delivered home
programs, exercise/education content and dosage, and treatment progression. Pomerance (2007)
compared a two week program directed by a therapist combined with a home program alone and
found no additional benefit in terms of grip or pinch strength in comparison to the home program
alone. Provinciali (2000) compared one hour sessions over 10 consecutive days of in-clinic
physiotherapy comprising a multimodal program with a home program that was progressed in
terms of strength/endurance. No benefit was found in outcome when measured by a CTS-specific
patient reported instrument.

There is no known harm to implementing this recommendation.
Future Research
More trials comparing different approaches are needed. These studies should include validated
measures of patient-reported outcomes, impairment, adherence and costs. Better description of
the characteristics of the exercise and education content, provider and delivery are needed.
Studies that address how to identify subsets that need different approaches (treatment-based
prediction rules) or targeting of interventions based on different surgical approaches, patient
presentations or individual circumstances are also needed.
684
STUDY QUALITY TABLE OF POST-OPERATIVE THERAPY
Random Incomplete Is there a large Influence of All Dose-

Allocation Selective Other
Study Sequence Blinding Outcome magnitude of Plausible Residual Response Inclusion Strength
Concealment Reporting Bias
Generation Data effect? Confounding Gradient
Alves,M.P.T., Moderate
Include
2011 Quality
Fagan,D.J., High
Include
2004 Quality
Jerosch-
Moderate
Herold,C., Include
Quality
2012
Pomerance,J., High
Include
2007 Quality
Provinciali,L., Moderate
Include
2000 Quality
685
RESULTS
TABLE 196: SUMMARY OF FINDINGS PICO 14 POST-OP THERAPY (EARLY FOLLOW-UP (< 1 MONTH))
Favors treatment 1
Favors treatment 2
Not significant
Pomerance,J., 2007
Provinciali,L., 2000
Alves,M.P.T., 2011
Meta-Analysis
Fagan,D.J., 2004
Outcomes
Complications
Function
Grip Strength NA
Pinch Strength NA
Boston CT score-walking with numbness NA
Functional sensibility (locognosia test) NA
Functional sensibility (Shape-Texture Identification (STI) test))
0 days NA
28 days NA
Functional sensibility (Weinstein Enhanced Sensory Test (WEST))
0 days NA
28 days NA
Moberg pick-up test
0 days NA
28 days NA
Two-point discrimination
Functional sensibility (static two point discrimination (2PD))
0 days NA
28 days NA
56 days NA
Other
Median nerve swelling NA
Questionnaire (General/undefined)
Boston CT score-duration of episode NA
Pain
Boston CT score-daytime pain NA
Boston CT score-recurrence of pain NA
Boston CT score-severity of pain NA
Boston CT score-waking with pain NA
VAS, 0-10
0 days NA
3 days NA
Symptom recurrence (palmar pain) NA
Quality Of Life
Return to Work NA
Symptoms
Boston CT score-numbness NA
Boston CT score-severity of numbness NA
Boston CT score-tingling sensation NA
Boston CT score-weakness NA
Symptom recurrence (Night time pain) NA
686
TABLE 197: SUMMARY OF FINDINGS PICO 14 POST-OP THERAPY (LATE FOLLOW-UP (> 1 MONTH))
Favors treatment 1
Jerosch-Herold,C., 2012
Favors treatment 2
Pomerance,J., 2007
Provinciali,L., 2000
Alves,M.P.T., 2011
Not significant
Meta-Analysis
Outcomes
Complications
Symptom occurrence (pillar pain)
60 days NA
90 days NA
180 days NA
Symptom occurrence (scar pain)
60 days NA
90 days NA
180 days NA
Function
Grip strength NA
Pinch Strength NA
Boston CT score-walking with numbness NA
Functional sensibility (locognosia test) NA
Functional sensibility (Shape-Texture Identification (STI) test)) NA
17.5 months
18.5 months
19.5 months
Functional sensibility (Weinstein Enhanced Sensory Test (WEST)) NA
17.5 months
18.5 months
19.5 months
Moberg pick-up test NA
17.5 months
18.5 months
19.5 months
17.5 months
18.5 months
19.5 months
Other
Boston CT score-duration of episode NA
Pain
Boston CT score-daytime pain NA
Boston CT score-recurrence of pain NA
Boston CT score-severity of pain NA
Boston CT score-waking with pain NA
Symptom recurrence (palmar pain)
60 days NA
90 days NA
180 days NA
Quality Of Life
Return to Work NA
Symptoms
Boston CT score-numbness NA
Boston CT score-severity of numbness NA
Boston CT score-tingling sensation NA
Boston CT score-weakness NA
Symptom recurrence (night time pain) NA
687
TABLE 198: PICO 14- POST-OP THERAPY: COMPLICATIONS

Alves,M.P.T., Moderate Symptom 1 month Low-level laser therapy 29 27.59% Placebo laser 29 20.69% RR 1.33(0.53,3.36) Not
2011 Quality occurrence (The treatment was therapy (The Significant
(pillar pain)( ) performed in 10 daily, treatment was (P-
consecutive sessions, with performed in 10 value>.05)
an interval of two days daily,
(weekend), using a total consecutive
of three Joules, at three sessions, with
points of the carpal tunnel an interval of
(in the topography of the two days
pisiform bone, in the (weekend),
middle of the carpal using a total of
tunnel and at the distal three Joules, at
limit of the carpal three points of
tunnel).) the carpal tunnel
(in the
topography of
the pisiform
bone, in the
middle of the
carpal tunnel
and at the distal
limit of the
carpal tunnel).)
688
Alves,M.P.T., Moderate Symptom 2 months Low-level laser therapy 29 13.79% Placebo laser 29 24.14% RR 0.57(0.19,1.74) Not
(in the
topography of
the pisiform
bone, in the
middle of the
carpal tunnel
and at the distal
limit of the
carpal tunnel).)
689
(in the
topography of
the pisiform
bone, in the
middle of the
carpal tunnel
and at the distal
limit of the
carpal tunnel).)
690
Alves,M.P.T., Moderate Symptom 5.9 Low-level laser therapy 29 0.00% Placebo laser 29 3.45% RD -0.03(- Not
2011 Quality occurrence months (The treatment was therapy (The 0.10,0.03) Significant
(in the
topography of
the pisiform
bone, in the
middle of the
carpal tunnel
and at the distal
limit of the
carpal tunnel).)
691
Alves,M.P.T., Moderate Symptom 1 month Low-level laser therapy 29 31.03% Placebo laser 29 55.17% RR 0.56(0.30,1.06) Not
(scar pain)( ) performed in 10 daily, treatment was (P-
(in the
topography of
the pisiform
bone, in the
middle of the
carpal tunnel
and at the distal
limit of the
carpal tunnel).)
692
(in the
topography of
the pisiform
bone, in the
middle of the
carpal tunnel
and at the distal
limit of the
carpal tunnel).)
693
(in the
topography of
the pisiform
bone, in the
middle of the
carpal tunnel
and at the distal
limit of the
carpal tunnel).)
694
Alves,M.P.T., Moderate Symptom 5.9 Low-level laser therapy 29 0.00% Placebo laser 29 3.45% RD -0.03(- Not
2011 Quality occurrence months (The treatment was therapy (The 0.10,0.03) Significant
(in the
topography of
the pisiform
bone, in the
middle of the
carpal tunnel
and at the distal
limit of the
carpal tunnel).)
695
TABLE 199: PICO 14- POST-OP THERAPY: FUNCTION
Treatment Group Mean1/P Treatment Group Result Favored

Reference Outcome 1 1 1 2 2 Mean2/P2 Effect (95% Treatme
Title Quality Details Duration (Details) N (SD1) (Details) N (SD2) Measure CI) nt
Pomerance,J High Grip strength(Kilograms) 2 weeks Home 73 19.1(10.6 No therapy 77 19.8(10.00) Mean -0.7(- Not
., 2007 Quality therapy 0) (No Differenc 4.00,2.601817) Significa
exercises therapist- e nt (P-
(Post-op 2 directed value>.05
week program )
therapist- (received
directed instructions
program) ))
Pomerance,J High Grip strength(Kilograms) 1 month Home 73 24(9.00) No therapy 77 23.8(9.90) Mean 0.2(- Not
., 2007 Quality therapy (No Differenc 2.83,3.225294) Significa
week program )
program) ))
Pomerance,J High Grip strength(Kilograms) 1.4 Home 73 24.8(9.20) No therapy 77 24.7(9.00) Mean 0.1(- Not
., 2007 Quality months therapy (No Differenc 2.81,3.014672) Significa
week program )
program) ))
Pomerance,J High Grip strength(Kilograms) 3 months Home 73 26(8.90) No therapy 77 26.6(8.80) Mean -0.6(- Not
week program )
program) ))
696
Pomerance,J High Grip strength(Kilograms) 5.9 Home 73 26.2(10.0 No therapy 77 26.6(9.90) Mean -0.4(- Not
., 2007 Quality months therapy 0) (No Differenc 3.59,2.786263) Significa
week program )
program) ))
Pomerance,J High Pinch Strength(Kilograms) 2 weeks Home 73 4.1(2.30) No therapy 77 4.8(2.20) Mean -0.7(- Not
week program )
program) ))
Pomerance,J High Pinch Strength(Kilograms) 1 month Home 73 5.6(2.00) No therapy 77 5.6(2.20) Mean 0(-0.67,0.672287) Not
., 2007 Quality therapy (No Differenc Significa
week program )
program) ))
Pomerance,J High Pinch Strength(Kilograms) 1.4 Home 73 6.9(2.50) No therapy 77 7(2.40) Mean -0.1(- Not
week program )
program) ))
697
Pomerance,J High Pinch Strength(Kilograms) 3 months Home 73 7.5(2.30) No therapy 77 7.7(2.50) Mean -0.2(- Not
week program )
program) ))
Pomerance,J High Pinch Strength(Kilograms) 5.9 Home 73 7.6(2.30) No therapy 77 7.8(2.30) Mean -0.2(- Not
week program )
program) ))
Jerosch- Moderat Questionnaire 17.5 4-week 16 41(12.94) No further 15 42.8(8.14) Mean -1.8(- Not
Herold,C., e (General/undefined)(Functi months sensory treatment Differenc 9.36,5.761265) Significa
2012 Quality onal sensibility (locognosia relearning (No further e nt (P-
test)) home treatment) value>.05
program )
(Post-op 4-
week
sensory
relearning
home
program)
Jerosch- Moderat Questionnaire 17.5 4-week 16 3.38(1.69) No further 15 2.67(1.99) Mean 0.71(- Not
2012 Quality onal sensibility (Shape- relearning (No further e nt (P-
Texture Identification home treatment) value>.05
(STI) test))) program )
(Post-op 4-
week
sensory
relearning
home
program)
698
2012 Quality onal sensibility (Weinstein relearning (No further e nt (P-
Enhanced Sensory Test home treatment) value>.05
(WEST))) program )
(Post-op 4-
week
sensory
relearning
home
program)
Jerosch- Moderat Questionnaire 17.5 4-week 16 3.72(0.57) No further 15 3.88(0.53) Mean -0.16(- Not
Herold,C., e (General/undefined)(Mobe months sensory treatment Differenc 0.55,0.227232) Significa
2012 Quality rg pick-up test) relearning (No further e nt (P-
home treatment) value>.05
program )
(Post-op 4-
week
sensory
relearning
home
program)
Jerosch- Moderat Questionnaire 18.5 4-week 13 48.85(6.9 No further 13 43.15(8.05) Mean 5.7(- Not
Herold,C., e (General/undefined)(Functi months sensory 1) treatment Differenc 0.07,11.46711) Significa
program )
(Post-op 4-
week
sensory
relearning
home
program)
699
Jerosch- Moderat Questionnaire 18.5 4-week 13 4.92(1.38) No further 13 3.31(1.93) Mean 1.61(0.32,2.89976 4-week
Herold,C., e (General/undefined)(Functi months sensory treatment Differenc 7) sensory
2012 Quality onal sensibility (Shape- relearning (No further e relearnin
Texture Identification home treatment) g home
(STI) test))) program program
(Post-op 4- (Post-op
week 4-week
sensory sensory
relearning relearnin
home g home
program) program
) (P-
value<.0
5)
2012 Quality onal sensibility (Weinstein relearning (No further e relearnin
Enhanced Sensory Test home treatment) g home
(WEST))) program program
week 4-week
sensory sensory
home g home
program) program
)
(P-
value<.0
5)
700
Jerosch- Moderat Questionnaire 18.5 4-week 13 3.36(0.22) No further 13 3.97(0.37) Mean -0.61(-0.84,- 4-week
Herold,C., e (General/undefined)(Mobe months sensory treatment Differenc 0.37599) sensory
2012 Quality rg pick-up test) relearning (No further e relearnin
home treatment) g home
program program
week 4-week
sensory sensory
home g home
program) program
) (P-
value<.0
5)
Jerosch- Moderat Questionnaire 19.5 4-week 11 49.46(5.0 No further 13 43.39(11.0 Mean 6.07(- Not
Herold,C., e (General/undefined)(Functi months sensory 5) treatment 8) Differenc 0.65,12.79196) Significa
program )
(Post-op 4-
week
sensory
relearning
home
program)
2012 Quality onal sensibility (Shape- relearning (No further e relearnin
Texture Identification home treatment) g home
(STI) test))) program program
week 4-week
sensory sensory
home g home
program) program
) (P-
value<.0
5)
701
2012 Quality onal sensibility (Weinstein relearning (No further e nt (P-
Enhanced Sensory Test home treatment) value>.05
(WEST))) program )
(Post-op 4-
week
sensory
relearning
home
program)
Jerosch- Moderat Questionnaire 19.5 4-week 11 3.33(0.37) No further 13 3.68(0.49) Mean -0.35(-0.69,- 4-week
Herold,C., e (General/undefined)(Mobe months sensory treatment Differenc 0.00538) sensory
2012 Quality rg pick-up test) relearning (No further e relearnin
home treatment) g home
program program
week 4-week
sensory sensory
home g home
program) program
) (P-
value<.0
5)
Jerosch- Moderat Two-point discrimination 17.5 4-week 16 5.19(3.24) No further 15 6.3(3.38) Mean -1.11(- Not
Herold,C., e (2PD)(Functional months sensory treatment Differenc 3.44,1.223739) Significa
2012 Quality sensibility (static two point relearning (No further e nt (P-
discrimination (2PD))) home treatment) value>.05
program )
(Post-op 4-
week
sensory
relearning
home
program)
702
Jerosch- Moderat Two-point discrimination 18.5 4-week 13 3.42(1.38) No further 13 5.81(2.89) Mean -2.39(-4.13,- 4-week
Herold,C., e (2PD)(Functional months sensory treatment Differenc 0.64905) sensory
2012 Quality sensibility (static two point relearning (No further e relearnin
discrimination (2PD))) home treatment) g home
program program
week 4-week
sensory sensory
home g home
program) program
) (P-
value<.0
5)
Jerosch- Moderat Two-point discrimination 19.5 4-week 11 4.18(1.74) No further 13 6.35(4.09) Mean -2.17(- Not
Herold,C., e (2PD)(Functional months sensory treatment Differenc 4.62,0.279618) Significa
2012 Quality sensibility (static two point relearning (No further e nt (P-
discrimination (2PD))) home treatment) value>.05
program )
(Post-op 4-
week
sensory
relearning
home
program)
703
Provinciali, Moderat Questionnaire NA Rehabilitati 50 3.84(.) Progressive 50 3.8(.) Author NA Not
L., 2000 e (General/undefined)(Bosto on program home Reported Significa
Quality n CT score-walking with (Post-op 10 exercise nt (P-
numbness) day 1-hour program value>.05
sessions of (Post-op )
physiothera non-
py 12 days splinting
after surgery progressive
(multimodal home
rehabilitativ exercise
e treatment)) program
designed to
gradually
increase
strength
and
endurance)
Provinciali, Moderat Questionnaire 1 month Rehabilitati 50 1(.) Progressive 50 1(.) Author NA Not
physiothera non-
(multimodal home
designed to
gradually
increase
strength
and
endurance)
704
Provinciali, Moderat Questionnaire 3 months Rehabilitati 50 1(.) Progressive 50 1(.) Author NA Not
physiothera non-
(multimodal home
designed to
gradually
increase
strength
and
endurance)
705
TABLE 200: PICO 14- POST-OP THERAPY: OTHER

Fagan,D.J., High Median nerve Peri-Op Elevation device 21 370(78.00) Simple 22 363(68.00) Mean 7(- Not
2004 Quality swelling(Swelling: volume (Post-op day- sling (Post- Difference 36.82,50.82237) Significant
of operated hand) case-4 hour op day- (P-
Home elevation case-4 hour value>.05)
device+Bradford Crepe sling
Sling with high held with
elevation) low
elevation
(below 90
degrees))
Fagan,D.J., High Median nerve 5 Days Elevation device 21 380(77.00) Simple 22 376(67.00) Mean 4(- Not
2004 Quality swelling(Swelling: volume (Post-op day- sling (Post- Difference 39.23,47.22583) Significant
of operated hand) case-4 hour op day- (P-
elevation) low
elevation
(below 90
degrees))
Jerosch- Moderate Questionnaire 17.5 4-week sensory 16 38.94(22.29) No further 15 47(19.88) Mean -8.06(- Not
Herold,C., Quality (DASH)(DASH addresses months relearning home treatment Difference 22.91,6.789555) Significant
2012 symptoms as well as program (Post- (No further (P-
function) op 4-week treatment) value>.05)
sensory
relearning home
program)
706
Jerosch- Moderate Questionnaire 18.5 4-week sensory 13 38.7(23.38) No further 13 46.28(18.90) Mean -7.58(- Not
sensory
relearning home
program)
Jerosch- Moderate Questionnaire 19.5 4-week sensory 11 32.28(23.10) No further 13 45.14(23.86) Mean -12.86(- Not
sensory
relearning home
program)
Provinciali,L., Moderate Questionnaire NA Rehabilitation 50 2.7(.) Progressive 50 3.02(.) Author NA Not
2000 Quality (General/undefined)(Boston program (Post- home Reported Significant
CT score-duration of op 10 day 1- exercise (P-
episode) hour sessions of program value>.05)
physiotherapy (Post-op
12 days after non-
surgery splinting
(multimodal progressive
rehabilitative home
treatment)) exercise
program
designed to
gradually
increase
strength
and
endurance)
707
Provinciali,L., Moderate Questionnaire 1 month Rehabilitation 50 2.04(.) Progressive 50 2.02(.) Author NA Not
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
Provinciali,L., Moderate Questionnaire 3 months Rehabilitation 50 1(.) Progressive 50 1(.) Author NA Not
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
708
TABLE 201: PICO 14- POST-OP THERAPY: PAIN

Fagan,D.J., High Questionnaire/Scale (VAS- 5 Days Elevation device 21 2.2(1.30) Simple 22 2.7(1.50) Mean -0.5(- Not
2004 Quality pain)( ) (Post-op day- sling (Post- Difference 1.34,0.337883) Significant
case-4 hour op day- (P-
elevation) low
elevation
(below 90
degrees))
709
Alves,M.P.T., Moderate Symptom recurrence 1 month Low-level laser 29 27.59% Placebo 29 37.93% RR 0.73(0.34,1.54) Not
2011 Quality (pain)(Palmar pain) therapy (The laser Significant
treatment was therapy (P-
performed in 10 (The value>.05)
daily, treatment
consecutive was
sessions, with an performed
interval of two in 10 daily,
days (weekend), consecutive
using a total of sessions,
three Joules, at with an
three points of interval of
the carpal tunnel two days
(in the (weekend),
topography of using a
the pisiform total of
bone, in the three
middle of the Joules, at
carpal tunnel three points
and at the distal of the
limit of the carpal
carpal tunnel).) tunnel (in
the
topography
of the
pisiform
bone, in the
middle of
the carpal
tunnel and
at the distal
limit of the
carpal
tunnel).)
710
Alves,M.P.T., Moderate Symptom recurrence 2 months Low-level laser 29 3.45% Placebo 29 20.69% RR 0.17(0.02,1.30) Not
2011 Quality (pain)(Palmar pain) therapy (The laser Significant
daily, treatment
consecutive was
(in the (weekend),
bone, in the three
limit of the carpal
the
topography
of the
pisiform
bone, in the
middle of
the carpal
tunnel and
at the distal
limit of the
carpal
tunnel).)
711
Alves,M.P.T., Moderate Symptom recurrence 3 months Low-level laser 29 0.00% Placebo 29 3.45% RD -0.03(- Not
2011 Quality (pain)(Palmar pain) therapy (The laser 0.10,0.03) Significant
daily, treatment
consecutive was
(in the (weekend),
bone, in the three
limit of the carpal
the
topography
of the
pisiform
bone, in the
middle of
the carpal
tunnel and
at the distal
limit of the
carpal
tunnel).)
712
Alves,M.P.T., Moderate Symptom recurrence 5.9 Low-level laser 29 3.45% Placebo 29 3.45% RR 1.00(0.07,15.24) Not
2011 Quality (pain)(Palmar pain) months therapy (The laser Significant
daily, treatment
consecutive was
(in the (weekend),
bone, in the three
limit of the carpal
the
topography
of the
pisiform
bone, in the
middle of
the carpal
tunnel and
at the distal
limit of the
carpal
tunnel).)
713
CT score-daytime pain) op 10 day 1- exercise (P-
hour sessions of program value>.05)
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
CT score-recurrence of op 10 day 1- exercise (P-
pain) hour sessions of program value>.05)
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
714
CT score-severity of pain) op 10 day 1- exercise (P-
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
CT score-waking with pain) op 10 day 1- exercise (P-
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
715
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
716
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
717
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
718
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
12 days after non-
surgery splinting
rehabilitative home
program
designed to
gradually
increase
strength
and
endurance)
719
TABLE 202: PICO 14- POST-OP THERAPY: QUALITY OF LIFE

Pomerance,J., High Return to NR Home therapy 73 30.14% No therapy (No 77 27.27% RR 1.11(0.67,1.83) Not
2007 Quality Work(after exercises (Post-op therapist- Significant
each 2 week therapist- directed program (P-
interval, directed program) (received value>.05)
same number instructions))
of patients
included
from
previous
interval (# is
# not
returning to
work))
Pomerance,J., High Return to 1.4 Home therapy 73 15.07% No therapy (No 77 16.88% RR 0.89(0.43,1.86) Not
2007 Quality Work(after months exercises (Post-op therapist- Significant
of patients
included
from
previous
interval (# is
# not
returning to
work))
720
Pomerance,J., High Return to 1.8 Home therapy 73 2.74% No therapy (No 77 6.49% RR 0.42(0.08,2.11) Not
2007 Quality Work(after months exercises (Post-op therapist- Significant
of patients
included
from
previous
interval (# is
# not
returning to
work))
721
TABLE 203: PICO 14- POST-OP THERAPY: SYMPTOMS
Treatment Group Mean1/P Treatment Group Mean2/P Effect Result

Reference Outcome 1 1 1 2 2 2 Measur (95% Favored
Alves,M.P.T., Moderat Symptom recurrence 1 month Low-level 29 0.00% Placebo 29 0.00% RD 0.00(0.00,0.00 Not
2011 e Quality (general) (Nighttime pain) laser therapy laser ) Significant
(The treatment therapy (P-
was performed (The value>.05)
in 10 daily, treatment
consecutive was
sessions, with performed
an interval of in 10 daily,
two days consecutiv
(weekend), e sessions,
using a total of with an
three Joules, at interval of
three points of two days
the carpal (weekend),
tunnel (in the using a
topography of total of
the pisiform three
bone, in the Joules, at
middle of the three
carpal tunnel points of
and at the the carpal
distal limit of tunnel (in
the carpal the
tunnel).) topography
of the
pisiform
bone, in
the middle
of the
carpal
tunnel and
at the distal
limit of the
carpal
tunnel).)
722
Alves,M.P.T., Moderat Symptom recurrence 2 months Low-level 29 0.00% Placebo 29 0.00% RD 0.00(0.00,0.00 Not
2011 e Quality (general)(Nighttime pain) laser therapy laser ) Significant
consecutive was
two days consecutiv
the pisiform three
middle of the three
the carpal the
of the
pisiform
bone, in
the middle
of the
carpal
tunnel and
at the distal
limit of the
carpal
tunnel).)
723
Alves,M.P.T., Moderat Symptom recurrence 3 months Low-level 29 0.00% Placebo 29 0.00% RD 0.00(0.00,0.00 Not
2011 e Quality (general)(Nighttime pain) laser therapy laser ) Significant
consecutive was
two days consecutiv
the pisiform three
middle of the three
the carpal the
of the
pisiform
bone, in
the middle
of the
carpal
tunnel and
at the distal
limit of the
carpal
tunnel).)
724
Alves,M.P.T., Moderat Symptom recurrence 5.9 Low-level 29 0.00% Placebo 29 0.00% RD 0.00(0.00,0.00 Not
2011 e Quality (general)(Nighttime pain) months laser therapy laser ) Significant
consecutive was
two days consecutiv
the pisiform three
middle of the three
the carpal the
of the
pisiform
bone, in
the middle
of the
carpal
tunnel and
at the distal
limit of the
carpal
tunnel).)
725
Alves,M.P.T., Moderat Symptom recurrence 1 month Low-level 29 10.34% Placebo 29 27.59% RR 0.38(0.11,1.27 Not
2011 e Quality (numbness)(May not laser therapy laser ) Significant
completely be a recurrence (The treatment therapy (P-
for all patients) was performed (The value>.05)
consecutive was
two days consecutiv
the pisiform three
middle of the three
the carpal the
of the
pisiform
bone, in
the middle
of the
carpal
tunnel and
at the distal
limit of the
carpal
tunnel).)
726
Alves,M.P.T., Moderat Symptom recurrence 2 months Low-level 29 0.00% Placebo 29 20.69% RD -0.21(-0.35,- Low-level
2011 e Quality (numbness)(May not laser therapy laser 0.06) laser
completely be a recurrence (The treatment therapy therapy
for all patients) was performed (The (The
in 10 daily, treatment treatment
consecutive was was
sessions, with performed performed
an interval of in 10 daily, in 10 daily,
two days consecutiv consecutiv
(weekend), e sessions, e sessions,
using a total of with an with an
three Joules, at interval of interval of
three points of two days two days
the carpal (weekend), (weekend),
tunnel (in the using a using a
topography of total of total of
the pisiform three three
bone, in the Joules, at Joules, at
middle of the three three
carpal tunnel points of points of
and at the the carpal the carpal
distal limit of tunnel (in tunnel (in
the carpal the the
tunnel).) topography topograph
of the y of the
pisiform pisiform
bone, in bone, in
the middle the middle
of the of the
carpal carpal
tunnel and tunnel and
at the distal at the
limit of the distal limit
carpal of the
tunnel).) carpal
tunnel).)
Significant
(P-
value<.05)
727
Alves,M.P.T., Moderat Symptom recurrence 3 months Low-level 29 0.00% Placebo 29 10.34% RD -0.10(- Not
2011 e Quality (numbness)(May not laser therapy laser 0.21,0.01) Significant
consecutive was
two days consecutiv
the pisiform three
middle of the three
the carpal the
of the
pisiform
bone, in
the middle
of the
carpal
tunnel and
at the distal
limit of the
carpal
tunnel).)
728
Alves,M.P.T., Moderat Symptom recurrence 5.9 Low-level 29 0.00% Placebo 29 6.90% RD -0.07(- Not
2011 e Quality (numbness)(May not months laser therapy laser 0.16,0.02) Significant
consecutive was
two days consecutiv
the pisiform three
middle of the three
the carpal the
of the
pisiform
bone, in
the middle
of the
carpal
tunnel and
at the distal
limit of the
carpal
tunnel).)
729
Provinciali,L. Moderat Questionnaire NA Rehabilitation 50 3.02(.) Progressiv 50 2.78(.) Author NA Not
, 2000 e Quality (General/undefined)(Bosto program (Post- e home Reporte Significant
n CT score-numbness) op 10 day 1- exercise d (P-
hour sessions program value>.05)
of (Post-op
physiotherapy non-
12 days after splinting
surgery progressive
(multimodal home
rehabilitative exercise
treatment)) program
designed to
gradually
increase
strength
and
endurance)
n CT score-severity of op 10 day 1- exercise d (P-
numbness) hour sessions program value>.05)
of (Post-op
physiotherapy non-
surgery progressive
(multimodal home
treatment)) program
designed to
gradually
increase
strength
and
endurance)
730
n CT score-tingling op 10 day 1- exercise d (P-
sensation) hour sessions program value>.05)
of (Post-op
physiotherapy non-
surgery progressive
(multimodal home
treatment)) program
designed to
gradually
increase
strength
and
endurance)
n CT score-weakness) op 10 day 1- exercise d (P-
of (Post-op
physiotherapy non-
surgery progressive
(multimodal home
treatment)) program
designed to
gradually
increase
strength
and
endurance)
731
Provinciali,L. Moderat Questionnaire 1 month Rehabilitation 50 1.02(.) Progressiv 50 1.08(.) Author NA Not
of (Post-op
physiotherapy non-
surgery progressive
(multimodal home
treatment)) program
designed to
gradually
increase
strength
and
endurance)
Provinciali,L. Moderat Questionnaire 1 month Rehabilitation 50 1(.) Progressiv 50 1.12(.) Author NA Not
of (Post-op
physiotherapy non-
surgery progressive
(multimodal home
treatment)) program
designed to
gradually
increase
strength
and
endurance)
732
Provinciali,L. Moderat Questionnaire 1 month Rehabilitation 50 1(.) Progressiv 50 1.04(.) Author NA Not
of (Post-op
physiotherapy non-
surgery progressive
(multimodal home
treatment)) program
designed to
gradually
increase
strength
and
endurance)
Provinciali,L. Moderat Questionnaire 1 month Rehabilitation 50 1.12(.) Progressiv 50 1(.) Author NA Not
of (Post-op
physiotherapy non-
surgery progressive
(multimodal home
treatment)) program
designed to
gradually
increase
strength
and
endurance)
733
Provinciali,L. Moderat Questionnaire 3 months Rehabilitation 50 1(.) Progressiv 50 1(.) Author NA Not
of (Post-op
physiotherapy non-
surgery progressive
(multimodal home
treatment)) program
designed to
gradually
increase
strength
and
endurance)
of (Post-op
physiotherapy non-
surgery progressive
(multimodal home
treatment)) program
designed to
gradually
increase
strength
and
endurance)
734
of (Post-op
physiotherapy non-
surgery progressive
(multimodal home
treatment)) program
designed to
gradually
increase
strength
and
endurance)
of (Post-op
physiotherapy non-
surgery progressive
(multimodal home
treatment)) program
designed to
gradually
increase
strength
and
endurance)
735
POSTOPERATIVE IMMOBILIZATION
Strong evidence supports no benefit to routine postoperative immobilization after carpal tunnel
release.

Description: Evidence from two or more High quality studies with consistent findings for recommending for or against the
intervention.
Rationale
There were two high quality studies (Bury et al, Finsen et al) and four moderate quality studies (Cebesay et al,
Cook et al, Huemer et al, Martins et al) that evaluated post-operative splinting in comparison to no splinting.
These studies did not identify any clear benefit to immediate post-operative splinting.
One high quality study (Bury et al) showed no short or long-term difference in regards to grip strength, pinch
strength, and range of motion between patients splinted for 2 weeks post-operatively and patients who had no
splinting. A second high quality study (Finsen et al) also showed no difference in grip strength and pinch at 1.4
and 5.9 months between the splinted and unsplinted groups.
A moderate strength study (Cook et al) did show a statistically significant improvement in grip and pinch
strength at 2 weeks and 4 weeks in patients who were not splinted and allowed to begin early range of motion
exercises compared with patients splinted for 2 weeks. A treatment effect of allowing early range of motion
exercises may have contributed to the increase in the improvement in motion in the short term. At three months
after surgery, there was no difference between the splinted and unsplinted groups in regards to grip and pinch
strength.
One moderate strength study (Martins et al) did show a short-term benefit to post-operative splinting in regards
to 2-point discrimination at 2 weeks in patients that were splinted, but this effect was not present at the 3 month
follow-up.
One high quality study (Ritting et al) showed no difference in wound complications between patients who
removed a bulky, post-operative dressing at 48-72 hours and patients who kept their dressing on for 2 weeks.
At two weeks follow-up, the group who removed their dressing early had better grip and 3-point pinch strength,
however, there was no difference in 3-point pinch strength between the groups at week follow up six and 12
weeks after surgery. Of note, the patients randomized to early dressing removal had better grip strength pre-
operatively, compared to the group randomized to maintaining the dressing for 2 weeks, which may have
accounted for the differences observed.
Risks and Harms of Implementing This Recommendation

There are no known harms associated with implementing this recommendation.
Future Research
Future research should focus on determining if there is a benefit to beginning early range of motion exercises
and when a patient may return to unrestricted activities.
736
STUDY QUALITY TABLE OF POST-OPERATIVE IMMOBILIZATION
Is there a Influence of All
Random Incomplete Dose-
Allocation Selective Other large Plausible
Study Sequence Blinding Outcome Response Inclusion Strength
Concealment Reporting Bias magnitude of Residual
Generation Data Gradient
effect? Confounding
Bury,T.F., High
Include
1995 Quality
Cebesoy,O., Moderate
Include
2007 Quality
Cook,A.C., Moderate
Include
1995 Quality
Finsen,V., High
Include
1999 Quality
Huemer,G.M., Moderate
Include
2007 Quality
Martins,R.S., Moderate
Include
2006 Quality
Ritting,A.W., High
Include
2012 Quality
737
RESULTS
TABLE 205: SUMMARY OF FINDINGS PICO 15 POST-OP IMMOBILIZATION (EARLY FOLLOW-UP (< 1
MONTH))

Favors treatment 1
Martins,R.S., 2006
Ritting,A.W., 2012
Favors treatment 2
Cebesoy,O., 2007
Cook,A.C., 1995
Bury,T.F., 1995
Not significant
Meta-Analysis
Outcomes
Complications
Function
Durkan's results NA
Grip strength
0 days NA
14 days NA
30 days NA
Pinch Strength NA
Pinch Strength (three-point pinch)
0 days NA
14 days NA
DI, discrimination index (equivalent to pre-op - post-op 2PD) NA
Functional Status Scale NA
Range of motion
Average wrist range of motion in flexionextension (degrees) NA
ROM-degrees (extension)
0 days NA
14 days NA
ROM-degrees (flexion) NA
ROM-degrees (supination) NA
Other
Levine-Katz score-Mean difference between both groups NA
Pain
Subjective pain (10 point scale) NA
Quality Of Life
Return to normal activities NA
Return to work NA
Symptoms
SSI, symptom severity index (equivalent to pre-op - post-op SSS) NA
Symptom intensity index (equivalent to preop - postop SIS) NA
Symptom Intensity Scale (SIS) NA
Symptom severity scale NA
738
TABLE 206: SUMMARY OF FINDINGS PICO 15 POST-OP IMMOBILIZATION (LATE FOLLOW-UP (> 1
MONTH))

Favors treatment 1
Huemer,G.M., 2007
Ritting,A.W., 2012
Favors treatment 2
Cebesoy,O., 2007
Cook,A.C., 1995
Finsen,V., 1999
Bury,T.F., 1995
Not significant
Meta-Analysis
Outcomes
Complications
Subjective patient score NA
Function
Grip Strength NA
Lifting
Pick-up test (mean) NA
NCS (DML) NA
Pinch Strength NA
Pinch Strength (three-point pinch) NA
Functional Status Scale NA
Range of motion
ROM-degrees (extension) NA
ROM-degrees (flexion) NA
ROM-degrees (supination) NA
Other
Levine-Katz score-Mean difference between both groups NA
Pain
Hypothenar pain NA
Subjective pain (10 point scale) NA
Thenar Atrophy NA
Symptoms
Symptom severity scale NA
739
TABLE 207: PICO 15 PART 1- POST-OP IMMOBILIZATION: COMPLICATIONS

Bury,T.F., High Questionnaire 5.9 Splint 26 8.1(.) Bulky 17 8(.) Author NA Not
1995 Quality (General/undefined)(subjective months (Bulky dress Reported Significant
patient score) dressing (Bulky (P-
and splint in dressing value>.05)
a 0-degree for 2
or neutral weeks)
wrist
position for
2 weeks)
Finsen,V., High Symptom occurrence (scar 1.4 Splint 36 44.44% Bulky 45 46.67% RR 0.95(0.59,1.54) Not
1999 Quality pain)(Scar discomfort/pain) months (Bulky bandage Significant
dressing (Bulky (P-
removed at dressing value>.05)
day 2 and removed at
well-padded day 2 and
plaster of light
Paris splint dressings
with the for 4
wrist in weeks)
slight
dorsiflexion
for 4
weeks)
740
Finsen,V., High Symptom occurrence (scar 5.9 Splint 37 16.22% Bulky 44 13.64% RR 1.19(0.42,3.38) Not
1999 Quality pain)(Scar discomfort/pain) months (Bulky bandage Significant
dressing (Bulky (P-
day 2 and removed at
well-padded day 2 and
plaster of light
Paris splint dressings
with the for 4
wrist in weeks)
slight
dorsiflexion
for 4
weeks)
Cook,A.C., Moderate Symptom occurrence (pillar 1 month Splint 25 48.00% No splint 25 20.00% RR 2.40(0.99,5.81) Not
1995 Quality pain)( ) (Splint for 2 (exercises) Significant
weeks) (Range-of- (P-
motion value>.05)
exercises
for 2
weeks)
Cook,A.C., Moderate Symptom occurrence (scar 1 month Splint 25 56.00% No splint 25 32.00% RR 1.75(0.90,3.42) Not
1995 Quality tenderness)( ) (Splint for 2 (exercises) Significant
weeks) (Range-of- (P-
motion value>.05)
exercises
for 2
weeks)
741
TABLE 208: PICO 15 PART 1- POST-OP IMMOBILIZATION: FUNCTION

Bury,T.F., High Grip strength(Kilograms) 5.9 Splint (Bulky 26 26.1(.) Bulky dress 17 29.4(.) Author NA Not
1995 Quality months dressing and (Bulky dressing Reported Significant
splint in a 0- for 2 weeks) (P-
degree or neutral value>.05)
wrist position
for 2 weeks)
Bury,T.F., High Pinch Strength(Kilograms) 5.9 Splint (Bulky 26 3.9(.) Bulky dress 17 3.8(.) Author NA Not
1995 Quality months dressing and (Bulky dressing Reported Significant
splint in a 0- for 2 weeks) (P-
wrist position
for 2 weeks)
Bury,T.F., High Range of motion(Average Post-Op Splint (Bulky 26 131.5(.) Bulky dress 17 129(.) Author NA Not
1995 Quality wrist range of motion in dressing and (Bulky dressing Reported Significant
flexionextension (degrees)) splint in a 0- for 2 weeks) (P-
wrist position
for 2 weeks)
Finsen,V., High Grip strength(Units not 1.4 Splint (Bulky 36 . % Bulky bandage 45 . % Author NA Not
1999 Quality reported) months dressing (Bulky dressing Reported Significant
removed at day removed at day (P-
2 and well- 2 and light value>.05)
padded plaster dressings for 4
of Paris splint weeks)
with the wrist in
slight
dorsiflexion for
4 weeks)
Finsen,V., High Grip strength(Units not 5.9 Splint (Bulky 37 . % Bulky bandage 44 . % Author NA Not
1999 Quality reported) months dressing (Bulky dressing Reported Significant
removed at day removed at day (P-
with the wrist in
slight
dorsiflexion for
4 weeks)
742
Finsen,V., High Pinch strength(Key pinch 1.4 Splint (Bulky 36 . % Bulky bandage 45 . % Author NA Not
1999 Quality strength (units not months dressing (Bulky dressing Reported Significant
reported)) removed at day removed at day (P-
with the wrist in
slight
dorsiflexion for
4 weeks)
Finsen,V., High Pinch strength(Key pinch 5.9 Splint (Bulky 37 . % Bulky bandage 44 . % Author NA Not
1999 Quality strength (units not months dressing (Bulky dressing Reported Significant
reported)) removed at day removed at day (P-
with the wrist in
slight
dorsiflexion for
4 weeks)
Ritting,A.W., High Grip strength(Kilograms) Peri-Op Bulky dressing 45 22.3(11.60) Bulky dressing 49 16.6(6.80) Mean 5.7(1.81,9.587473) Bulky
2012 Quality removed at 48- removed at 2 Difference dressing
72 hours with weeks (Bulky removed at
placement of an dressing 48-72 hours
adhesive strip removed at 2 with
(Bulky dressing weeks) placement
removed at 48- of an
72 hours with adhesive
placement of an strip
adhesive strip) (P-
value<.05)
Ritting,A.W., High Grip strength(Kilograms) 2 weeks Bulky dressing 45 13.9(9.90) Bulky dressing 49 10.3(7.90) Mean 3.6(- Not
2012 Quality removed at 48- removed at 2 Difference 0.04,7.241421) Significant
72 hours with weeks (Bulky (P-
placement of an dressing value>.05)
adhesive strip removed at 2
(Bulky dressing weeks)
removed at 48-
72 hours with
placement of an
adhesive strip)
743
Ritting,A.W., High Grip strength(Kilograms) 2.8 Bulky dressing 30 24.2(13.90) Bulky dressing 36 8.2(7.70) Mean 16(10.43,21.57387) Bulky
2012 Quality months removed at 48- removed at 2 Difference dressing
adhesive strip) (P-
value<.05)
Ritting,A.W., High Pinch Strength (three-point Peri-Op Bulky dressing 45 5.8(3.10) Bulky dressing 49 5(2.10) Mean 0.8(- Not
2012 Quality pinch)(Units not reported) removed at 48- removed at 2 Difference 0.28,1.879879) Significant
removed at 48-
72 hours with
placement of an
adhesive strip)
Ritting,A.W., High Pinch Strength (three-point 2 weeks Bulky dressing 45 4.9(2.10) Bulky dressing 49 3.9(1.90) Mean 1(0.19,1.812096) Bulky
2012 Quality pinch)(Units not reported) removed at 48- removed at 2 Difference dressing
adhesive strip) (P-
value<.05)
Ritting,A.W., High Pinch Strength (three-point 2.8 Bulky dressing 30 6.4(2.80) Bulky dressing 36 5.3(1.90) Mean 1.1(- Not
2012 Quality pinch)(Units not reported) months removed at 48- removed at 2 Difference 0.08,2.278628) Significant
removed at 48-
72 hours with
placement of an
adhesive strip)
744
Ritting,A.W., High Range of motion(RoM- Peri-Op Bulky dressing 45 70(10.00) Bulky dressing 49 61(11.00) Mean 9(4.75,13.24538) Bulky
2012 Quality degrees (extension)) removed at 48- removed at 2 Difference dressing
adhesive strip) (P-
value<.05)
Ritting,A.W., High Range of motion(RoM- Peri-Op Bulky dressing 45 59(12.00) Bulky dressing 49 60(13.00) Mean -1(-6.05,4.053980) Not
2012 Quality degrees (flexion)) removed at 48- removed at 2 Difference Significant
removed at 48-
72 hours with
placement of an
adhesive strip)
Ritting,A.W., High Range of motion(RoM- Peri-Op Bulky dressing 45 74(11.00) Bulky dressing 49 74(8.00) Mean 0(-3.92,3.917554) Not
2012 Quality degrees (supination)) removed at 48- removed at 2 Difference Significant
removed at 48-
72 hours with
placement of an
adhesive strip)
Ritting,A.W., High Range of motion(RoM- 2 weeks Bulky dressing 45 65(10.00) Bulky dressing 49 61(10.00) Mean 4(-0.05,8.046836) Not
2012 Quality degrees (extension)) removed at 48- removed at 2 Difference Significant
removed at 48-
72 hours with
placement of an
adhesive strip)
745
Ritting,A.W., High Range of motion(RoM- 2 weeks Bulky dressing 45 55(11.00) Bulky dressing 49 56(14.00) Mean -1(-6.07,4.069125) Not
2012 Quality degrees (flexion)) removed at 48- removed at 2 Difference Significant
removed at 48-
72 hours with
placement of an
adhesive strip)
Ritting,A.W., High Range of motion(RoM- 2 weeks Bulky dressing 45 72(9.00) Bulky dressing 49 75(9.00) Mean -3(-6.64,0.642153) Not
2012 Quality degrees (supination)) removed at 48- removed at 2 Difference Significant
removed at 48-
72 hours with
placement of an
adhesive strip)
Ritting,A.W., High Range of motion(RoM- 2.8 Bulky dressing 30 66(10.00) Bulky dressing 36 65(8.00) Mean 1(-3.43,5.431122) Not
2012 Quality degrees (extension)) months removed at 48- removed at 2 Difference Significant
removed at 48-
72 hours with
placement of an
adhesive strip)
Ritting,A.W., High Range of motion(RoM- 2.8 Bulky dressing 30 60(12.00) Bulky dressing 36 62(13.00) Mean -2(-8.04,4.039359) Not
2012 Quality degrees (flexion)) months removed at 48- removed at 2 Difference Significant
removed at 48-
72 hours with
placement of an
adhesive strip)
746
Ritting,A.W., High Range of motion(RoM- 2.8 Bulky dressing 30 71(13.00) Bulky dressing 36 74(11.00) Mean -3(-8.88,2.878184) Not
2012 Quality degrees (supination)) months removed at 48- removed at 2 Difference Significant
removed at 48-
72 hours with
placement of an
adhesive strip)
Cebesoy,O., Moderate Questionnaire 1 month Splint (Splint at 20 13.5(.) Bulky dressing 20 12.9(.) Author NA Not
2007 Quality (General/undefined) day 10 followed (Immediate Reported Significant
(functional status scale.) by exercises at 3 exercise (P-
weeks) followed by value>.05)
bulky bandage
at day 10)
Cebesoy,O., Moderate Questionnaire 3 months Splint (Splint at 20 10.65(.) Bulky dressing 20 10.26(.) Author NA Not
2007 Quality (General/undefined) day 10 followed (Immediate Reported Significant
(functional status scale.) by exercises at 3 exercise (P-
bulky bandage
at day 10)
Cook,A.C., Moderate Grip strength(Kilograms) 2 weeks Splint (Splint for 25 10(.) No splint 25 15(.) Author NA No splint
1995 Quality 2 weeks) (exercises) Reported (exercises)
(Range-of- (Range-of-
motion motion
exercises for 2 exercises for
weeks) 2 weeks)
(P-
value<.05)
Cook,A.C., Moderate Grip strength(Kilograms) 1 month Splint (Splint for 25 14(.) No splint 25 18(.) Author NA No splint
motion motion
weeks) 2 weeks)
(P-
value<.05)
747
Cook,A.C., Moderate Pinch Strength(Kilograms) 2 weeks Splint (Splint for 25 4(.) No splint 25 6(.) Author NA No splint
motion motion
weeks) 2 weeks)
(P-
value<.05)
Cook,A.C., Moderate Pinch Strength(Kilograms) 1 month Splint (Splint for 25 5(.) No splint 25 7(.) Author NA No splint
motion motion
weeks) 2 weeks)
(P-
value<.05)
Cook,A.C., Moderate Pinch Strength(Kilograms) 3 months Splint (Splint for 25 . % No splint 25 . % Author NA Not
1995 Quality 2 weeks) (exercises) Reported Significant
(Range-of- (P-
motion value>.05)
exercises for 2
weeks)
Huemer,G.M., Moderate Grip strength(Kilograms) 3 months Splinted (Bulky 25 44(.) Non-splinted 25 40(.) Author NA Not
2007 Quality dressing with (Light bandage Reported Significant
volar splint for 2 for 2 days) (P-
days) value>.05)
Huemer,G.M., Moderate Lifting(Pick-up test 3 months Splinted (Bulky 25 19(.) Non-splinted 25 17(.) Author NA Not
2007 Quality (mean)) dressing with (Light bandage Reported Significant
days) value>.05)
Huemer,G.M., Moderate NCS (DML)(Distal motor 3 months Splinted (Bulky 25 2.47(.) Non-splinted 25 2.48(.) Author NA Not
2007 Quality latency (ms) dressing with (Light bandage Reported Significant
(improvement)) volar splint for 2 for 2 days) (P-
days) value>.05)
Huemer,G.M., Moderate Two-point 3 months Splinted (Bulky 25 6(.) Non-splinted 25 6(.) Author NA Not
2007 Quality discrimination(Millimeters) dressing with (Light bandage Reported Significant
days) value>.05)
748
Martins,R.S., Moderate Durkans results(+durken's 2 weeks Splint (Neutral- 26 96.15% No splint (No 26 100.00% RR .(.,.) Not
2006 Quality test) position wrist wrist Significant
splint immobilization) (P-
continuously for value>.05)
two weeks)
Martins,R.S., Moderate Phalen's test score(# 2 weeks Splint (Neutral- 26 92.31% No splint (No 26 96.15% RR 0.96(0.84,1.10) Not
2006 Quality positive) position wrist wrist Significant
two weeks)
Martins,R.S., Moderate Questionnaire 2 weeks Splint (Neutral- 26 0.27(0.27) No splint (No 26 0.29(0.28) Mean -0.02(- Not
2006 Quality (General/undefined)(DI, position wrist wrist Difference 0.17,0.129516) Significant
discrimination index splint immobilization) (P-
(equivalent to pre-op - continuously for value>.05)
post-op 2PD)) two weeks)
Martins,R.S., Moderate Tinel's Sign/Test(# 2 weeks Splint (Neutral- 26 80.77% No splint (No 26 88.46% RR 0.91(0.72,1.15) Not
2006 Quality positive) position wrist wrist Significant
two weeks)
Martins,R.S., Moderate Two-point 2 weeks Splint (Neutral- 26 3.69(1.19) No splint (No 26 5.12(2.53) Mean -1.43(-2.50,- Splint
2006 Quality discrimination(Millimeters) position wrist wrist Difference 0.35529) (Neutral-
splint immobilization) position
continuously for wrist splint
two weeks) continuously
for two
weeks)
(P-
value<.05)
749
TABLE 209: PICO 15 PART 1- POST-OP IMMOBILIZATION: OTHER

Ritting,A.W., High Questionnaire Peri-Op Bulky 45 34(34.23) Bulky 49 38(28.57) Mean -4(- Not
2012 Quality (General/undefined)(Levine- dressing dressing Difference 16.81,8.81) Significant
Katz score-Mean difference removed at removed at 2 (P-
between both groups) 48-72 hours weeks (Bulky value>.05)
with dressing
placement of removed at 2
an adhesive weeks)
strip (Bulky
dressing
removed at
48-72 hours
with
placement of
an adhesive
strip)
Ritting,A.W., High Questionnaire 2 weeks Bulky 45 19(20.54) Bulky 49 20(25.00) Mean -1(- Not
2012 Quality (General/undefined)(Levine- dressing dressing Difference 10.22,8.22) Significant
with dressing
an adhesive weeks)
strip (Bulky
dressing
removed at
48-72 hours
with
placement of
an adhesive
strip)
750
Ritting,A.W., High Questionnaire 2.8 Bulky 30 16(13.97) Bulky 36 17(18.37) Mean -1(- Not
2012 Quality (General/undefined)(Levine- months dressing dressing Difference 8.81,6.81) Significant
with dressing
an adhesive weeks)
strip (Bulky
dressing
removed at
48-72 hours
with
placement of
an adhesive
strip)
751
TABLE 210: PICO 15 PART 1- POST-OP IMMOBILIZATION: PAIN
Treatmen
Treatment Group Mean1/P t Group Mean2/P Effect Result Favored
Reference Outcome Duratio 1 1 1 2 2 2 Measur (95% Treatmen
Title Quality Details n (Details) N (SD1) (Details) N (SD2) e CI) t
Finsen,V., High Hypothenar pain( ) 1.4 Splint 36 13.89% Bulky 45 11.11% RR 1.25(0.39,3.99) Not
1999 Quality months (Bulky bandage Significant
dressing (Bulky (P-
day 2 and removed
well- at day 2
padded and light
plaster of dressings
Paris splint for 4
with the weeks)
wrist in
slight
dorsiflexio
n for 4
weeks)
Finsen,V., High Hypothenar pain( ) 5.9 Splint 37 8.11% Bulky 44 2.27% RR 3.57(0.39,32.87 Not
1999 Quality months (Bulky bandage ) Significant
dressing (Bulky (P-
day 2 and removed
well- at day 2
padded and light
Paris splint for 4
with the weeks)
wrist in
slight
dorsiflexio
n for 4
weeks)
752
Treatmen
Finsen,V., High Thenar Atrophy(Thenar pain) 1.4 Splint 36 5.56% Bulky 45 2.22% RR 2.50(0.24,26.48 Not
dressing (Bulky (P-
day 2 and removed
well- at day 2
padded and light
Paris splint for 4
with the weeks)
wrist in
slight
dorsiflexio
n for 4
weeks)
Finsen,V., High Thenar Atrophy(Thenar pain) 5.9 Splint 37 2.70% Bulky 44 2.27% RR 1.19(0.08,18.36 Not
dressing (Bulky (P-
day 2 and removed
well- at day 2
padded and light
Paris splint for 4
with the weeks)
wrist in
slight
dorsiflexio
n for 4
weeks)
753
Treatmen
Cook,A.C., Moderat Questionnaire 2 weeks Splint 25 2.4(.) No splint 25 0.9(.) Author NA No splint
1995 e Quality (General/undefined)(Subjectiv (Splint for (exercises) Reporte (exercises
e pain (10 point scale)) 2 weeks) (Range-of- d ) (Range-
motion of-motion
exercises exercises
for 2 for 2
weeks) weeks)
(P-
value<.05
)
Cook,A.C., Moderat Questionnaire 1 month Splint 25 1.5(.) No splint 25 0.5(.) Author NA No splint
1995 e Quality (General/undefined)(Subjectiv (Splint for (exercises) Reporte (exercises
e pain (10 point scale)) 2 weeks) (Range-of- d ) (Range-
motion of-motion
exercises exercises
for 2 for 2
weeks) weeks)
(P-
value<.05
)
Cook,A.C., Moderat Questionnaire 5.9 Splint 25 . % No splint 25 . % Author NA Not
1995 e Quality (General/undefined)(Subjectiv months (Splint for (exercises) Reporte Significant
e pain (10 point scale)) 2 weeks) (Range-of- d (P-
motion value>.05)
exercises
for 2
weeks)
Huemer,G.M. Moderat Questionnaire/Scale (VAS- 3 months Splinted 25 1(.) Non- 25 1(.) Author NA Not
, 2007 e Quality pain)( ) (Bulky splinted Reporte Significant
dressing (Light d (P-
with volar bandage value>.05)
splint for 2 for 2 days)
days)
754
TABLE 211: PICO 15 PART 1- POST-OP IMMOBILIZATION: QUALITY OF LIFE

Cook,A.C., Moderate Return to Post-Op Splint (Splint for 2 25 12(.) No splint 25 6(.) Author NA No splint
1995 Quality Normal weeks) (exercises) (Range- Reported (exercises)
Activities( ) of-motion exercises (Range-of-
for 2 weeks) motion
exercises
for 2
weeks)
(P-
value<.05)
Cook,A.C., Moderate Return to Post-Op Splint (Splint for 2 25 27(.) No splint 25 17(.) Author NA No splint
1995 Quality Work(Full weeks) (exercises) (Range- Reported (exercises)
duty work) of-motion exercises (Range-of-
for 2 weeks) motion
exercises
for 2
weeks)
(P-
value<.05)
755
TABLE 212: PICO 15 PART 1- POST-OP IMMOBILIZATION: SYMPTOMS

Cebesoy,O., Moderate Questionnaire 1 month Splint (Splint at 20 16.5(.) Bulky dressing 20 16.84(.) Author NA Not
2007 Quality (General/undefined)(symptom day 10 followed by (Immediate Reported Significant
severity scale) exercises at 3 exercise (P-
bulky bandage
at day 10)
Cebesoy,O., Moderate Questionnaire 3 months Splint (Splint at 20 13.5(.) Bulky dressing 20 11.9(.) Author NA Bulky
2007 Quality (General/undefined)(symptom day 10 followed by (Immediate Reported dressing
severity scale) exercises at 3 exercise (Immediate
weeks) followed by exercise
bulky bandage followed by
at day 10) bulky
bandage at
day 10)
(P-
value<.05)
Martins,R.S., Moderate Questionnaire 2 weeks Splint (Neutral- 26 0.64(0.15) No splint (No 26 0.61(0.12) Mean 0.03(- Not
2006 Quality (General/undefined)(SSI, position wrist wrist Difference 0.04,0.103838) Significant
symptom severity index splint continuously immobilization) (P-
(equivalent to pre-op - post- for two weeks) value>.05)
op SSS))
Martins,R.S., Moderate Questionnaire 2 weeks Splint (Neutral- 26 0.91(0.15) No splint (No 26 0.8(0.27) Mean 0.11(- Not
2006 Quality (General/undefined)(symptom position wrist wrist Difference 0.01,0.228725) Significant
intensity index (equivalent to splint continuously immobilization) (P-
preop - postop SIS)) for two weeks) value>.05)
Martins,R.S., Moderate Questionnaire 2 weeks Splint (Neutral- 26 0.77(1.31) No splint (No 26 1.54(1.96) Mean -0.77(- Not
2006 Quality (General/undefined) position wrist wrist Difference 1.68,0.136185) Significant
(Symptom Intensity Scale - splint continuously immobilization) (P-
SIS).) for two weeks) value>.05)
Martins,R.S., Moderate Questionnaire (Levine- 2 weeks Splint (Neutral- 26 11.38(4.57) No splint (No 26 12.33(4.77) Mean -0.95(- Not
2006 Quality SSS)(Symptom Severity position wrist wrist Difference 3.49,1.589222) Significant
Score) splint continuously immobilization) (P-
for two weeks) value>.05)
756
757
VII. APPENDIXES
758
APPENDIX I
WORK GROUP ROSTER
Brent Graham, MD, MSc, FRCSC, Chair John Stephenson, MD

Representing Society(ies): Representing Society(ies):
American Society for Surgery of the Hand American Academy of Orthopaedic Surgeons
Toronto Western Hospital University of Arkansas for Medical Sciences-
399 Bathurst Street, 2E-425 Department of Orthopaedic Surgery
Toronto, Ontario M5T 2S8 4301 W. Markham St.
Little Rock, AR 72205
Allan E. Peljovich, MD, MPH, Vice-Chair
Representing Society(ies): Andrew Gurman, MD
American Academy of Orthopaedic Surgeons Representing Society(ies):
The Hand & Upper Extremity Center of American Medical Association
Georgia, P.C. Altonna Hand and Wrist Surgery, LLC
Northside Doctors Centre 1701 Twelfth Avenue, Suite C-2
980 Johnsons Ferry Road, Suite 1020 Altonna, PA 16601
Atlanta, GA 30342 Denise.Graddy@ama-assn.org
Robert Afra, MD Joy MacDermid, PhD

Representing Society(ies): Representing Society(ies):
American Academy of Orthopaedic Surgeons American Society of Hand Therapist
American Orthopaedics and Sports Medicine Hand and Upper Limb Centre
317 N. El Camino Real, Suite 405 St. Josephs Health Centre
Encinitas, CA 268 Grosvenor Street
London, Ontario N6A 4L6 Canada
Mickey S. Cho, MD
Representing Society(ies): Gary Mlady, MD
Dept. of Orthopaedic Surgery & Rehabilitation American College of Radiology
San Antonio Military Medical Center Department of Radiology
3851 Roger Brooke Dr MSC10 5530
Ft Sam Houston, TX 78234 1 University of New Mexico
Albuquerque, NM 87131-0001
Rob Gray, MD
Representing Society(ies): Atul T. Patel, MD
North-Shore University HealthCare System American Academy for Physical Medicine and
NorthShore Medical Group Rehabilitation
9650 Gross Point Rd., Suite 2900 Kansas City Bone & Joint Clinic, P.A.
Skokie, IL 60076 Corporate Medical Plaza, Building #1
10701 Nall Avenue, Suite 200
Overland Park, KS 66211
759
David Rempel, MD, MPH
Representing Society(ies):
American College of Occupational and Environmental Medicine
University of California, San Francisco
Ergonomics Program Division of Occupational and Environmental Medicine
1301 South 46th Street, Building 163 Richmond, CA 94804
Tamara D. Rozental, MD
American Society for Surgery of the Hand
Beth Israel Deaconess Medical Center
Department of Orthopaedic Surgery
330 Brookline Avenue Stoneman 10
Boston, MA 02215
Mohammad Kian Salajegheh, MD

American Academy of Neurology
Department of Neurology
Brigham and Womens Hospital
75 Francis Street, Tower 5D
Boston, MA 02115
760
GUIDELINES OVERSIGHT CHAIR
Michael Warren Keith, MD
The MetroHealth System
2500 Metro Health Dr.
Cleveland, OH 44109-1900
EVIDENCE-BASED QUALITY AND VALUE COMITTEE CHAIR

David Jevsevar, MD, MBA
Dartmouth-Hitchcock Medical Ctr
One Medical Center Drive
Lebanon, NH 03756
AAOS CLINICAL PRACTICE GUIDELINES SECTION LEADER

Kevin Shea, MD
Intermountain Orthopaedics
600 N. Robbins Rd Ste 400
Boise, ID 83702
AAOS COUNCIL ON RESEARCH AND QUALITY CHAIR

Kevin John Bozic, MD, MBA
Dell Medical School, University of Texas At Austin
Sanchez Education Building
1912 Speedway, Suite 562
Austin, TX 78712
761
ADDITIONAL CONTRIBUTING MEMBERS
The following participants contributed to the development of the preliminary recommendations
during the introductory meeting, but did not participate in the final meeting where the evidence
was reviewed and the final recommendations were developed:
Julie Adams, MD
Jay Mark Evans, MD
John Lubahn, MD
Wilson Zachary Ray, MD
Robert Spinner, MD
Grant Thomson, MD, MSc
AAOS STAFF
William Shaffer, MD Peter Shores, MPH
AAOS Medical Director Evidence-Based Medicine Statistician
Deborah Cummins, PhD Kaitlyn Sevarino, MBA

Director, Research & Scientific Affairs Evidence-Based Quality and Value
Coordinator
Jayson Murray, MA
Manager, Evidence-Based Medicine Unit Anne Woznica, MLS
Medical Librarian
Mukarram Mohiuddin, MPH
Lead Research Evidence-Based Medicine Yasseline Martinez
Research Analyst Administrative Coordinator
Kyle Mullen, MPH Erica Linskey

Evidence-Based Medicine Research Analyst Administrative Assistant
762
APPENDIX II
AAOS BODIES THAT APPROVED THIS CLINICAL PRACTICE GUIDELINE
Committee on Evidence Based Quality and Value
The committee on Evidence Based Quality and Value (EBQV) consists of twenty AAOS
members who implement evidence-based quality initiatives such as clinical practice guidelines
(CPGs) and appropriate use criteria (AUCs). They also oversee the dissemination of related
educational materials and promote the utilization of orthopaedic value products by the
Academys leadership and its members.
Council on Research and Quality

The Council on Research and Quality promotes ethically and scientifically sound clinical and
translational research to sustain patient care in musculoskeletal disorders. The Council also
serves as the primary resource for educating its members, the public, and public policy makers
regarding evidenced-based medical practice, orthopaedic devices and biologics, regulatory
pathways and standards development, patient safety, occupational health, technology assessment,
and other related important errors.
The Council is comprised of the chairs of the committees on Biological Implants, Biomedical
Engineering, Occupational Health and Workers Compensation, Patient Safety, Research
Development, U.S. Bone and Joint Decade, and chair and Appropriate Use Criteria and Clinical
Practice Guideline section leaders of the Evidence Based Quality and Value committee. Also on
the Council are the second vice-president, three members at large, and representatives of the
Diversity Advisory Board, Women's Health Issues Advisory Board, Board of Specialty Societies
(BOS), Board of Councilors (BOC), Communications Cabinet, Orthopaedic Research Society
(ORS), Orthopedic Research and Education Foundation (OREF).
Board of Directors
The 17 member Board of Directors manage the affairs of the AAOS, set policy, and oversee the
Strategic Plan.
763
APPENDIX III
A Priori Pico Questions and Additional Details Regarding Pico Questions
1. For patients with symptoms consistent with CTS (median nerve involvement at the level of the
wrist) what physical examination maneuvers lead to an accurate diagnosis of CTS?
Additional Information regarding this PICO question and the resulting recommendation:
One member of the guideline development group chose not to approve the rationale that
accompanied recommendation 1C: Maneuvers.
wrist) what topics should be addressed in the history interview lead to an accurate diagnosis of
CTS?
wrist) are imaging modalities necessary to aid the diagnosis, management, and prognosis of
CTS?
wrist) are diagnostic scales necessary to aid the diagnosis, management, and prognosis of CTS?
Additional Information regarding PICO question or resulting recommendation: One

member of the guideline development group chose not to approve the guideline
recommendation and the rationale that accompanied this recommendation.
5. Are there specific activities or exposures that can be correlated with the development of carpal
tunnel syndrome?
6. Do any of the selected conservative treatments result in relief of symptoms and/or functional
improvement while resulting in minimal complications? Or do they play a role in diagnosis or
prediction of prognosis (injections)?
7. For patients with symptoms consistent with CTS, does surgical carpal tunnel release relieve
symptoms and/or improve function?
8. For patients with symptoms consistent with CTS, do adjunctive/alternative surgical techniques
relieve symptoms and/or improve function?
wrist) with bilateral involvement, does simultaneous bilateral surgical release relieve symptoms
and/or improve function without negative consequence?
10. For pregnant women with symptoms consistent with CTS (median nerve involvement at the level
of the wrist) are the selected conservative treatments safe and do they relive symptoms and/or
improve function with minimum complications?
764
11. For patients undergoing surgical treatment for CTS (median nerve involvement at the level of the
wrist) do patient oriented outcomes differ between various modes of anesthesia?
wrist), do various post-operative complications significantly differ between those who undergo
peri-operative anticoagulation cessation only, with those who undergo continued anti-
coagulation treatment.
wrist), are there significant differences in infection rates between those treated with prophylactic
antibiotics and those not treated with prophylactic antibiotics peri-operatively.
14. For patients who have been treated with a surgical intervention for CTS, is therapy indicated? If
so, who, when, what (certain treatments), and how long (duration of therapy)?
15. For patients who have been treated with a surgical intervention for CTS, does post-operative
immobilization result in significant differences in symptom relief and functional improvement,
as compared to those who undergo early mobilization or unrestricted movement.
16. For diabetic patients who have been treated with a surgical intervention for CTS, which post-
operative management modalities are safe and effective?
765
APPENDIX IV
STUDY ATTRITION FLOWCHART
10804 abstracts reviewed. Search

performed on February 27, 2015
8341 articles excluded from title

and abstract review
2463 articles recalled for full text

review
2233 articles excluded after full

text review for not meeting the a
priori inclusion criteria or not best
available evidence
230 articles included after full text

review and quality analysis
766
APPENDIX V
LITERATURE SEARCH STRATEGIES
Guideline: Diagnosis and Treatment of Carpal Tunnel Syndrome

Total citations added to the database: 691 Ref IDs: 14542-15449 Date: 02/27/2015
Database: PubMed (http://www.pubmed.gov) Date searched: 02/27/2015

Search Results: 314 De-duplicated:305 Ref IDs: 14542-14855
Search Strategy
#1
carpal tunnel syndrome[mh] OR carpal tunnel[tw] OR (carpal[tiab] AND tunnel[tiab])
#2
(Median entrapment neuropathy[tw] OR Median nerve neuropathy[tw] OR median
neuropathy[mh:noexp] OR (nerve compression syndromes[mh:noexp] AND median
nerve[tw])) AND (carpal[tw] OR wrist[tw] OR distal[tw])
#3
(animals[mh] NOT humans[mh]) OR cadaver[mh] OR cadaver*[ti] OR ((comment[pt] OR
editorial[pt] OR letter[pt] OR "historical article"[pt]) NOT "clinical trial"[pt]) OR addresses[pt]
OR news[pt] OR "newspaper article"[pt] OR "case report"[ti] OR pmcbook
#4
(#1 OR #2) NOT #3
#5
#4 AND English[lang] AND 1966[dp]:2015[dp]
#6
("2014/02/27"[Date - Entrez] : "3000"[Date - Entrez])
#7
#5 AND #6
PubMed Search Results

Search Results De-duplicated* Ref IDs
314 305 14542-14855
*De-duplication also removes retracted articles.
767
Database: Embase (http://www.embase.com) Date searched: 02/27/2015
Search Results: 560 De-duplicated:376Ref IDs: 14861-15415
Search Strategy
#1
'carpal tunnel syndrome'/exp OR 'carpal tunnel questionnaire'/exp OR 'carpal tunnel':ab,ti OR
('median neuropathy':ab,ti OR 'median entrapment':ab,ti OR 'median nerve':ab,ti AND
('carpal':ab,ti OR 'wrist':ab,ti OR 'distal':ab,ti))
#2
[english]/lim AND [Embase]/lim AND [1966-2015]/py
#3
cadaver/de OR 'in vitro study'/exp OR 'abstract report'/de OR book/de OR editorial/de OR
note/de OR letter/de OR 'case report':ti
#4
(#1 AND #2) NOT #3
Embase Search Results

560 376 14861-15415
Database: The Cochrane Library (Wiley interface) Date searched: 02/27/2015
Search Results:37 De-duplicated:10 Ref IDs: 15416-15449

Search Strategy
#1
"carpal tunnel":ti,ab,kw (Word variations have been searched)
#2
MeSH descriptor: [Carpal Tunnel Syndrome] explode all trees
#3
#1 or #2 from 1966 to 2015
Cochrane Search Results

37 10 15416-15449
*Foreign language also removed.
768
Database: PEDro (http://pedro.org.au) Date searched: 02/27/2015
Search Results: 6 De-duplicated:0 Ref IDs: --
Search Strategy
Abstract & Title: carpal tunnel

Published since: 1966
PEDro Search Results

6 0 --
*Foreign language also removed.
769
APPENDIX VI
COMPANION CONSENSUS STATEMENTS
For PICO questions which returned no evidence, the guideline development group is given the
option to form a consensus statement. PICO questions which did not have supporting evidence
can be found in Appendix III. If the guideline development group makes the decision to
construct consensus statements, they participate in a modified Delphi method designed to help
target the most clinically applicable consensus statement (see Companion Consensus Statement
Protocol). All consensus statements will be published in a separate document in an effort to
clearly distinguish between the evidence-based recommendations in this document and the
complimentary consensus statements. All companion consensus statements can be found on the
AAOS website (www.aaos.org). Although expert opinion is a form of evidence, it is also
important to avoid liberal use in a guideline since research shows that expert opinion can be
incorrect.
Sometimes guideline development group members change their views. At any time during the
discussion of the consensus statements, any member of the guideline development group can
make a motion to withdraw a statement. Appendix III of the guideline will list all PICO
questions, including those that returned no evidence/have consensus statements.
COMPANION CONSENSUS STATEMENT PROTOCOL
770
Appendix VIII
APPENDIX VII
PARTICIPATING PEER REVIEW ORGANIZATIONS
Peer review of the guideline is completed by interested external organizations. The AAOS
solicits reviewers for each guideline. They consist of experts in the topic area and represent
professional societies other than AAOS. Review organizations are nominated by the guideline
development group at the introductory meeting. For this guideline, AAOS contacted 18
organizations with content expertise to review a draft of the clinical practice guideline during the
peer review period from September 8th, 2015 to October 8th, 2015. Eleven individuals provided
comments via the electronic structured peer review form, representing seven professional
medical organizations (listed below).
Participating Societies
American Academy of Physical Medicine and Rehabilitation (AAPM&R)
American Society of Plastic Surgeons (ASPS)
American Association for Hand Surgery (AAHS)
American Society of Hand Therapists (ASHT)
American Academy of Neurology (AAN)
American Association of Neuromuscular and Elctrodiagnostic Medicine (AANEM)
American Society for Surgery of the Hand (ASSH)
Peer review comments will be available on www.aaos.org/guidelinepeerreview.
Participation in the AAOS guideline peer review process does not constitute an
endorsement nor does it imply that the reviewer supports this document.
771
STRUCTURED PEER REVIEW FORM
Peer reviewers are asked to read and review the draft of the clinical practice guideline with a
particular focus on their area of expertise. Their responses to the answers below are used to
assess the validity, clarity, and accuracy of the interpretation of the evidence.
772
To view an example of the structured peer review form, please select the following link:
Structured Peer Review Form
773
APPENDIX VIII
INTERPRETING THE FOREST PLOTS
We use descriptive diagrams known as forest plots to present data from studies comparing the
differences in outcomes between two treatment groups when a meta-analysis has been performed
(combining results of multiple studies into a single estimate of overall effect). The overall effect
is shown at the bottom of the graph as a diamond to illustrate the confidence intervals. The
standardized mean difference or odds ratio are measures used to depict differences in outcomes
between treatment groups. The horizontal line running through each point represents the 95%
confidence interval for that point estimate. The solid vertical line represents no effect and is
where the standardized mean difference = 0 or odds ratio = 1.
774
APPENDIX IX
CONFLICT OF INTEREST
Prior to the development of this guideline, guideline development group members disclose
conflicts of interest (COI). They disclose COIs in writing to the American Academy of
Orthopaedic Surgeons via a private on-line reporting database and also verbally at the
recommendation approval meeting.
Brent Graham, MD, Work Group Chair: Journal of Bone and Joint Surgery - American:
Editorial or governing board; Publishing royalties, financial or material support (Submitted on:
05/06/2015)
Allan E Peljovich, MD, Work Group Vice-Chair: AAOS: Board or committee member;
American Society for Surgery of the Hand: Board or committee member (Submitted on:
10/01/2015)
Robert Afra, MD: (This individual reported nothing to disclose); Submitted on: 05/07/2015
Mickey S Cho, MD: American Society for Surgery of the Hand: Board or committee member
(Submitted on: 05/07/2015)
Robert Gray, MD: American Society for Surgery of the Hand: Board or committee member;
Skeletal Dynamics: Paid presenter or speaker (Submitted on: 04/23/2015)
Andrew Gurman, MD: I am a member of the Board of Trustees of the American Medical
Association, which is the publisher of JAMA and Archives of Surgery: Editorial or governing
board; I am the Speaker of the House of Delegates and a member of the Board of Trustees of the
American Medical Association: Board or committee member (Submitted on 04/29/2015)
Joy C MacDermid, PhD: American Association for Hand Surgery: Board or committee
member; Journal of Orthopaedic and Sports Physical Therapy Journal of Hand Therapy Open
Orthopedics: Editorial or governing board; SLACK Incorporated: Publishing royalties, financial
or material support (Submitted on: 05/13/2015)
Gary Mlady, MD: (This individual reported nothing to disclose); Submitted on: 04/14/2015
Atul T Patel, MD: Allergan: Paid presenter or speaker; Research support; Isen: Research
support; Merz: Research support; Pfizer: Research support (Submitted on: 04/29/2015)
David Rempel, MD: American College of Occupational and Environmental Medicine: Board or
committee member; Applied Ergonomics: Editorial or governing board; Human Factors:
Editorial or governing board; Occupational and Environmental Medicine/Lange: Publishing
royalties, financial or material support (Submitted on: 04/29/2015)
Tamara D Rozental, MD: AAOS: Board or committee member; American Society for Surgery
of the Hand: Board or committee member; Journal of Hand Surgery - American: Editorial or
governing board (Submitted on: 04/02/2015)
Mohammad Kian Salajegheh, MD: (This individual reported nothing to disclose); Submitted
on: 05/04/2015
John Michael Stephenson, MD: American Society for Surgery of the Hand: Board or
committee member; Journal of Hand Surgery - American: Editorial or governing board
775
Michael Warren Keith, MD, Work Group Oversight Chair: AAOS: Board or committee
member; Neuros: Unpaid consultant (Submitted on: 04/02/2015)
ADDITIONAL CONTRIBUTING MEMBERS

Julie E Adams, MD: American Association for Hand Surgery: Board or committee member;
American Shoulder and Elbow Surgeons: Board or committee member; American Society for
Surgery of the Hand: Board or committee member; Arthrex, Inc: IP royalties; Paid presenter or
speaker; Arthroscopy Association of North America: Board or committee member; Biomet: IP
royalties; Elsevier: Yearbook of Hand Surgery: Editorial or governing board; Journal of Hand
Surgery - American: Editorial or governing board; Minnesota Orthopaedic Society: Board or
committee member; Saunders/Mosby-Elsevier: Yearbook of hand surgery: Publishing royalties,
financial or material support (Submitted on: 10/01/2015)
J Mark Evans, MD: American Society for Surgery of the Hand: Board or committee member;
Journal of Urgent Care Medicine, Editorial board (wife): Editorial or governing board
John D Lubahn, MD: Auxillium - Xiaflex: Research support (Submitted on: 10/14/2015)
Wilson Ray, MD: DePuy, A Johnson & Johnson Company: Paid consultant; LDR Holding:
Stock or stock Options; Ulrich: Paid consultant (Submitted on: 05/01/2015)
Robert Jay Spinner, MD: American Association for Hand Surgery: Board or committee
member; American Society for Peripheral Nerve: Board or committee member; Clinical
Anatomy: Editorial or governing board; J Surgical Orthopedic Advances: Editorial or governing
board; Mayo Clinic Proceedings: Editorial or governing board; Mayo Medical Ventures: Paid
consultant; Neurosurgery: Editorial or governing board; Saunders/Mosby-Elsevier: Publishing
royalties, financial or material support; World Neurosurgery: Editorial or governing board
Grant Thomson, MD, MSc: American Association of Plastic Surgeons: Board or committee
member; Smith & Nephew: Research support; Springer: Editorial or governing board (Submitted
on: 05/06/2015)
AAOS Staff
William Shaffer: (This individual reported nothing to disclose); Submitted on: 10/09/2015
Deborah Cummins, PhD: (This individual reported nothing to disclose); Submitted on:
10/07/2015
Jayson Murray, MA: (This individual reported nothing to disclose); Submitted on: 05/19/2015
Mukarram Mohiuddin: (This individual reported nothing to disclose); Submitted on:

10/13/2015
Kyle Mullen: No disclosure available
776
Anne Woznica: (This individual reported nothing to disclose); Submitted on: 10/01/2015
Peter Shores: (This individual reported nothing to disclose); Submitted on: 10/01/2015
Erica Linskey: (This individual reported nothing to disclose); Submitted on: 10/01/2015
Yasseline Martinez: (This individual reported nothing to disclose); Submitted on: 04/02/2015
Disclosure Items: (n) = Respondent answered 'No' to all items indicating no conflicts. 1 = Royalties
from a company or supplier; 2 = Speakers bureau/paid presentations for a company or supplier; 3A =
Paid employee for a company or supplier; 3B = Paid consultant for a company or supplier; 3C =
Unpaid consultant for a company or supplier; 4 = Stock or stock options in a company or supplier; 5
= Research support from a company or supplier as a PI; 6 = Other financial or material support from
a company or supplier; 7 = Royalties, financial or material support from publishers; 8 =
Medical/Orthopaedic publications editorial/governing board; 9 = Board member/committee
appointments for a society.
777
APPENDIX X
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792
EXCLUDED STUDIES
Reason for
Authors Year Article Title Periodical
Exclusion
Abbas,M.A.; Afifi,A.A.; Meta-analysis of published studies of
1998 Int.J Occup.Environ.Health meta-analysis
Zhang,Z.W.; Kraus,J.F. work-related carpal tunnel syndrome
Abbas,M.F.; Faris,R.H.; Worksite and personal factors
Harber,P.I.; Mishriky,A.M.; El- associated with carpal tunnel syndrome
2001 Int.J Occup.Environ.Health very low quality
Shahaly,H.A.; Waheeb,Y.H.; in an Egyptian electronics assembly
Kraus,J.F. factory
Can wrist splints or steroid injections
reduce the need for decompression Health Technology Assessment
Abbotts,J.; McIntosh,H. 2013 Narrative review
surgery in carpal tunnel syndrome? Database
(Structured abstract)
A comparative electrophysiological and
Abbruzzese,M.; Loeb,C.; histological study of sensory conduction review; not exclusive to
1977 Eur.Neurol.
Ratto,S.; Sacco,G. velocity and Meissner corpuscles of the CTS
median nerve in pneumatic tool workers
Abdulrazzaq,Y.M.; Nan,Z.;
2003 Acupuncture in the management of pain Emirates Medical Journal Background article
Xin,G.K.
Clinical evaluation of a resorbable
Aberg,M.; Ljungberg,C.; wrap-around implant as an alternative
Edin,E.; Millqvist,H.; to nerve repair: a prospective, assessor- Does not address
2009 J Plast.Reconstr.Aesthet.Surg
Nordh,E.; Theorin,A.; blinded, randomised clinical study of question of interest
Terenghi,G.; Wiberg,M. sensory, motor and functional recovery
after peripheral nerve repair
Abichandani,S.; Shaikh,S.; Carpal tunnel syndrome - an
2013 Int.Dent.J literature review
Nadiger,R. occupational hazard facing dentistry
Prevalence of carpal tunnel syndrome in
Ablove,R.H.; Ablove,T.S. 2009 WMJ narrative review
pregnant women
Psychophysically determined work-
Abu-Ali,M.; Purswell,J.L.; International Journal of Industrial
1996 cycle parameters for repetitive hand review; recommendations
Schlegel,R.E. Ergonomics
gripping
Return to functional hand use and work
Acharya,A.D.; Auchincloss,J.M. 2005 J Hand Surg Br
following open carpal tunnel surgery
Adams,B.D. 1994 Endoscopic Carpal Tunnel Release J Am Acad Orthop Surg Background article
793
Reason for
Exclusion
Tendon transfers for irreparable nerve
Adams,J.; Wood,V.E. 1981 Orthop.Clin.North Am. Background article
damage in the hand
Outcome of carpal tunnel surgery in
Adams,M.L.; Franklin,G.M.; medical records review;
1994 Washington State workers' Am J Ind.Med
Barnhart,S. insufficient data
compensation
Adamson,J.E.; Srouji,S.J.;
1971 The acute carpal tunnel syndrome Plast.Reconstr.Surg case reports
Horton,C.E.; Mladick,R.A.
Effects of carpal tunnel syndrome on
Afifi,M.; Santello,M.; +Does not answer a
2012 adaptation of multi-digit forces to Clin Neurophysiol.
Johnston,J.A. question of interest
object texture
Agabegi,S.S.; Freiberg,R.A.; Thumb abduction strength measurement insufficient data; very
2007 J Hand Surg Am
Plunkett,J.M.; Stern,P.J. in carpal tunnel syndrome low study design
A prospective study of the long-term
Agarwal,V.; Singh,R.;
efficacy of local methyl prednisolone
Sachdev,A.; Wiclaff; 2005 Rheumatology (Oxford) Very Low Quality
acetate injection in the management of
Shekhar,S.; Goel,D.
mild carpal tunnel syndrome
Agarwal,V.; Singh,R.; Long term efficacy of local methyl
Sachdev,A.; Wiclaff; 2007 prednisolone acetate injection in the Indian Journal of Rheumatology Very Low Quality
Shekhar,S.; Goel,D. management of carpal tunnel syndrome
Agee,J.M.; McCarroll,H.R.; Endoscopic carpal tunnel release using
1994 Hand Clin Background article
North,E.R. the single proximal incision technique
Endoscopic carpal tunnel release: a
Agee,J.M.; Peimer,C.A.;
1995 prospective study of complications and J Hand Surg Am very low quality
Pyrek,J.D.; Walsh,W.E.
surgical experience
Ahan,U.; Arne,Z.M.; Surgical technique to reduce scar duplicate of
2002 Journal of Hand Surgery
Bajrovi,F.; Zorman,P. discomfort after carpal tunnel surgery PM:12239671
Ahcan,U.; Arnez,Z.M.; Surgical technique to reduce scar
2002 J Hand Surg Am very low quality
Bajrovic,F.; Zorman,P. discomfort after carpal tunnel surgery
Ahmed,M.S.; Ali,R.;
Carpal tunnel syndrome in patients with
Mojaddidi,M.; Thomsen,N.;
2010 diabetes is associated with increased Diabet.Med. summary report; abstract
Dahlin,L.; Jeziorska,M.;
expression of VEGF and its receptors
Malik,R.
Hand elevation: a new test for carpal insufficient data; very
Ahn,D.S. 2001 Ann.Plast.Surg
tunnel syndrome low study design
Aiache,A.E. 1978 An early sign of carpal tunnel syndrome Plast.Reconstr.Surg case report
794
Reason for
Exclusion
The impact of wrist extension
<10 patients in CTS
Aird,J.; Cady,R.; Nagi,H.; provocation on current perception
2006 J Hand Ther group; very low study
Kullar,S.; MacDermid,J.C. thresholds in patients with carpal tunnel
design
syndrome: a pilot study
Ajeena,I.M.; Al-Saad,R.H.; Al- Ultrasonic assessment of females with
insufficient data; very
Mudhafar,A.; Hadi,N.R.; Al- 2013 carpal tunnel syndrome proved by nerve Neural Plast.
low study design
Aridhy,S.H. conduction study
Value of power Doppler and gray-scale
US in the diagnosis of carpal tunnel
Akcar,N.; Ozkan,S.;
syndrome: contribution of cross- insufficient data; very
Mehmetoglu,O.; Calisir,C.; 2010 Korean J Radiol.
sectional area just before the tunnel low study design
Adapinar,B.
inlet as compared with the cross-
sectional area at the tunnel
Akkus,S.; Kutluhan,S.; Does fibromyalgia affect the outcomes Does not answer a
Akhan,G.; Tunc,E.; Ozturk,M.; 2002 of local steroid treatment in patients Rheumatol.Int. question of interest; no
Koyuncuoglu,H.R. with carpal tunnel syndrome? assessment of risk factors
Does the provocation maneuvers
Aktas,I.; Sunter,G.; Uluc,K.;
increase the sensitivity of sensory nerve Turkiye Fiziksel Tip ve Rehabilitasyon insufficient data; no true
Isak,B.; Tanridag,T.; Akyuz,G.; 2012
conduction studies in diagnosis of Dergisi reference standard
Us,O.
carpal tunnel syndrome?
Pregnancy-induced carpal tunnel
al Qattan,M.M.; no comparison group;
1994 syndrome requiring surgical release Obstet.Gynecol.
Manktelow,R.T.; Bowen,C.V. very low study design
longer than 2 years after delivery
Al-Benna,S.; Nano,P.G.; El- Extended open-carpal tunnel release in
2012 Saudi J Kidney Dis Transpl. Retrospective case series
Enin,H. renal dialysis patients
The Alderson-McGall hand function
questionnaire for patients with Carpal Does not address
Alderson,M.; McGall,D. 1999 J Hand Ther
Tunnel syndrome: a pilot evaluation of question of interest
a future outcome measure
Relative refractory period: A measure
Alderson,M.K.; Petajan,J.H. 1987 Muscle Nerve Not relevant to CTS
to detect early neuropathy in alcoholics
Aldridge,J.W.; Bruno,R.J.;
2001 Nerve entrapment in athletes Clin.Sports Med. background
Strauch,R.J.; Rosenwasser,M.P.
Aleman,L.; Berna,J.D.; Reproducibility of sonographic +Does not answer a
2008 J Ultrasound Med
Reus,M.; Martinez,F.; measurements of the median nerve question of interest
795
Reason for
Exclusion
Domenech-Ratto,G.;
Campos,M.
Alexanian,R.; Fraschini,G.; Amyloidosis in multiple myeloma or not relevant to CTS; bio-
1984 Arch Intern.Med
Smith,L. without apparent cause study
Background Information;
Alfonso,M.I.; Dzwierzynski,W. 1998 Hoffman-Tinel sign: The realities Phys.Med.Rehabil.Clin.N.Am.
case reports
Limited joint mobility in diabetes.
Aljahlan,M.; Lee,K.-C.;
1999 Diabetic cheiroarthropathy may be a Postgrad.Med. Background Information
Toth,E.
clue to more serious complications
Aljure,J.; Eltorai,I.; Not relevant,does not
Carpal tunnel syndrome in paraplegic
Bradley,W.E.; Lin,J.E.; 1985 answer the PICO
patients
Johnson,B. question
Weight of evidence links obesity,
fitness to carpal tunnel syndrome.
Allen,C.W.,Jr. 1993 Companies implementing wellness Occup.Health Saf Background Information
programs experience a reduction in
CTS incidence
Allmann,K.H.; Horch,R.;
Uhl,M.; Gufler,H.; insufficient data; very
1997 MR imaging of the carpal tunnel Eur.J Radiol.
Altehoefer,C.; Stark,G.B.; low study design
Langer,M.
Almeyda,J.R.; Thorne,N.;
1969 Myxoedema--carpal tunnel syndrome Br J Dermatol. notes
Russell,B.
Variations in the course of the thenar
motor branch of the median nerve and
Al-Qattan,M.M. 2010 their relationship to the hypertrophic J Hand Surg Am very low quality
muscle overlying the transverse carpal
ligament
Altinok,M.T.; Baysal,O.; Sonographic evaluation of the carpal +not best available
Karakas,H.M.; Firat,A.K. tunnel after provocative exercises evidence
Altinok,T.; Baysal,O.;
Ultrasonographic assessment of mild
Karakas,H.M.; Sigirci,A.; insufficient data; very
2004 and moderate idiopathic carpal tunnel Clin Radiol.
Alkan,A.; Kayhan,A.; low study design
syndrome
Yologlu,S.
Management of nerve compression Background Information;
Amadio,P.C. 2003 Hand Clin.
syndrome in musicians review
796
Reason for
Exclusion
Journal of Bone and Joint Surgery -
Amadio,P.C. 2003 What's new in hand surgery background
Series A
Grip strength as a predictor for the
Amayyreh,I.; Almutaseb,N. 2011 severity of carpal tunnel syndrome in Jordan Medical Journal
low study design
female patients
Amick III,B.C.; Habeck,R.V.; Predictors of Successful Work Role
Does not addess question
Ossmann,J.; Fossel,A.H.; 2004 Functioning after Carpal Tunnel J.Occup.Environ.Med.
of interest
Keller,R.; Katz,J.N. Release Surgery
Amirfeyz,R.; Clark,D.;
Parsons,B.; Melotti,R.; Clinical tests for carpal tunnel insufficient data; very
2011 Arch Orthop Trauma Surg
Bhatia,R.; Leslie,I.; syndrome in contemporary practice low study design
Bannister,G.
Amirfeyz,R.; Gozzard,C.; Hand elevation test for assessment of +not best available
2005 J Hand Surg Br
Leslie,I.J. carpal tunnel syndrome evidence
Amirfeyz,R.; Mehendale,S.;
Tyrrell,S.; Bhatia,R.; Leslie,I.; 2010 Katz and Stirrat hand diagram revisited Hand Surg
low study design
Bannister,G.
Discriminative validity and test-retest
Amirjani,N.; Ashworth,N.L.;
reliability of the Dellon-modified insufficient data; very
Olson,J.L.; Morhart,M.; 2011 J Peripher.Nerv.Syst.
Moberg pick-up test in carpal tunnel low study design
Chan,K.M.
syndrome patients
Amirjani,N.; Ashworth,N.L.; Validity and reliability of the Purdue
Olson,J.L.; Morhart,M.; 2011 Pegboard Test in carpal tunnel Muscle Nerve
low study design
Chan,K.M. syndrome
Self-administered diagram for European Journal of Physical Medicine Not best evidence for
Ammer,K.; Mayr,H.; Thur,H. 1993
diagnosing carpal tunnel syndrome and Rehabilitation hand diagram
Andary,M.T.; Fankhauser,M.J.;
Comparison of sensory mid-palm
Ritson,J.L.; Spiegel,N.; insufficient data; very
1996 studies to other techniques in carpal Electromyogr.Clin Neurophysiol.
Hulce,V.; Yosef,M.; low study design
tunnel syndrome
Stanton,D.F.
Andersen,J.H.; Thomsen,J.F.;
Does not answer a
Overgaard,E.; Lassen,C.F.; Computer use and carpal tunnel
2003 question of interest; no
Brandt,L.P.; Vilstrup,I.; syndrome: a 1-year follow-up study
diagnosis of CTS
Kryger,A.I.; Mikkelsen,S.
Surface recording of orthodromic
Andersen,K. 1985 Muscle Nerve only normal subjects used
sensory nerve action potentials in
797
Reason for
Exclusion
median and ulnar nerves in normal
subjects
Anderson,L.P. 1986 Carpal tunnel syndrome Orthop Nurs. background
Andreu,J.L.; Ly-Pen,D.; Local injection versus surgery in carpal Duplicate study
Millan,I.; de,Blas G.; Sanchez- 2014 tunnel syndrome: Neurophysiologic Clin.Neurophysiol. (duplicate to AAOS ID
Olaso,A. outcomes of a randomized clinical trial 137)
Andrew,C.Y.H.; Hua,L.K.; Carpal tunnel syndrome - Splinting or
2005 Singapore General Hospital Proceedings Systematic review
Kiong,P.B.; Dennis,K. surgery? A systematic review
Angelis,M.V.; Pierfelice,F.; Efficacy of a soft hand brace and a wrist Duplicate article
Giovanni,P.; Staniscia,T.; 2009 splint for carpal tunnel syndrome: a Acta Neurol.Scand. (duplicate with AAOS ID
Uncini,A. randomized controlled study 455)
The relationship between symptoms,
Ansari,N.N.; Adelmanesh,F.; clinical tests and nerve conduction insufficient data; not best
2009 Electromyogr.Clin Neurophysiol.
Naghdi,S.; Mousavi,S. study findings in carpal tunnel evidence
syndrome
Aoki,T.; Oshige,T.;
Matsuyama,A.; Oki,H.;
High-resolution MRI predicts steroid
Kinoshita,S.; Yamashita,Y.;
2014 injection response in carpal tunnel Eur.Radiol. Very Low Quality
Takahashi,H.; Hayashida,Y.;
syndrome patients
Sakai,A.; Hisaoka,M.;
Korogi,Y.
Aoki,T.; Oshige,T.;
Matsuyama,A.; Oki,H.;
High-resolution MRI predicts steroid Duplicate article
Kinoshita,S.; Yamashita,Y.;
2013 injection response in carpal tunnel Eur.Radiol. (duplicate with AAOS ID
Takahashi,H.; Hayashida,Y.;
syndrome patients 1637)
Sakai,A.; Hisaoka,M.;
Korogi,Y.
Apfelberg,D.B.; Maser,M.R.;
Rheumatoid hand deformities:
Lash,H.; Kaye,R.L.; 1978 West J Med Background article
pathophysiology and treatment
Britton,M.C.; Bobrove,A.
Functional outcomes post carpal tunnel +Does not answer a
Appleby,M.A.; Neville-
2009 release: a modified replication of a J Hand Ther question of interest; not
Smith,M.; Parrott,M.W.
previous study best available evidence
Subclinical cervico-spino-bulbar effects
Araki,S.; Murata,K.; Aono,H. 1986 of lead: A study of short-latency Am.J.Ind.Med. Not relevant to CTS
somatosensory evoked potentials in
798
Reason for
Exclusion
workers exposed to lead, zinc, and
copper
Arendt-Nielsen,L.; Involvement of thin afferents in carpal

Does not answer a
Gregersen,H.; Toft,E.; 1991 tunnel syndrome: evaluated Muscle Nerve
question of interest
Bjerring,P. quantitatively by argon laser stimulation
The significance of second lumbrical-
Argyriou,A.A.; Karanasios,P.; insufficient data; very
2009 interosseous latency comparison in the Acta Neurol Scand.
Makridou,A.; Makris,N. low study design
diagnosis of carpal tunnel syndrome
Argyriou,A.A.;
The significance of intact sympathetic
Polychronopoulos,P.; insufficient data; very
2006 skin responses in carpal tunnel Eur.J Neurol
Moutopulou,E.; Aplada,M.; low study design
syndrome
Chroni,E.
The palmar approach for the
Ariyan,S.; Watson,H.K. 1977 visualization and release of the carpal Plast.Reconstr.Surg Retrospective case series
tunnel. An analysis of 429 cases
Arminio,J.A. 1986 Etiology of carpal: tunnel syndrome Del Med J background
Armstong,A.P.; Flynn,J.R.; Endoscopic carpal tunnel release. A
1997 Journal of Hand Surgery Retrospective case series
Davies,D.M. review of 208 consecutive cases
Armstrong,M.B.; Surgical treatment of carpal tunnel
1997 Phys.Med.Rehabil.Clin.N.Am. Background article
Villalobos,R.E. syndrome
Intracarpal steroid injection is safe and Does not meet inclusion
Armstrong,T.; Devor,W.;
2004 effective for short-term management of Muscle Nerve criteria (follow-up<1
Borschel,L.; Contreras,R.
carpal tunnel syndrome month)
Some histological changes in carpal
Armstrong,T.J.; Castelli,W.A.;
1984 tunnel contents and their biomechanical J Occup.Med cadaver study
Evans,F.G.; Diaz-Perez,R.
implications
Carpal tunnel syndrome and selected no comparison group;
Armstrong,T.J.; Chaffin,D.B. 1979 J Occup.Med
personal attributes very low study design
Some biomechanical aspects of the
Armstrong,T.J.; Chaffin,D.B. 1979 J Biomech. biomechanical study
carpal tunnel
Sensory disturbances after two-portal
Arner,M.; Hagberg,L.;
1994 endoscopic carpal tunnel release: a J Hand Surg Am Retrospective case series
Rosen,B.
preliminary report
Arnold,W.D.; Elsheikh,B.H. 2013 Entrapment neuropathies Neurol.Clin. background
799
Reason for
Exclusion
Results of treatment of carpal tunnel
Arons,J.A.; Collins,N.; +Does not answer a
1999 syndrome with associated hourglass J Hand Surg Am
Arons,M.S. question of interest
deformity of the median nerve
Aroori,S.; Spence,R.A. 2008 Carpal tunnel syndrome Ulster Med J background
Carpal tunnel syndrome in the
Ashe,M. 2004 Can.Pharm.J. Background article
pharmacy
Ashraf,A.; Daghaghzadeh,A.;
A study of interpolation method in insufficient data; very
Naseri,M.; Nasiri,A.; 2013 Ann.Indian Acad Neurol
diagnosis of carpal tunnel syndrome low study design
Fakheri,M.
The diagnostic value of ultrasonography
Ashraf,A.R.; Jali,R.; insufficient data; very
2009 in patients with electrophysiologicaly Electromyogr.Clin Neurophysiol.
Moghtaderi,A.R.; Yazdani,A.H. low study design
confirmed carpal tunnel syndrome
Ashworth,N. 2005 Carpal tunnel syndrome Clin Evid. background
Ashworth,N. 2007 Carpal tunnel syndrome Am Fam Physician background
Ashworth,N.L. 2011 Carpal tunnel syndrome Clin Evid.(Online) systematic review
Incorrect patient
Effectiveness of second corticosteroid
Ashworth,N.L.; Bland,J.D. 2013 Muscle Nerve population (2nd
injections for carpal tunnel syndrome
treatment)
Hyperventilation provokes symptoms of +Does not answer a
Aslam,U.; Afzal,S.; Syed,S. 2012 Hand Surg
carpal tunnel syndrome question of interest
Relationship between cutaneous
Aszmann,O.C.; Dellon,A.L. 1998 pressure threshold and two-point J Reconstr.Microsurg. <10 patients per group
discrimination
Results of decompression of peripheral
Aszmann,O.C.; Kress,K.M.; Does not address
2000 nerves in diabetics: a prospective, Plast.Reconstr.Surg
Dellon,A.L. question of interest
blinded study
Decompression of multiple peripheral
Incorrect patient
nerves in the treatment of diabetic
Aszmann,O.C.; Lee,Dellon A. 2001 Acta Chirurgica Austriaca population (<10
neuropathy: A prospective, blinded
patients/group)
study
Erratum: Carpal Tunnel syndrome: Is it
abstract correction; no
Atcheson,S.G. 1999 work-related (Hospital Practice (March Hosp.Pract.
text
15) (52))
800
Reason for
Exclusion
Atcheson,S.G.; Ward,J.R.; Concurrent medical disease in work- +not best available
1998 Arch Intern.Med
Lowe,W. related carpal tunnel syndrome evidence
Comparison of ring versus disposable
Athar,P.; Jilani,A.; disk electrodes in recording antidromic insufficient data; very
2013 J Clin Neurophysiol.
Nguyen,T.T. sensory median nerve conduction study low study design
for diagnosis of carpal tunnel syndrome
Follow-up after carpal tunnel
Atherton,W.G.; Faraj,A.A.; decompression - general practitioner
1999 J Hand Surg Br Insufficient data
Riddick,A.C.; Davis,T.R. surgery or hand clinic? A randomized
prospective study
Atisook,R.; Benjapibal,M.; Carpal tunnel syndrome during
Does not address
Sunsaneevithayakul,P.; 1995 pregnancy: prevalence and blood level J Med Assoc Thai.
Roongpisuthipong,A. of pyridoxine
Assessment of the carpal tunnel +insufficient data; does
Atroshi,I.; Breidenbach,W.C.;
1997 outcome instrument in patients with J Hand Surg Am not answer question of
McCabe,S.J.
nerve-compression symptoms interest
Non-surgical treatment in carpal tunnel
Atroshi,I.; Gummesson,C. 2009 The Lancet Commentary
syndrome
Atroshi,I.; Gummesson,C.; Severe carpal tunnel syndrome +Does not answer a
Johnsson,R.; McCabe,S.J.; 2003 potentially needing surgical treatment in J Hand Surg Am question of interest; very
Ornstein,E. a general population low study design
Atroshi,I.; Gummesson,C.; The SF-6D health utility index in carpal +Does not answer a
2007 J Hand Surg Eur.Vol.
McCabe,S.J.; Ornstein,E. tunnel syndrome question of interest
Atroshi,I.; Gummesson,C.;
Carpal tunnel syndrome and keyboard Not relevant, prevalence
Ornstein,E.; Johnsson,R.; 2007 Arthritis Rheum.
use at work: a population-based study study
Ranstam,J.
Evaluation of portable nerve conduction
Atroshi,I.; Johnsson,R. 1996 testing in the diagnosis of carpal tunnel J Hand Surg Am
low study design
syndrome
Use of outcome instruments to compare
Atroshi,I.; Johnsson,R.;
workers' compensation and non- +Does not answer a
Nouhan,R.; Crain,G.; 1997 J Hand Surg Am
workers' compensation carpal tunnel question of interest
McCabe,S.J.
syndrome
801
Reason for
Exclusion
Endoscopic carpal tunnel release: Insufficient data (results
Atroshi,I.; Johnsson,R.;
1997 prospective assessment of 255 J Hand Surg Br not stratified by
Ornstein,E.
consecutive cases anaesthetic type))
The 6-item CTS symptoms scale: a
Atroshi,I.; Lyren,P.E.; Insufficient data (no post-
2009 brief outcomes measure for carpal Qual.Life Res.
Gummesson,C. op findings)
tunnel syndrome
The six-item CTS symptoms scale and
Atroshi,I.; Lyren,P.E.;
2011 palmar pain scale in carpal tunnel J Hand Surg Am very low quality
Ornstein,E.; Gummesson,C.
syndrome
Atterbury,M.R.; Limke,J.C.;
Nested case-control study of hand and
Lemasters,G.K.; Li,Y.;
1996 wrist work-related musculoskeletal Am J Ind.Med not exclusive to CTS
Forrester,C.; Stinson,R.;
disorders in carpenters
Applegate,H.
Neurovascular injuries in the hands of
Aulicino,P.L. 1990 Hand Clin. Background information
athletes
+Does not answer a
Aurora,S.K.; Ahmad,B.K.; Silent period abnormalities in carpal
1998 Muscle Nerve question of interest; very
Aurora,T.K. tunnel syndrome
low study design
Austad,W.R. 1968 The carpal tunnel syndrome Med Times background
Awada,A.A.; Bashi,S.A.; Carpal Tunnel Syndrome in type 2 Not relevant, prevalence
2000 Neurosciences (Riyadh.)
Aljumah,M.A.; Heffernan,L.P. diabetic patients study
Sensitivity of median sensory nerve
Aydin,G.; Keles,I.; insufficient data; very
2004 conduction tests in digital branches for Am J Phys Med Rehabil.
Ozbudak,Demir S.; Baysal,A.I. low study design
the diagnosis of carpal tunnel syndrome
Ultrasonographically checking the
Aydin,K.; Cokluk,C.; sectioning of the transverse carpal Does not address
2007 Turk Neurosurg.
Piskin,A.; Kocabicak,E. ligament during carpal tunnel surgery question of interest
with limited uni skin incisions
Analysis of reporting return to work in
Ayeni,O.; Thoma,A.; studies comparing open with
2005 Can J Plast.Surg systematic review
Haines,T.; Sprague,S. endoscopic carpal tunnel release: A
review of randomized controlled trials
Determination of sensitive
Aygl,R.; Ulvi,H.; Journal of clinical neurophysiology : Duplicate article
electrophysiologic parameters at
Karatay,S.; Deniz,O.; 2005 official.publication.of the American (duplicate with AAOS ID
follow-up of different steroid treatments
Varoglu,A.O. Electroencephalographic.Society 676)
of carpal tunnel syndrome
802
Reason for
Exclusion
this is more of a
diagnostic study of NCS
Sensitivities of conventional and new parameters, but for
Aygul,R.; Ulvi,H.; Kotan,D.; electrophysiological techniques in diagnostic it would be
2009 J Brachial.Plex.Peripher.Nerve Inj.
Kuyucu,M.; Demir,R. carpal tunnel syndrome and their very low quality due to
relationship to body mass index spectrum bias. for BMI
this would be not best
available evidence
Long-term clinical and
electrophysiological results of local
Ayhan-Ardic,F.F.; Erdem,H.R. 2000 Funct.Neurol Very Low Quality
steroid injection in patients with carpal
tunnel syndrome
Ayhan-Ardic,F.F.; Erdem,H.R.;
Short term results of local steroid
Karaoglan,B.; 1997 Turkish Journal of Medical Sciences Very Low Quality
injection in carpal tunnel syndrome
Yorgancioglu,Z.R.; Ayhan,O.
Incidence of trapezius myofascial
Azadeh,H.; Dehghani,M.; +Does not answer a
2010 trigger points in patients with the J Res.Med Sci
Zarezadeh,A. question of interest
possible carpal tunnel syndrome
Azami,A.; Maleki,N.; Anari,H.; The diagnostic value of ultrasound
International Journal of Rheumatic insufficient data; very
Iranparvar,Alamdari M.; 2014 compared with nerve conduction
Diseases low study design
Kalantarhormozi,M.; Tavosi,Z. velocity in carpal tunnel syndrome
Axonal degeneration of the ulnar nerve
Azmy,R.M.; Labib,A.A.; +Does not answer a
2013 secondary to carpal tunnel syndrome: Neural Regeneration Research
Elkholy,S.H. question of interest
Fact or fiction?
The role of steroid injection in the
Babu,S.R.; Britton,J.M. 1994 Journal of Orthopaedic Rheumatology Very Low Quality
management of carpal tunnel syndrome
Backhouse,K.M.; Kay,A. 1969 Carpal-tunnel syndrome letter
Badalamente,M.; Coffelt,L.;
Elfar,J.; Gaston,G.;
Measurement scales in clinical research
Hammert,W.; Huang,J.;
of the upper extremity, part 2: Outcome
Lattanza,L.; MacDermid,J.; 2013 Journal of Hand Surgery background information
measures in studies of the hand/wrist
Merrell,G.; Netscher,D.;
and shoulder/elbow
Panthaki,Z.; Rafijah,G.;
Trczinski,D.; Graham,B.
803
Reason for
Exclusion
Repeated electrophysiologic studies in
Badarny,S.; Rawashdeh,H.; patients with carpal tunnel syndrome
2011 Isr.Med Assoc J Very Low Quality
Meer,J.; Abed,S.; Habib,G. following local corticosteroid injection
using a novel approach
Neurologic and neuromuscular disease
Bader,A.M. 1999 Problems in Anesthesia Background article
in the obstetric patient
The carpal tunnel syndrome is a all confirmed CTS cases;
Bagatur,A.E.; Zorer,G. 2001 J Bone Joint Surg Br
bilateral disorder no comparison groups
Baguneid,M.S.; Sochart,D.H.; Carpal tunnel decompression under
1997 J Hand Surg Br Survey study
Dunlop,D.; Kenny,N.W. local anaesthetic and tourniquet control
Carpal tunnel syndrome: a series
Bahou,Y.G. 2002 observed at Jordan University Hospital Clin Neurol Neurosurg. records review
(JUH), June 1999-December 2000
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Fereidouni,M.; Baghbani,M. syndrome (CTS) during pregnancy question of interest
Bak,L.; Bak,S.; Gaster,P.;
MR imaging of the wrist in carpal
Mathiesen,F.; Ellemann,K.; 1997 Acta Radiol. insufficient data
tunnel syndrome
Bertheussen,K.; Zeeberg,I.
Preventing the work-related carpal
Baker,E.L.; Ehrenberg,R.L. 1990 tunnel syndrome: physician reporting Ann.Intern.Med review
and diagnostic criteria
Symptom severity and conservative
treatment for carpal tunnel syndrome in Does not address
Baker,N.A.; Livengood,H.M. 2014 J Hand Surg Am
association with eventual carpal tunnel question of interest
release
A simple way to reduce neurovascular
Baker,R.H.; Gill,K.;
2008 complications in open carpal tunnel Plast.Reconstr.Surg Narrative review
Davey,P.A.
decompression
Assessment of validity, reliability,
Bakhsh,H.; Ibrahim,I.; responsiveness and bias of three
Khan,W.; Smitham,P.; 2012 commonly used patient-reported Ortop.Traumatol.Rehabil. very low quality
Goddard,N. outcome measures in carpal tunnel
syndrome
Balakrishnan,C.; Mussman,J.L.; Acute carpal tunnel syndrome from
2009 Can J Plast.Surg case report
Balakrishnan,A.; Khalil,A.J. burns of the hand and wrist
804
Reason for
Exclusion
Carpal tunnel syndrome and metabolic all CTS cases; no
Balci,K.; Utku,U. 2007 Acta Neurol Scand.
syndrome comparison group
Ball,C.; Pearse,M.; Validation of a one-stop carpal tunnel
Kennedy,D.; Hall,A.; 2011 clinic including nerve conduction Ann.R Coll Surg Engl. very low quality
Nanchahal,J. studies and hand therapy
The results of carpal tunnel release:
Bande,S.; De,Smet L.; Fabry,G. 1994 J Hand Surg Br very low quality
open versus endoscopic technique
Bandinelli,F.; Kaloudi,O.;
Early detection of median nerve
Candelieri,A.; Conforti,M.L.;
syndrome at the carpal tunnel with Does not answer a
Casale,R.; Cammarata,S.;
2010 high-resolution 18 MHz Clin Exp.Rheumatol. question of interest; no
Grassiri,G.; Miniati,I.;
ultrasonography in systemic sclerosis CTS develpment
Melchiorre,D.; Matucci-
patients
Cerinic,M.
Banerjee,T.; Meagher,J.N. 1974 Carpal desmotomy: a technical note N.C Med J Background article
A prospective, nonrandomized study of
iontophoresis, wrist splinting, and
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treatment of early-mild carpal tunnel
syndrome
Barbosa,R.I.; da Silva
Effectiveness of low-level laser therapy
Rodrigues,E.K.; Tamanini,G.;
for patients with carpal tunnel
Marcolino,A.M.; Elui,V.M.; de 2012 BMC Musculoskelet.Disord. Review
syndrome: design of a randomized
Jesus Guirro,R.R.; Mazzer,N.;
single-blinded controlled trial
de Cassia Registro,Fonseca M.
Carpal tunnel syndrome and its
Barcenilla,A.; March,L.;
2011 relationship to occupation: A meta- Internal Medicine Journal meta-analysis
Chen,J.; Sambrook,P.
analysis
Carpal tunnel syndrome and its
Barcenilla,A.; March,L.M.;
2012 relationship to occupation: a meta- Rheumatology (Oxford) meta-analysis
Chen,J.S.; Sambrook,P.N.
analysis
MRI's role uncertain in carpal tunnel
Barnes,D.E. 1992 Diagn.Imaging (San.Franc.) Commentary/review
syndrome
Barnes,L.; Rodnan,G.P.; Eosinophilic fasciitis. A pathologic
1979 Am J Pathol. Not relevant to CTS
Medsger,T.A.; Short,D. study of twenty cases
Occupational medicine: carpal tunnel
Barnhart,S.; Daniell,W. 1988 West J Med Background Information
syndrome-a cumulative trauma disorder
805
Reason for
Exclusion
Barnhart,S.; Demers,P.A.;
Carpal tunnel syndrome among ski Not relevant, prevalence
Miller,M.; Longstreth,W.T.,Jr.; 1991 Scand.J Work Environ.Health
manufacturing workers study
Rosenstock,L.
Gaining the upper hand on carpal tunnel
Barrer,S.J. 1991 Occup.Health Saf background
syndrome
The effectiveness of particular
physiotherapy techniques in the
Bartkowiak,Z.; Zgorzalewicz-
2011 treatment of carpal tunnel syndrome - Fizjoterapia literature review
Stachowiak,M.; Nowicka,A.
Application of low-level laser therapy
based on a review of the literature
Amyloidosis and the carpal tunnel
Bastian,F.O. 1974 Am J Clin Pathol. biopsy study
syndrome
The de Quervain's screening tool:
Batteson,R.; Hammond,A.; validity and reliability of a measure to
2008 Musculoskeletal Care not exclusive to CTS
Burke,F.; Sinha,S. support clinical diagnosis and
management
Batur Caglayan,H.Z.; Nerve conduction velocities in not relevant; CTS
2013 Neuroendocrinology Letters
Nazliel,B.; Irkec,C. hyperlipidemic patients patients excluded
Carpal tunnel syndrome. An
Bauer,M.E. 1985 Dent.Hyg.(Chic.) Background Information
occupational risk to the dental hygienist
Bayrak,A.O.; Tilki,H.E.; Sympathetic skin response and axon insufficient data; very
Coskun,M. count in carpal tunnel syndrome low study design
Ultrasonography in carpal tunnel
Bayrak,I.K.; Bayrak,A.O.;
syndrome: comparison with insufficient data; very
Tilki,H.E.; Nural,M.S.; 2007 Muscle Nerve
electrophysiological stage and motor low study design
Sunter,T.
unit number estimate
Upper extremity cumulative trauma
Bear-Lehman,J. 1997 Work Background Information
disorder and return to work assessment
Beck,J.D.; Jones,R.B.;
Magnetic resonance imaging after
Malone,W.J.; Heimbach,J.L.; 2013 J Hand Surg Am Not relevant
endoscopic carpal tunnel release
Ebbitt,T.; Klena,J.C.
Changes in treatment plan for carpal
Becker,S.J.; Makanji,H.S.; Does not answer a
2014 tunnel syndrome based on J Hand Surg Eur.Vol.
Ring,D. question of interest
electrodiagnostic test results
Becker,S.J.; Makanji,H.S.; Expected and actual improvement of
Ring,D. symptoms with carpal tunnel release
806
Reason for
Exclusion
Carpal tunnel syndrome--diagnosis and
Becton,J.L. 1969 J Med Assoc Ga background
management
High-resolution sonography of the
Beekman,R.; Visser,L.H. 2004 peripheral nervous system -- a review of Eur.J Neurol literature review
the literature
Sonography in the diagnosis of carpal
Beekman,R.; Visser,L.H. 2003 tunnel syndrome: a critical review of Muscle Nerve literature review
the literature
Letter: Carpal tunnel syndrome and
Beer,T.C.; Memon,N. 1976 Br Med J letter
tennis elbow
Increased risk of median nerve
Bekkelund,S.I.; Torbergsen,T.; dysfunction in floor cleaners: a Not relevant, CTS
2001 Scand.J Plast.Reconstr.Surg Hand Surg
Rom,A.K.; Mellgren,S.I. controlled clinical and diagnosis not made
neurophysiological study
Reversal of the carpal tunnel syndrome
Bell,D.S.H.; Clements,Jr 1983 Case report
after change of insulin injection sites
'Pocket filaments' and specifications for review; background
Bell-Krotoski,J. 1994 Star
the Semmes-Weinstein monofilaments information
Surgeon's acute carpal tunnel syndrome:
Belsole,R.J.; Greeley,J.M. 1988 J Fla Med Assoc case report
an occupational hazard?
Diagnosis of compressive and
Beltran,J.; Rosenberg,Z.S. 1994 entrapment neuropathies of the upper Am.J.Roentgenol. Background Information
extremity: Value of MR imaging
Bendler,E.M.; Greenspun,B.; The bilaterality of carpal tunnel
1977 Arch Phys Med Rehabil. records review
Yu,J.; Erdman,W.J. syndrome
Benson,L.S.; Bare,A.A.;
Complications of endoscopic and open
Nagle,D.J.; Harder,V.S.; 2006 systematic review
carpal tunnel release
Williams,C.S.; Visotsky,J.L.
The long-term follow-up of treatment
Berger,M.; Vermeulen,M.;
with corticosteroid injections in patients
Koelman,J.H.; van Schaik,I.N.; 2013 J Hand Surg Eur.Vol. Very Low Quality
with carpal tunnel syndrome. When are
Roos,Y.B.
multiple injections indicated?
Berger,M.R.; Froimson,A.I. 1979 Hands that hurt: carpal tunnel syndrome Am J Nurs. not relevant
Bergfield,T.G.; Aulicino,P.L.;
1983 The carpal tunnel syndrome Orthop.Rev. background
DePuy,T.E.
807
Reason for
Exclusion
The (cost-)effectiveness of a lifestyle
physical activity intervention in
Bernaards,C.M.; Ariens,G.A.;
2006 addition to a work style intervention on BMC Musculoskelet.Disord. Not relevant
Hildebrandt,V.H.
the recovery from neck and upper limb
symptoms in computer workers
Insufficient data (Mean
Dose-range effects of clonidine added
Bernard,J.M.; Macaire,P. 1997 scores to relevant
to lidocaine for brachial plexus block
outcomes not reported)
Carpal tunnel syndrome: identification
Bernard,M.L. 1979 Occup.Health Nurs. background
and control
Bernstein,R.A. 1994 Endoscopic carpal tunnel release Conn.Med Narrative review
Bessette,L.; Keller,R.B.;
Prognostic value of a hand symptom
Lew,R.A.; Simmons,B.P.; very low strength of
1997 diagram in surgery for carpal tunnel J Rheumatol.
Fossel,A.H.; Mooney,N.; evidence
syndrome
Katz,J.N.
Bessette,L.; Sangha,O.; Comparative responsiveness of generic
Kuntz,K.M.; Keller,R.B.; versus disease-specific and weighted +Does not answer a
1998 Med Care
Lew,R.A.; Fossel,A.H.; versus unweighted health status question of interest
Katz,J.N. measures in carpal tunnel syndrome
Early detection of carpal tunnel insufficient data; very
Bhala,R.P.; Thoppil,E. 1981 Electromyogr.Clin Neurophysiol.
syndrome by sensory nerve conduction low study design
Bhatia,R.; Field,J.; Grote,J.; Does splintage help pain after carpal Insufficient data
2000 J Hand Surg Br
Huma,H. tunnel release? (conference poster)
A randomized controlled trial of Does not meet inclusion
Bhattacharya,R.; Birdsall,P.D.;
2004 knifelight and open carpal tunnel J Hand Surg Br criteria (invasive follow-
Finn,P.; Stothard,J.
release up<3 month)
Bialosky,J.E.; Bishop,M.D.; A randomized sham-controlled trial of a
Price,D.D.; Robinson,M.E.; 2009 neurodynamic technique in the J Orthop Sports Phys Ther Manuscript
Vincent,K.R.; George,S.Z. treatment of carpal tunnel syndrome
Heightened pain sensitivity in
Bialosky,J.E.; Bishop,M.D.; individuals with signs and symptoms of
Robinson,M.E.; Price,D.D.; 2011 carpal tunnel syndrome and the Man.Ther Manuscript
George,S.Z. relationship to clinical outcomes
following a manual therapy intervention
Bianchi,S.; Martinoli,C.; High-frequency ultrasound examination
1999 Skeletal Radiol. Background Information
Abdelwahab,I.F. of the wrist and hand
808
Reason for
Exclusion
Bianchi,S.; Montet,X.;
High-resolution sonography of Background Information;
Martinoli,C.; Bonvin,F.; 2004 J.Clin.Ultrasound
compressive neuropathies of the wrist review
Fasel,J.
Patient satisfaction with tourniquet
Bidwai,A.S.; Benjamin-
application and local anaesthesia
Laing,H.E.; Shaw,D.A.;
2013 infiltration in carpal tunnel J Plast.Surg Hand Surg Very low quality
Iqbal,S.; Jones,W.A.;
decompression and the relationship with
Brown,D.J.
overall satisfaction
Peripheral nerve compression
Bienek,T.; Kusz,D.; insufficient data; no
2006 neuropathy after fractures of the distal J Hand Surg Br
Cielinski,L. comparison group
radius
Does dexamethasone improve the
Bigat,Z.; Boztug,N.;
quality of intravenous regional Deemed clinically
Hadimioglu,N.; Cete,N.; 2006 Anesth.Analg.
anesthesia and analgesia? A irrelevant
Coskunfirat,N.; Ertok,E.
randomized, controlled clinical study
Comparison of the effect of low-dose
Bigat,Z.; Karsli,B.; Boztug,N.; ropivacaine and lidocaine in Deemed clinically
2005 Clinical Drug Investigation
Cete,N.; Ertok,E. intravenous regional anaesthesia: A irrelevant
randomised, double-blind clinical study
Practice standards, guidelines and
Biondi,R. 1997 options for Carpal Tunnel Syndrome: Europa Medicophysica systematic review
Usefulness and limitations
+not best available
Occupation in relation to the carpal
Birkbeck,M.Q.; Beer,T.C. 1975 Rheumatol.Rehabil. evidence; confounding
tunnel syndrome
comorbidities
Bischoff,C.; Isenberg,C.; Lack of hyperlipidemia in carpal tunnel insufficient data; very
1991 Eur.Neurol
Conrad,B. syndrome low study design
An open twin incision technique of
Biyani,A.; Downes,E.M. 1993 carpal tunnel decompression with J Hand Surg Br very low quality
reduced incidence of scar tenderness
Avoiding complications of surgery for
Blair,S.J. 1988 Orthop Clin North Am Background article
nerve compression syndromes
Self-reported carpal tunnel syndrome:
Blanc,P.D.; Faucett,J.;
predictors of work disability from the
Kennedy,J.J.; Cisternas,M.; 1996 Am J Ind.Med very low quality
National Health Interview Survey
Yelin,E.
Occupational Health Supplement
809
Reason for
Exclusion
Do nerve conduction studies predict the
Bland,J.D. 2001 outcome of carpal tunnel Muscle Nerve Retrospective case series
decompression?
A neurophysiological grading scale for
Bland,J.D. 2000 Muscle Nerve report
carpal tunnel syndrome
Ultrasound imaging of the median
Bland,J.D.P.; Rudolfer,S.M. 2014 nerve as a prognostic factor for carpal Muscle Nerve Very low strength
tunnel decompression
Vibration perception thresholds in review; background
Bleecker,M.L. 1986 J Occup.Med
entrapment and toxic neuropathies information
New techniques for the diagnosis of
Bleecker,M.L.; Agnew,J. 1987 Scand.J Work Environ.Health Background Information
Bloem,J.J.;
The post-carpal tunnel syndrome.
Pradjarahardja,M.C.; 1986 Neth.J Surg Retrospective case series
Causes and prevention
Vuursteen,P.J.
Behavior of beta 2-microglobulin in
patients with chronic renal failure
Blumberg,A.; Burgi,W. 1987 undergoing hemodialysis, Clin Nephrol. Not relevant to CTS
hemodiafiltration and continuous
ambulatory peritoneal dialysis (CAPD)
A prospective, longitudinal outcome
Bodavula,V.K.; Burke,F.D.;
study of patients with carpal tunnel +Does not answer a
Dubin,N.H.; Bradley,M.J.; 2007 Hand (N.Y)
surgery and the relationship of body question of interest
Wilgis,E.F.
mass index
Boden,B.P.; Kozin,S.H.;
1995 Wrist arthroscopy Am.J.Orthop. Background article
Berlet,A.C.
+Does not answer a
A mathematical model for peripheral
Bodofsky,E.B. 2003 Electromyogr.Clin Neurophysiol. question of interest; not
nerve conduction velocity
best available evidence
Bodofsky,E.B.;
Age and the severity of carpal tunnel insufficient data; very
Campellone,J.V.; Wu,K.D.; 2004 Electromyogr.Clin Neurophysiol.
syndrome low study design
Greenberg,W.M.
Does not answer a
Bodofsky,E.B.; Median nerve compression at the wrist:
2001 Electromyogr.Clin Neurophysiol. question of interest;
Greenberg,W.M.; Wu,K.D. is it ever unilateral?
insufficient data
810
Reason for
Exclusion
Bodofsky,E.B.; Wu,K.D.; A sensitive new median-ulnar technique +not best available
Campellone,J.V.; 2005 for diagnosing mild Carpal Tunnel Electromyogr.Clin Neurophysiol. evidence; very low study
Greenberg,W.M.; Tomaio,A.C. Syndrome design
Does endoscopic carpal tunnel release
have a higher rate of complications than
Boeckstyns,M.E.; Sorensen,A.I. 1999 J Hand Surg Br Systematic review
open carpal tunnel release? An analysis
of published series
Carpal tunnel release: scoping out the
Boggins-Magill,M.K. 1994 Todays.OR Nurse Background article
carpal tunnel
Bogner,R.H.; Banga,A.K. 1994 Iontophoresis and phonophoresis U.S.Pharmacist Background information
Vascular factors in carpal tunnel +Does not answer a
Boland,R.A.; Adams,R.D. 2002 J Hand Ther
syndrome question of interest
A treatment for carpal tunnel syndrome:
Bonebrake,A.R. 1994 J Manipulative Physiol Ther Letter
results of follow-up study
Bonebrake,A.R.; A treatment for carpal tunnel syndrome:
+not best available
Fernandez,J.E.; Marley,R.J.; 1990 evaluation of objective and subjective J Manipulative Physiol Ther
evidence
Dahalan,J.B.; Kilmer,K.J. measures
Bonel,H.M.; Heuck,A.; Carpal tunnel syndrome: assessment by
Frei,K.A.; Herrmann,K.; turbo spin echo, spin echo, and insufficient data; very
2001 J Comput.Assist.Tomogr.
Scheidler,J.; Srivastav,S.; magnetization transfer imaging applied low study design
Reiser,M. in a low-field MR system
Bonfiglioli,R.; Botter,A.; Surface electromyography features in
+Does not answer a
Calabrese,M.; Mussoni,P.; 2012 manual workers affected by carpal Muscle Nerve
Violante,F.S.; Merletti,R. tunnel syndrome
Boninger,M.L.; Cooper,R.A.;
Wheelchair pushrim kinetics: body
Baldwin,M.A.; Shimada,S.D.; 1999 Arch Phys Med Rehabil. biomechanical case series
weight and median nerve function
Koontz,A.
Boogaarts,H.D.; Verbeek,A.L.; Surgery for carpal tunnel syndrome
2010 Clin Neurol Neurosurg.
Bartels,R.H. under antiplatelet therapy
Boonyapisit,K.; Katirji,B.; Lumbrical and interossei recording in no comparison group;
2002 Muscle Nerve
Shapiro,B.E.; Preston,D.C. severe carpal tunnel syndrome very low study design
Booth-Jones,A.D.;
Reliability of questionnaire information not exclusive to CTS;
Lemasters,G.K.; Succop,P.;
1998 measuring musculoskeletal symptoms Am.Ind.Hyg.Assoc.J. does not answer a
Atterbury,M.R.;
and work histories question of interest
Bhattacharya,A.
811
Reason for
Exclusion
Incorrect patient
Bora,Jr; Osterman,A.L.; Osteotomy of the distal radius with a
1984 Bull.Hosp.Jt.Dis.Orthop.Inst. population (does not
Zielinski,C.J. biplanar iliac bone graft for malunion
include CTS patients)
Diagnostic value of quantitative sensory insufficient data; very
Borg,K.; Lindblom,U. 1988 Acta Neurol Scand.
testing (QST) in carpal tunnel syndrome low study design
Increase of vibration threshold during not best available
Borg,K.; Lindblom,U. 1986 wrist flexion in patients with carpal evidence; very low study
tunnel syndrome design
Provoked changes in vibratory
perception threshold versus stationary +not best available
Borg,K.; Lindblom,U. 1984 Acta Neurol.Scand.
impairment of sensibility in carpal evidence
tunnel syndrom
Borgman,M.F. 1978 Carpal tunnel syndrome Nurse Pract. background
Neurophysiological recovery after open No patient oriented
carpal tunnel decompression: outcomes or clinical
Borisch,N.; Haussmann,P. 2003 J Hand Surg Br
comparison of simple decompression outcomes of interest
and decompression with epineurotomy reported.
Boshes,B.; Brumlik,J.;
1968 Clinical neurology Prog.Neurol Psychiatry book chapter
Blonsky,E.R.
Bostrom,L.; Gothe,C.J.; Surgical treatment of carpal tunnel the outcome is successful
Hansson,S.; Lugnegard,H.; 1994 syndrome in patients exposed to Scand.J Plast.Reconstr.Surg Hand Surg response after CTS
Nilsson,B.Y. vibration from handheld tools surgery
Bouaziz,H.; Kinirons,B.P.; Sufentanil does not prolong the duration
Deemed clinically
Macalou,D.; Heck,M.; Dap,F.; 2000 of analgesia in a mepivacaine brachial Anesth.Analg.
irrelevant
Benhamou,D.; Laxenaire,M.C. plexus block: a dose response study
Clinic-based nerve conduction studies
Bourke,H.E.; Read,J.;
reduce time to surgery and are cost +Does not answer a
Kampa,R.; Hearnden,A.; 2011 Ann.R Coll Surg Engl.
effective: a comparison with formal question of interest
Davey,P.A.
electrophysiological testing
Hand-arm vibration syndrome and
dose-response relation for vibration
Not exclusive to CTS; not
induced white finger among quarry
Bovenzi,M. 1994 Occup.Environ.Med sufficient number of CTS
drillers and stonecarvers. Italian Study
diagnoses
Group on Physical Hazards in the Stone
Industry
812
Reason for
Exclusion
Bovenzi,M.; Della,Vedova A.; Work-related disorders of the upper
Nataletti,P.; Alessandrini,B.; 2005 limb in female workers using orbital Int.Arch Occup.Environ.Health very low quality
Poian,T. sanders
Vibration-induced multifocal
neuropathy in forestry workers:
Bovenzi,M.; Giannini,F.; <10 patients per group;
2000 electrophysiological findings in relation Int.Arch Occup.Environ.Health
Rossi,S. not exclusive to CTS
to vibration exposure and finger
circulation
Occupational musculoskeletal disorders
Bovenzi,M.; Zadini,A.; Not relevant, prevalence
1991 in the neck and upper limbs of forestry
Franzinelli,A.; Borgogni,F. study
workers exposed to hand-arm vibration
Bowens,B.A. 1981 Carpal tunnel syndrome J Neurosurg.Nurs. background
Bowie,E.A.; Brimer,K.M.;
Kidder,M.S.; Wallis,M.L.; Median and ulnar nerve conduction Not relevant, CTS
2000 Medical Problems of Performing Artists
Darr,N.S.; Halle,J.S.; studies in young adult violinists diagnosis not made
Greathouse,D.G.
Boya,H.; Ozcan,O.; Long-term complications of open carpal
2008 Muscle Nerve Retrospective case series
Oztekin,H.H. tunnel release
Effects of bias on the results of
Boyer,K.; Wies,J.;
2009 diagnostic studies of carpal tunnel J Hand Surg Am systematic review
Turkelson,C.M.
syndrome
Corticosteroid injection for carpal
Boyer,M.I. 2008 J Hand Surg Am Narrative review
tunnel syndrome
Braddom,R.L.; Johnson,E.W.; Curriculum objectives in rehabilitation
1974 Arch Phys Med Rehabil. not relevant
Trzebiatowski,G. medicine: Results of a survey
Brahme,S.K.; Hodler,J.;
Dynamic MR imaging of carpal tunnel insufficient data; very
Braun,R.M.; Sebrechts,C.; 1997 Skeletal Radiol.
Jackson,W.; Resnick,D.
Haemostasis during carpal tunnel
Braithwaite,B.D.; release under local anaesthesia: a
1993 J Hand Surg Br Very low quality
Robinson,G.J.; Burge,P.D. controlled comparison of a tourniquet
and adrenaline infiltration
Second lumbrical muscle recordings
no comparison group or
Brannegan,R.; Bartt,R. 2007 improve localization in severe carpal Arch Phys Med Rehabil.
reference standard
tunnel syndrome
813
Reason for
Exclusion
Brantingham,J.W.; Cassa,T.K.; Manipulative and multimodal therapy
Bonnefin,D.; Pribicevic,M.; for upper extremity and
2013 J Manipulative Physiol Ther systematic review
Robb,A.; Pollard,H.; Tong,V.; temporomandibular disorders: a
Korporaal,C. systematic review
Braun,R.M.; Davidson,K.; Provocative testing in the diagnosis of +Does not answer a
1989 J Hand Surg Am
Doehr,S. dynamic carpal tunnel syndrome question of interest
Electrical studies as a prognostic factor
Braun,R.M.; Jackson,W.J. 1994 in the surgical treatment of carpal J Hand Surg Am very low quality
tunnel syndrome
Bravaccio,F.; Trabucco,M.; Carpal tunnel syndrome: a clinical all CTS cases; no
1990 Neurophysiol.Clin
Ammendola,A.; Cantore,R. electrophysiological study of 84 cases comparison group
Breuer,B.; Sperber,K.; Clinically significant placebo analgesic
Wallenstein,S.; Kiprovski,K.; response in a pilot trial of botulinum B
2006 Pain Med Very Low Quality
Calapa,A.; Snow,B.; in patients with hand pain and carpal
Pappagallo,M. tunnel syndrome
Cutaneomuscular reflex in a peripheral insufficient data; very
Brezinova,V. 1988 Electromyogr.Clin.Neurophysiol.
nerve lesion low study design
Brick,J.E.; Brick,J.F.; Musculoskeletal disorders. When are review; background
1991 Postgrad.Med
Elnicki,D.M. they caused by hormone imbalance? information
Predicting the result of nerve insufficient data; does not
Bridges,M.J.; Robertson,D.C.;
2011 conduction tests in carpal tunnel Hand Surg answer question of
Chuck,A.J.
syndrome using a questionnaire interest
Briemberg,H.R. 2007 Neuromuscular diseases in pregnancy Semin.Neurol. background
Number of potential reversals (turns)
and amplitude of the pattern of
Bril,V.; Fuglsang- not exclusive to CTS;
1984 electrical activity of the abductor Acta Neurol Scand.
Frederiksen,A. very low study design
pollicis brevis muscle in patients with
neurogenic diseases
Changes in electrical threshold in
Brismar,T. 1985 J Neurol Sci <10 patients per group
human peripheral neuropathy
Nerve conduction in the hands of
Brismar,T.; Ekenvall,L. 1992 Electroencephalogr.Clin Neurophysiol. Not relevant
vibration exposed workers
Carpal tunnel syndrome: correlation of
Britz,G.W.; Haynor,D.R.;
magnetic resonance imaging, clinical, insufficient data; very
Kuntz,C.; Goodkin,R.; 1995
electrodiagnostic, and intraoperative low study design
Gitter,A.; Kliot,M.
findings
814
Reason for
Exclusion
Patterns of sensory nerve conduction
Bromberg,M.B.; Albers,J.W. 1993 abnormalities in demyelinating and Muscle Nerve Not relevant to CTS
axonal peripheral nerve disorders
Provocative motor nerve conduction
+Does not answer a
testing in presumptive carpal tunnel
Bronson,J.; Beck,J.; Gillet,J. 1997 J Hand Surg Am question of interest; very
syndrome unconfirmed by traditional
low study design
electrodiagnostic testing
Coexistence of muscle anomalies and
Brown,F.E.; Morgan,G.J.,Jr.;
1984 rheumatoid arthritis in patients with Clin Exp.Rheumatol. case reports
Taylor,T.; O'Connor,G.T.
Brown,M.G.; Keyser,B.;
1992 Endoscopic carpal tunnel release J Hand Surg Am very low quality
Rothenberg,E.S.
Brown,M.G.; Rothenberg,E.S.; Results of 1236 endoscopic carpal
Keyser,B.; Woloszyn,T.T.; 1993 tunnel release procedures using the Contemp Orthop no control group
Wolford,A. Brown technique
Differentiating the diabetic
Brown,M.J.; Baringer,J.R. 1994 Hosp.Pract. Case reports
neuropathies
Brown,R.A.; Gelberman,R.H.;
Seiler,J.G.,III; Carpal tunnel release. A prospective, Does not meet inclusion
Abrahamsson,S.O.; 1993 randomized assessment of open and J Bone Joint Surg Am criteria (invasive follow-
Weiland,A.J.; Urbaniak,J.R.; endoscopic methods up<3 month)
Schoenfeld,D.A.; Furcolo,D.
not exclusive to CTS;
Estimates of functional motor axon loss
Brown,W.F.; Feasby,T.E. 1974 J.Neurol.Sci. does not answer a
in diabetics
The location of conduction +Does not answer a
Brown,W.F.; Ferguson,G.G.;
1976 abnormalities in human entrapment Can J Neurol Sci question of interest;
Jones,M.W.; Yates,S.K.
neuropathies insufficient data
Browne,D.L.; McCrae,F.C.;
2001 Musculoskeletal disease in diabetes Practical Diabetes International review
Shaw,K.M.
Carpal tunnel syndrome caused by hand insufficient data; no
Browne,E.Z.,Jr.; Snyder,C.C. 1975 Plast.Reconstr.Surg
injuries comparison group
Carpal tunnel syndrome in rheumatoid
Brumfield,Jr 1983 Orthop.Rev. Retrospective case series
arthritis
Surgical exposure of flexor tendons in
Bruner,J.M. 1973 Ann.R Coll Surg Engl. Commentary
the hand
815
Reason for
Exclusion
The operative treatment of carpal tunnel Does not meet inclusion
Bruser,P.; Richter,M.;
1999 syndrome and its relevance to European Journal of Plastic Surgery criteria (invasive follow-
Larkin,G.; Lefering,R.
endoscopic release up<3 month)
The usefulness of the Phalen test and
Bruske,J.; Bednarski,M.; insufficient data; very
2002 the Hoffmann-Tinel sign in the Acta Orthop Belg.
Grzelec,H.; Zyluk,A. low study design
Multiple nerve entrapments associated
with carpal tunnel syndrome. A four Does not address
Bryar,G.E. 1984 Int.Angiol.
year prospective study of 97 surgically question of interest
treated patients
Cochrane corner: ergonomic
Buchan,S.; Amirfeyz,R. 2013 positioning or equipment for treating J Hand Surg Eur.Vol. systematic review
Buchberger,W.; Judmaier,W.;
Carpal tunnel syndrome: diagnosis with insufficient data; very
Birbamer,G.; Lener,M.; 1992 AJR Am J Roentgenol.
high-resolution sonography low study design
Schmidauer,C.
Buchberger,W.; Schon,G.; High-resolution ultrasonography of the insufficient data; very
Strasser,K.; Jungwirth,W. carpal tunnel low study design
Correlation of clinical signs with nerve
not best available
Buch-Jaeger,N.; Foucher,G. 1994 conduction tests in the diagnosis of J Hand Surg Br
evidence
Sensory conduction from digit to palm
very low study design;
Buchthal,F.; Rosenfalck,A. 1971 and from palm to wrist in the carpal J Neurol Neurosurg.Psychiatry
<10 patients per group
tunnel syndrome
Electrophysiological findings in no comparison of
Buchthal,F.; Rosenfalck,A.;
1974 entrapment of the median nerve at wrist J Neurol Neurosurg.Psychiatry modalities; very low
Trojaborg,W.
and elbow study design
Buckle,P.W. 1997 Work factors and upper limb disorders Br.Med.J. clinical review
The diagnostic and grading value of
Bulut,H.T.; Yildirim,A.; case control; CTS and
2014 diffusion tensor imaging in patients Acad Radiol
Ekmekci,B.; Gunbey,H.P. healthy
with carpal tunnel syndrome
Difference in normal values of median
Burg,E.W.; Bathala,L.; only healthy study
2013 nerve cross sectional area between Muscle Nerve
Visser,L.H. subjects
Dutch and Indian subjects
816
Reason for
Exclusion
Burke,D.T.; Burke,M.A.;
Subjective swelling: a new sign for not best available
Bell,R.; Stewart,G.W.; 1999 Am J Phys Med Rehabil.
carpal tunnel syndrome evidence
Mehdi,R.S.; Kim,H.J.
Burke,F.D.; Ellis,J.; Primary care management of carpal
2003 Postgrad.Med J Background artcle
McKenna,H.; Bradley,M.J. tunnel syndrome
The management of carpal tunnel
Burke,F.D.; Hasham,S. 2005 Minerva Ortopedica e Traumatologica background
syndrome
Burke,F.D.; Wilgis,E.F.; Relationship between the duration and
Does not address
Dubin,N.H.; Bradley,M.J.; 2006 severity of symptoms and the outcome J Hand Surg Am
Sinha,S. of carpal tunnel surgery
Burke,J.; Buchberger,D.J.;
A pilot study comparing two manual
Carey-Loghmani,M.T.; deemed clinically
2007 therapy interventions for carpal tunnel J Manipulative Physiol Ther
Dougherty,P.E.; Greco,D.S.; irrelevant
syndrome
Dishman,J.D.
Musculoskeletal disorders in diabetes
Burnet,S.; McNeil,J. 2001 Medicine Today Background Information
mellitus
Effect of hand warming on
electrodiagnostic testing results and +Does not answer a
Burnham,R.S.; Burnham,T.R. 2009 Arch Phys Med Rehabil.
diagnosis in patients with suspected question of interest
Carpal tunnel syndrome among
employees at a window hardware
Burt,S. 1991 AAOHN J evaluation narrative
manufacturing plant. Health hazard
evaluation series
Burton,N.C.; MacDonald,L.; Ergonomic assessment of trimming jobs Applied Occupational and
1998 not exclusive to CTS
Estill,C.F. at a shoe manufacturing plant Environmental Hygiene
Advanced glycation end products and
Not relevant, predictors
Busch,M.; Schwenzky,A.; beta(2)-microglobulin as predictors of
2012 Blood Purif. of CTS in hemodialysis
Franke,S.; Stein,G.; Wolf,G. carpal tunnel syndrome in hemodialysis
patients
patients
Clinical and employment outcomes of
all CTS cases; no
Butterfield,P.G. 1997 carpal tunnel syndrome in oregon Journal of Occupational Rehabilitation
comparison group
workers' compensation recipients
Pyridoxine metabolism in carpal tunnel
Byers,C.M.; DeLisa,J.A.;
1984 syndrome with and without peripheral Arch Phys Med Rehabil. <10 patients per group
Frankel,D.L.; Kraft,G.H.
neuropathy
817
Reason for
Exclusion
Caccia,M.R.; Galimberti,V.;
Peripheral autonomic involvement in insufficient data; very
Valla,P.L.; Salvaggio,A.; 1993 Acta Neurol Scand.
the carpal tunnel syndrome low study design
Dezuanni,E.; Mangoni,A.
Axonal degeneration in association with insufficient data; very
Caetano,M.R. 2003 Arq Neuropsiquiatr.
carpal tunnel syndrome low study design
Warm-needling plus Tuina relaxing for
Cai,D.F. 2010 J Tradit.Chin Med Very Low Quality
the treatment of carpal tunnel syndrome
Caliandro,P.; Giannini,F.;
A new clinical scale to grade the
Pazzaglia,C.; Aprile,I.; insufficient data; no
2010 impairment of median nerve in carpal Clin Neurophysiol.
Minciotti,I.; Granata,G.; comparison group
tunnel syndrome
Tonali,P.; Padua,L.
not best available
Cambi,V.; Nizzoli,M.; Danger of an unnecessarily prolonged
1986 Artif.Organs evidence; very low study
Paganelli,E.; David,S.; Bono,F. dialysis session: carpal tunnel syndrome
design
Candelise,L.; Cantisani,T.A.;
Celani,M.G.; Incorvaia,B.;
Righetti,E.; Salinas,R.; Carpal tunnel syndrome: One flew over
Journal of Orthopaedics and
Schoenhuber,R.; Altissimi,M.; 2004 the surgeon's nest. The Cochrane literature review
Traumatology
Azzara,A.; Pecorelli,F.; Neurological Network
Luchetti,R.; Padua,L.;
Perticoni,G.; Ricci,S.
Cannon,L.J.; Bernacki,E.J.; Personal and occupational factors
1981 J Occup.Med very low quality
Walter,S.D. associated with carpal tunnel syndrome
Cantatore,F.P.; Dell'Accio,F.;
1997 Carpal tunnel syndrome: a review Clin Rheumatol. background
Lapadula,G.
Management of extreme carpal tunnel
Capasso,M.; Manzoli,C.;
2009 syndrome: evidence from a long-term Muscle Nerve Retrospective case series
Uncini,A.
follow-up study
Pitfalls in using the ring finger test
Capone,L.; Pentore,R.; no comparison group;
1998 alone for the diagnosis of carpal tunnel Ital.J Neurol Sci
Lunazzi,C.; Schonhuber,R. very low study design
syndrome
Cappellari,M.; Cavallaro,T.;
Ferrarini,M.; Cabrini,I.; Variable presentations of TTR-related
Taioli,F.; Ferrari,S.; Merlini,G.; 2011 familial amyloid polyneuropathy in J Peripher.Nerv.Syst. Not relevant to CTS
Obici,L.; Briani,C.; seventeen patients
Fabrizi,G.M.
818
Reason for
Exclusion
Carpal tunnel syndrome: the cause
Carneiro,R.S. 1999 Cleve.Clin J Med Background article
dictates the treatment
Repetitive trauma and nerve
Carragee,E.J.; Hentz,V.R. 1988 Orthop Clin North Am background
compression
Comparison of median and radial nerve
sensory latencies in the insufficient data; no
Carroll,G.J. 1987 Electroencephalogr.Clin Neurophysiol.
electrophysiological diagnosis of carpal comparison of modalities
tunnel syndrome
Rare anomalous muscle cause of carpal
Carroll,M.P.; Montero,C. 1980 Orthop.Rev. case report
tunnel syndrome
The relationship of thoracic outlet +Does not answer a
Carroll,R.E.; Hurst,L.C. 1982 Clin Orthop Relat Res.
syndrome and carpal tunnel syndrome question of interest
Does not meet inclusion
The effectiveness of magnet therapy for
criteria (conservative
Carter,R.; Aspy,C.B.; Mold,J. 2002 treatment of wrist pain attributed to J Fam Pract.
treatment follow-up at
<1 month)
Electrodiagnostic techniques in the pre-
Carter,T.; Jordan,R.; surgical assessment of patients with Health Technology Assessment
2000 background info
Cummins,C. carpal tunnel syndrome (Structured Database
abstract)
Cartwright,M.S.; Hobson-
Webb,L.D.; Boon,A.J.;
Evidence-based guideline:
Alter,K.E.; Hunt,C.H.;
2012 neuromuscular ultrasound for the Muscle Nerve systematic review
Flores,V.H.; Werner,R.A.;
Shook,S.J.; Thomas,T.D.;
Primack,S.J.; Walker,F.O.
Cartwright,M.S.; Walker,F.O.;
Newman,J.C.; Arcury,T.A.; Muscle Intrusion as a Potential Cause of
2014 Muscle Nerve very low strength
Mora,D.C.; Chen,H.; Carpal Tunnel Syndrome
Quandt,S.A.
Cartwright,M.S.; White,D.L.;
Demar,S.; Wiesler,E.R.;
Sarlikiotis,T.; Chloros,G.D.; Median nerve changes following steroid
2011 Muscle Nerve Very Low Quality
Yoon,J.S.; Won,S.J.; injection for carpal tunnel syndrome
Molnar,J.A.; Defranzo,A.J.;
Walker,F.O.
819
Reason for
Exclusion
Pain and electrophysiological
parameters are improved by combined
830-1064 high-intensity LASER in Does not meet inclusion
Casale,R.; Damiani,C.;
2013 symptomatic carpal tunnel syndrome Eur.J Phys Rehabil.Med criteria (follow-up <1
Maestri,R.; Wells,C.D.
versus Transcutaneous Electrical Nerve month)
Stimulation. A randomized controlled
study
Carpal tunnel syndrome: Relief for a
Case,W.S. 1995 Physician and Sportsmedicine background
common wrist problem
Digital nerve action potentials in no comparison of
Casey,E.B.; Le Quesne,P.M. 1972 healthy subjects, and in carpal tunnel J Neurol Neurosurg.Psychiatry modalities; very low
and diabetic patients study design
Cassvan,A.; Ralescu,S.; Median and radial sensory latencies to
no reference standard;
Shapiro,E.; Moshkovski,F.G.; 1988 digit I as compared with other screening Am J Phys Med Rehabil.
very low study design
Weiss,J. tests in carpal tunnel syndrome
Cassvan,A.; Rosenberg,A.; Ulnar nerve involvement in carpal +Does not answer a
1986 Arch Phys Med Rehabil.
Rivera,L.F. tunnel syndrome question of interest
Comparison of longitudinal open
Castillo,T.N.; Yao,J. 2010 incision and two-incision techniques for J Hand Surg Am very low quality
Activity limitations before and after
Cederlund,R.I.; Dahlin,L.B.; Does not address
2012 surgical carpal tunnel release among J Rehabil.Med
Thomsen,N.O. question of interest
patients with and without diabetes
no true comparison; does
Review of different electrodiagnostic
Celik,B.; Guven,Z. 2008 Neurosurgery Quarterly not answer a question of
studies in mild carpal tunnel syndrome
interest
Carpal tunnel syndrome reverse review; background
Cerimagic,D.; Bilic,E. 2010 Translational Neuroscience
Phalen's versus Phalen's maneuver information
Cevik,M.U.; Altun,Y.; Uzar,E.;
Acar,A.; Yucel,Y.; Diagnostic value of F-wave inversion in
Arikanoglu,A.; Varol,S.; 2012 patients with early carpal tunnel Neurosci.Lett.
low study design
Sariyildiz,M.A.; Tahtasiz,M.; syndrome
Tasdemir,N.
Cha,J.G.; Han,J.K.; Im,S.B.; Median nerve T2 assessment in the insufficient data; very
2013 J.Magn.Reson.Imaging
Kang,S.J. wrist joints: Preliminary study in low study design
820
Reason for
Exclusion
patients with carpal tunnel syndrome
and healthy volunteers
Does not answer a
Chacko,J.P.; Chand,R.P.; Clinical profile of Carpal Tunnel
2000 Neurosciences (Riyadh.) question of interest; no
Bulusu,S.; Tharakan,J.J. Syndrome in Oman
assessment of risk factors
One portal simultaneous bilateral
endoscopic carpal tunnel release under
Chalidis,B.E.; Dimitriou,C.G. 2013 Int.Orthop Very low quality
local anaesthesia. Do the results justify
the effort?
Gouty tenosynovitis and the carpal
Champion,D. 1969 Med J Aust. case reports
tunnel syndrome
Ultrasonography in the evaluation of
Chan,K.-Y.; George,J.; Goh,K.- carpal tunnel syndrome: Diagnostic insufficient data; very
2011 Neurology Asia
J.; Ahmad,T.S. criteria and comparison with nerve low study design
conduction studies
Chan,L.; Turner,J.A.;
The relationship between
Comstock,B.A.;
electrodiagnostic findings and patient +not best available
Levenson,L.M.; 2007 Arch Phys Med Rehabil.
symptoms and function in carpal tunnel evidence
Hollingworth,W.; Heagerty,P.J.;
syndrome
Kliot,M.; Jarvik,J.G.
Short versus long-acting local
anaesthetic in open carpal tunnel
Chan,Z.H.; Balakrishnan,V.; Deemed clinically
2013 release: which provides better Hand Surg
McDonald,A. irrelevant
preemptive analgesia in the first 24
hours?
Comparison is for timing
of surgery and not
Chandra,P.S.; Singh,P.K.; Early versus delayed endoscopic
comparing different CTR
Goyal,V.; Chauhan,A.K.; 2013 surgery for carpal tunnel syndrome: World Neurosurg.
tecjniques. Does not
Thakkur,N.; Tripathi,M. prospective randomized study
answer question of
interest.
Which nerve conduction parameters can insufficient data; healthy
Chang,C.W.; Lee,W.J.;
2013 predict spontaneous electromyographic Clin Neurophysiol. controls used for
Liao,Y.C.; Chang,M.H.
activity in carpal tunnel syndrome? comparison
821
Reason for
Exclusion
Comparison of sensory nerve
conduction in the palmar cutaneous
Chang,C.W.; Lien,I.N. 1991 branch and first digital branch of the Muscle Nerve
low study design
median nerve: a new diagnostic method
for carpal tunnel syndrome
A practical electrophysiological guide
Chang,C.W.; Wang,Y.C.;
2008 for non-surgical and surgical treatment J Hand Surg Eur.Vol. very low quality
Chang,K.F.
Oral drugs of choice in carpal tunnel Abstract/conference
Chang,M. 1998 Muscle Nerve
syndrome [abstract] poster
The cause of slowed forearm median
Chang,M.H.; Chiang,H.T.; insufficient data; very
2000 conduction velocity in carpal tunnel Clin Neurophysiol.
Ger,L.P.; Yang,D.A.; Lo,Y.K. low study design
syndrome
The role of forearm mixed nerve
Chang,M.H.; Lee,Y.C.; conduction study in the evaluation of insufficient data; very
2008 Clin Neurophysiol.
Hsieh,P.F. proximal conduction slowing in carpal low study design
tunnel syndrome
The real role of forearm mixed nerve
Chang,M.H.; Lee,Y.C.; conduction velocity in the assessment insufficient data; very
Hsieh,P.F. of proximal forearm conduction low study design
slowing in carpal tunnel syndrome
Electrodiagnosis of carpal tunnel
Chang,M.H.; Liao,Y.C.; insufficient data; very
2009 syndrome: which transcarpal J Clin Neurophysiol.
Lee,Y.C.; Hsieh,P.F.; Liu,L.H. low study design
conduction technique is best?
Comparison of sensitivity of transcarpal
Chang,M.H.; Liu,L.H.; median motor conduction velocity and
Lee,Y.C.; Wei,S.J.; 2006 conventional conduction techniques in Clin Neurophysiol.
low study design
Chiang,H.L.; Hsieh,P.F. electrodiagnosis of carpal tunnel
syndrome
Chang,M.H.; Wei,S.J.; Comparison of motor conduction
insufficient data; no
Chiang,H.L.; Wang,H.M.; 2002 techniques in the diagnosis of carpal
comparison group
Hsieh,P.F.; Huang,S.Y. tunnel syndrome
Does direct measurement of forearm
Chang,M.H.; Wei,S.J.;
mixed nerve conduction velocity reflect insufficient data; very
Chiang,H.L.; Wang,H.M.; 2002 Clin Neurophysiol.
actual nerve conduction velocity low study design
Hsieh,P.F.; Huang,S.Y.
through the carpal tunnel?
822
Reason for
Exclusion
Changulani,M.; Okonkwo,U.; Outcome evaluation measures for wrist
2008 Int.Orthop systematic review
Keswani,T.; Kalairajah,Y. and hand: which one to choose?
Poor outcome for neural surgery
(epineurotomy or neurolysis) for carpal
Chapell,R.; Coates,V.;
2003 tunnel syndrome compared with carpal Plast.Reconstr.Surg Meta-analysis
Turkelson,C.
tunnel release alone: a meta-analysis of
global outcomes
Carpal tunnel syndrome and routine +Does not answer a
Chaplin,E.; Kasdan,M.L. 1985 Plast.Reconstr.Surg
blood chemistries question of interest
Single versus double incision technique
Abstract/conference
Chari,R.; Hamed,A.; Packer,G. 2004 in carpal tunnel decompression. A The Journal of Bone and Joint Surgery
poster
randomised controlled trial
Chassin,S.L.; Little,J.W.; Compound nerve action potentials from only healthy study
DeLisa,J.A. the median and ulnar nerves subjects
Chaudhuri,K.R.; Limited joint mobility and carpal tunnel insufficient data; very
1989 Br J Rheumatol.
Davidson,A.R.; Morris,I.M. syndrome in insulin-dependent diabetes low study design
Patient-reported outcomes after acute
Chauhan,A.; Bowlin,T.C.; carpal tunnel release in patients with
2012 Hand (N.Y) very low quality
Mih,A.D.; Merrell,G.A. distal radius open reduction internal
fixation
Checkosky,C.M.; Assessment of vibrotactile sensitivity in insufficient data; very
1996 J Occup.Environ.Med
Bolanowski,S.J.; Cohen,J.C. patients with carpal tunnel syndrome low study design
Work practices and histopathological
changes in the tenosynovium and flexor cadavers used as
Chell,J.; Stevens,A.; Davis,T.R. 1999 J Bone Joint Surg Br
retinaculum in carpal tunnel syndrome reference; biopsies
in women
retrospective chart
Chen,C.H.; Wu,T.; Sun,J.S.; Unusual causes of carpal tunnel
2012 J Hand Surg Eur.Vol. review; no comparison
Lin,W.H.; Chen,C.Y. syndrome: space occupying lesions
group
Chen,C.K.; Chung,C.B.;
Carpal tunnel syndrome caused by retrospective records
Yeh,L.; Pan,H.B.; Yang,C.F.;
2000 tophaceous gout: CT and MR imaging AJR Am J Roentgenol. review; no comparison
Lai,P.H.; Liang,H.L.;
features in 20 patients group
Resnick,D.
823
Reason for
Exclusion
incorrect patient
The effect of acupuncture treatment on population (post-op vs.
Chen,G.S. 1990 American Journal of Acupuncture
Carpal Tunnel Syndrome pre-op patients not
stratified)
Chen,H.T.; Chen,H.C.;
1999 Endoscopic carpal tunnel release Changgeng Yi Xue Za Zhi Very Low Quality
Wei,F.C.
Effectiveness and safety of endoscopic
Chen,L.; Duan,X.; Huang,X.;
2014 versus open carpal tunnel Arch Orthop Trauma Surg Meta-analysis
Lv,J.; Peng,K.; Xiang,Z.
decompression
Ultrasonographic median nerve cross-
Chen,S.F.; Lu,C.H.; section areas measured by 8-point
Huang,C.R.; Chuang,Y.C.; "inching test" for idiopathic carpal insufficient data; very
2011 BMC Med Imaging
Tsai,N.W.; Chang,C.C.; tunnel syndrome: a correlation of nerve low study design
Chang,W.N. conduction study severity and duration
of clinical symptoms
Cheng,C.J.; Mackinnon-
Scratch collapse test for evaluation of insufficient data; very
Patterson,B.; Beck,J.L.; 2008 J Hand Surg Am
carpal and cubital tunnel syndrome low study design
Mackinnon,S.E.
Proximal pain in carpal tunnel insufficient data;
Cherington,M. 1974 Arch Surg
syndrome summary document
Detailed clinical assessment of +Does not answer a
Cherniack,M.G.; Let,R.;
1990 neurological function in symptomatic Br.J.Ind.Med. question of interest; not
Gerr,F.; Brammer,A.; Pace,P.
shipyard workers best available evidence
A comparison of traditional
Cherniack,M.G.; Moalli,D.; electrodiagnostic studies, insufficient data; very
1996 J Hand Surg Am
Viscolli,C. electroneurometry, and vibrometry in low study design
Surgical release of carpal tunnel
Chia,J.; Pho,R.W.H. 1997 Journal of Orthopaedic Surgery Retrospective case series
syndrome under local anaesthesia
Chiang,H.C.; Ko,Y.C.; Prevalence of shoulder and upper-limb
Prevalence study; not
Chen,S.S.; Yu,H.S.; Wu,T.N.; 1993 disorders among workers in the fish- Scand.J Work Environ.Health
best evidence
Chang,P.Y. processing industry
Chidgey,L.K. 1992 Chronic wrist pain Orthop.Clin.North Am. background
Does the severity of bilateral carpal
Chin,S.H.; Tom,L.K.;
2011 tunnel syndrome influence the timing of Ann.Plast.Surg Retrospective case series
Thomson,J.G.
staged bilateral release?
824
Reason for
Exclusion
Carpal tunnel syndrome: splinting or
Chin,Y.H.; Lim,K.H.;
2005 surgery? A systematic review Singapore General Hospital Proceedings systematic review
Poh,B.K.; Koh,D.
(Provisional abstract)
Chiotis,K.; Dimisianos,N.;
Role of anthropometric characteristics insufficient data; very
Rigopoulou,A.; 2013 Arch Phys Med Rehabil.
in idiopathic carpal tunnel syndrome low study design
Chrysanthopoulou,A.; Chroni,E.
Chmielewska,D.; Skeczek- Effectiveness of carpal tunnel syndrome
Urbaniak,A.; Kubacki,J.; 2013 rehabilitation after endoscopic versus Ortop.Traumatol.Rehabil.
Blaszczak,E.; Kwasna,K. open surgical release
The electrodiagnosis of the carpal review; background
Cho,D.S.; Cho,M.J. 1989 S.D J Med
tunnel syndrome information
The Chow technique of endoscopic
release of the carpal ligament for carpal
Chow,J.C. 1993 Retrospective case series
tunnel syndrome: four years of clinical
results
Endoscopic release of the carpal
Does not address
Chow,J.C. 1989 ligament: a new technique for carpal
tunnel syndrome
Endoscopic carpal tunnel release: Chow
Chow,J.C.Y.; Papachristos,A.A. 2006 Techniques in Orthopaedics Background article
technique
Prevalence of carpal tunnel syndrome
Christensen,J.E.; Peter,P.J.; Not relevant, prevalence
1998 among individuals with Down Am J Ment.Retard.
Nielsen,V.K.; Mai,J. study
syndrome
Chroni,E.; Paschalis,C.;
Arvaniti,C.; Zotou,K.; Carpal tunnel syndrome and hand insufficient data; very
2001 Muscle Nerve
Nikolakopoulou,A.; configuration low study design
Papapetropoulos,T.
Chrysopoulo,M.T.; The hypothenar fat pad transposition
2006 Tech.Hand Up Extrem.Surg Background information
Greenberg,J.A.; Kleinman,W.B. flap: a modified surgical technique
Sonography in the evaluation of carpal
Chuang,Y.-M.; Chiou,H.-J. 2001 Acta Neurologica Taiwanica case report
tunnel syndrome
Factors influencing prioritization for +Does not answer a
Chung,B.; Morris,S.F. 2013 Can J Plast.Surg
carpal tunnel syndrome consultation question of interest
Current status of outcomes research in
Chung,K.C. 2006 Hand (N.Y) review
carpal tunnel surgery
825
Reason for
Exclusion
Reliability and validity testing of the
Chung,K.C.; Pillsbury,M.S.; +Does not answer a
1998 Michigan Hand Outcomes J Hand Surg Am
Walters,M.R.; Hayward,R.A. question of interest
Questionnaire
Prevalence of Raynaud's phenomenon
Chung,M.S.; Gong,H.S.; +Does not answer a
1999 in patients with idiopathic carpal tunnel J Bone Joint Surg Br
Baek,G.H. question of interest
syndrome
Ciftdemir,M.; Copuroglu,C.; Carpal tunnel syndrome in manual tea all CTS cases; no
2013 Eklem.Hastalik.Cerrahisi.
Ozcan,M.; Cavdar,L. harvesters comparison group
Cimmino,M.A.; Bountis,C.; An appraisal of magnetic resonance
Silvestri,E.; Garlaschi,G.; 2000 imaging of the wrist in rheumatoid Semin.Arthritis Rheum. Not relevant to CTS
Accardo,S. arthritis
Diagnostic specificity of sensory and
Cioni,R.; Passero,S.;
motor nerve conduction variables in insufficient data; very
Paradiso,C.; Giannini,F.; 1989 J Neurol
early detection of carpal tunnel low study design
Battistini,N.; Rushworth,G.
syndrome
Local symptoms after open carpal Insufficient data (missing
Citron,N.D.; Bendall,S.P. 1997 tunnel release. A randomized J Hand Surg Br N at each follow-up time
prospective trial of two incisions point)
Carpal tunnel syndrome diagnosed by
Claes,F.; Bernsen,H.; +Does not answer a
2012 general practitioners: an observational Neurol Sci
Meulstee,J.; Verhagen,W.I. question of interest
study
Clayburgh,R.H.; Carpal tunnel release in patients with
1987 J Hand Surg Am Retrospective case series
Beckenbaugh,R.D.; Dobyns,J.H. diffuse peripheral neuropathy
Carpal tunnel surgery: should the
Clayton,M.L.; Linscheid,R.L. 1988 Background article
incision be above or below the wrist?
Provocative exercise maneuver: its
Does not answer a
Clifford,J.C.; Israels,H. 1994 effect on nerve conduction studies in Arch Phys Med Rehabil.
Motor conduction studies and needle
Clinchot,D.M. 1997 electromyography in carpal tunnel Phys.Med.Rehabil.Clin.N.Am. Background Information
syndrome
Cobb,T.K.; Dalley,B.K.; The carpal tunnel as a compartment. An
1992 Orthop Rev. cadaver study
Posteraro,R.H.; Lewis,R.C. anatomic perspective
826
Reason for
Exclusion
Cocito,D.; Ciaramitaro,P.;
The occurrence of carpal tunnel
Tavella,A.; Poglio,F.;
2005 syndrome in chronic inflammatory Clin Neurophysiol. letter to the editor
Paolasso,I.; Bergamasco,B.;
demyelinating polyneuropathy
Isoardo,G.
Cocito,D.; Tavella,A.;
Ciaramitaro,P.; Costa,P.;
A further critical evaluation of requests +Does not answer a
Poglio,F.; Paolasso,I.; 2006 Neurol Sci
for electrodiagnostic examinations question of interest
Duranda,E.; Cossa,F.M.;
Bergamasco,B.
Nerve compression syndromes: Finding
Cohen,M.S.; Garfin,S.R. 1997 Background Information
the cause of upper-extremity symptoms
The changes of the sectional surface
Cokluk,C.; Aydin,K.; area of the median nerve compartment insufficient data; very
2006 Turkish Neurosurgery
Iyigun,O.; Rakunt,C.; Celik,F. in hands with symptomatic carpal low study design
tunnel syndrome and normal hands
for rec 7, this would not
be best available
Colak,A.; Kutlay,M.;
evidence. if used as a
Pekkafali,Z.; Saracoglu,M.; Use of sonography in carpal tunnel
2007 Neurol Med Chir (Tokyo) diagnostic study of ultra-
Demircan,N.; Simsek,H.; syndrome surgery. A prospective study
sound, quality would be
Akin,O.N.; Kibici,K.
very low due to the use of
health controls
The reliability of one vs. three grip
+Does not answer a
Coldham,F.; Lewis,J.; Lee,H. 2006 trials in symptomatic and asymptomatic J Hand Ther
subjects
Comi,G.; Lozza,L.; Galardi,G.; Presence of carpal tunnel syndrome in
Not relevant, not a CTS
Ghilardi,M.F.; Medaglini,S.; 1985 diabetics: effect of age, sex, diabetes Acta Diabetol.Lat.
correlational study
Canal,N. duration and polyneuropathy
Concannon,M.J.; The incidence of recurrence after very low strength of
2000 Plast.Reconstr.Surg
Brownfield,M.L.; Puckett,C.L. endoscopic carpal tunnel release evidence
The predictive value of
Concannon,M.J.; Gainor,B.; insufficient data; very
1997 electrodiagnostic studies in carpal Plast.Reconstr.Surg
Petroski,G.F.; Puckett,C.L. low study design
tunnel syndrome
Intradermal therapy (mesotherapy) for
Conforti,G.; Capone,L.;
2014 the treatment of acute pain in carpal Korean J Pain Very Low Quality
Corra,S.
tunnel syndrome: a preliminary study
827
Reason for
Exclusion
Conington,K.A.; Fields,K.; What is the best diagnostic approach to
2002 J.Fam.Pract. letter
Nashelsky,J. paresthesias of the hand?
A randomized controlled trial
evaluating an alternative mouse or +not best available
Conlon,C.F.; Krause,N.;
2009 forearm support on change in median Am.J.Ind.Med. evidence; no diagnosis of
Rempel,D.M.
and ulnar nerve motor latency at the CTS
wrist
Upper extremity mononeuropathy no diagnosis of CTS; no
Conlon,C.F.; Rempel,D.M. 2005 J.Occup.Environ.Med.
among engineers unexposed group
Does not address
Conolly,W.B. 1978 Pitfalls in carpal tunnel decompression Aust.N.Z.J Surg
Conrad,J.C.; Osborn,J.B.; Peripheral nerve dysfunction in insufficient data; no
1990 J Dent.Hyg.
Conrad,K.J.; Jetzer,T.C. practicing dental hygienists diagnosis of CTS
background information;
Conway,R.R. 1999 Needle EMG is often unnecessary Muscle Nerve
commentary
Cook,T.M.; Rosecrance,J.C.; Reliability of a digital
Brokman,S.J.; Rulon,A.S.; 1991 electroneurometer for the determination J Occup.Rehabil.
low study design
Wise,C.A. of motor latency of the median nerve
The future of arthroscopic surgery in
Cooney,W.P. 1995 Hand Clin. Editorial
the hand and wrist
Cooper,C.; Baker,P.D. 1996 Upper limb disorders Occup.Med. background
Copeland,D.A.; Stoukides,C.A. 1994 Pyridoxine in carpal tunnel syndrome Ann.Pharmacother. Narrative review
Corbin,D.E. 2000 Carpal tunnel syndrome recovery Occup.Health Saf background
Median nerve F-wave conduction in only healthy study
Cornwall,M.W.; Nelson,C. 1984 Phys.Ther.
healthy subjects subjects
Corradi,M.; Paganelli,E.; Carpal tunnel syndrome in long-term insufficient data; no
1989 J Reconstr.Microsurg.
Pavesi,G. hemodialyzed patients comparison group
Magnetic resonance imaging in the a
Cosgrove,J.L. 2000 J Clin Neuromuscul.Dis lit review
literature review
Does not answer a
Cosgrove,J.L.; Chase,P.M.; Thenar motor syndrome: median
2002 Am J Phys Med Rehabil. question of interest; no
Mast,N.J. mononeuropathy of the hand
comparison group
Costa,V.V.; Oliveira,S.B.; Duplicate study
Incidence of regional pain syndrome
Fernandes,Mdo C.; 2011 Rev.Bras.Anestesiol. (duplicate with AAOS ID
after carpal tunnel release. Is there a
Saraiva,R.? 302)
828
Reason for
Exclusion
correlation with the anesthetic
technique?
Splinting for symptoms of carpal tunnel
Courts,R.B. 1995 J Hand Ther Very low quality
syndrome during pregnancy
Incorrect patient
Cracchiolo,A.,III; Marmor,L. 1968 Peripheral entrapment neuropathies population (not exclusive
to CTS patients)
Cracchiolo,III A.;
1977 Peripheral nerve entrapments West.J.Med. background
Namerow,N.S.; Campion,D.S.
Cramer,H.; Lauche,R.; Yoga for rheumatic diseases: a
2013 Rheumatology (Oxford) Systematic reveiw
Langhorst,J.; Dobos,G. systematic review
Conservative treatment of work-related
Crawford,J.O.; Laiou,E. 2007 Occup.Med (Lond) Systematic review
upper limb disorders: a review
Rheumatologic manifestations of
Crispin,J.C.; Alcocer-Varela,J. 2003 Am.J.Med. review
diabetes mellitus
Effect of ischaemia on sensory evoked
potentials. 2. Study in patients with +Does not answer a
Cruz,Martinez A.; Perez
1980 diabetes mellitus, alcoholism, chronic Electromyogr.Clin Neurophysiol. question of interest; very
Conde,M.C.; Ferrer,M.T.
renal failure, carpal tunnel syndrome low study design
and hyperparathyroidism
Cuevas-Trisan,R.L.; Ojeda- Relation of wrist angles to median
2006 Bol.Asoc.Med P R <10 patients per group
Rodriguez,A.G. nerve conduction studies
Occupation and the carpal tunnel
Cullum,D.E.; Molloy,C.J. 1994 Med J Aust. Background Information
syndrome
Corrigenda: Occupation and the carpal
Cullum,D.E.; Molloy,C.J. 1994 tunnel syndrome (Medical Journal of Med.J.Aust.
review
Australia (1994) 161 (552-554))
Incidence of regional pain syndrome
da Costa,V.V.; de Oliveira,S.B.; after carpal tunnel release. Is there a Deemed clinically
2011 Rev.Bras.Anestesiol.
Fernandes,Mdo C.; Saraiva,R.A. correlation with the anesthetic irrelevant
technique?
Aspects on pathophysiology of nerve
Dahlin,L.B. 1991 entrapments and nerve compression Neurosurg.Clin N.Am Background Information
injuries
829
Reason for
Exclusion
Incorrect patient
Coverage of the median nerve with free
Dahlin,L.B.; Lekholm,C.; population (prior surgical
2002 and pedicled flaps for the treatment of Scand.J Plast.Reconstr.Surg Hand Surg
Kardum,P.; Holmberg,J. intervention prior to
recurrent severe carpal tunnel syndrome
study)
Dahlin,L.B.; Salo,M.; Carpal tunnel syndrome and treatment
2010 Scand.J Plast.Reconstr.Surg Hand Surg background
Thomsen,N.; Stutz,N. of recurrent symptoms
The value of iontophoresis combined
Dakowicz,A.; Latosiewicz,R. 2005 with ultrasound in patients with the Rocz.Akad.Med Bialymst. Very Low Quality
Comparison of Automated Versus
Dale,A.M.; Agboola,F.;
Traditional Nerve Conduction Study insufficient data; not best
Yun,A.; Zeringue,A.; Al- 2014 PM R
Methods for Median Nerve Testing in a evidence
Lozi,M.T.; Evanoff,B.
General Worker Population
Dale,A.M.; Gardner,B.T.; The effectiveness of post-offer pre-
Zeringue,A.; Werner,R.; 2014 placement nerve conduction screening J Occup Environ Med not best evidence
Franzblau,A.; Evanoff,B. for carpal tunnel syndrome
Dale,A.M.; Harris-Adamson,C.;
Rempel,D.; Gerr,F.; Prevalence and incidence of carpal
pooled data and varying
Hegmann,K.; Silverstein,B.; tunnel syndrome in US working
2013 Scand.J Work Environ.Health methods, designs, and
Burt,S.; Garg,A.; Kapellusch,J.; populations: pooled analysis of six
data types
Merlino,L.; Thiese,M.S.; prospective studies
Eisen,E.A.; Evanoff,B.
Incorrect patient
Management of thoracic outlet
Dale,W.A.; Lewis,M.R. 1975 Ann.Surg population (does not
syndrome
include CTS patients)
Two injections with steroids close to the
carpal tunnel are a greater help in CTS Journal of the Peripheral Nervous Abstract/conference
Dammers,H.J.; Veering,M.M. 2001
than one injection: 76.5% and 50% System : JPNS. poster
success
Injection with methylprednisolone
Dammers,J.W.; Veering,M.M.;
1999 proximal to the carpal tunnel: Very Low Quality
Vermeulen,M.
randomised double blind trial
Methylprednisolone injection improved
Dammers,J.W.; Veering,M.M.;
2000 symptoms for 1 year in patients with the Evidence-Based Medicine Insufficient data
Vermeulen,M.
Dan,N.G. 1976 Entrapment syndromes Med J Aust. background
830
Reason for
Exclusion
Dandy,D.J. 1992 The present state of arthroscopy Minimally Invasive Therapy Background article
Work-related carpal tunnel syndrome in
Does not answer a
Daniell,W.E.; Fulton-Kehoe,D.; Washington State workers'
2009 Am J Ind.Med question of interest; not
Franklin,G.M. compensation: utilization of surgery and
the duration of lost work
Referral diagnosis versus
no comparison of
electroneurophysiological finding. Two
Danner,R. 1990 Electromyogr.Clin Neurophysiol. modalities; not CTS
years electroneuromyographic
exclusive
consultation in a rehabilitation clinic
Transfer of the flexor carpi radialis to
Danoff,J.R.; Birman,M.V.; the abductor pollicis brevis tendon for
2014 J Hand Surg Eur.Vol. Retrospective case series
Rosenwasser,M.P. the restoration of tip-pinch in severe
The rational clinical examination. Does
D'Arcy,C.A.; McGee,S. 2000 this patient have carpal tunnel systematic review
syndrome?
Clinical diagnosis of carpal tunnel
D'Arcy,C.A.; McGee,S. 2000 letters to the editor
syndrome
Review: Hand symptom diagrams,
weak thumb abduction, and hypalgesia
D'Arcy,C.A.; McGee,S. 2001 Evidence-Based Medicine literature review
are helpful in diagnosing carpal tunnel
syndrome
Surveillance of work-related carpal
tunnel syndrome in Massachusetts,
Davis,L.; Wellman,H.; 1992-1997: a report from the
2001 Am J Ind.Med review of case reports
Punnett,L. Massachusetts Sentinel Event
Notification System for Occupational
Risks (SENSOR)
Carpal tunnel syndrome: conservative
Davis,P.T.; Hulbert,J.R. 1998 and nonconservative treatment. A J Manipulative Physiol Ther systematic review
chiropractic physician's perspective
The patient's perspective on carpal
Davison,P.G.; Cobb,T.; Deemed clinically
2013 tunnel surgery related to the type of Hand (N.Y)
Lalonde,D.H. irrelevant
anesthesia: a prospective cohort study
Practical considerations in the treatment
Davne,A. 1982 J Med Soc.N.J Retrospective case series
831
Reason for
Exclusion
Recurrent Bell's palsy, carpal tunnel
Daw,E.; Ogbonna,B. 1984 J.Obstet.Gynaecol. Case report
syndrome and meralgia in pregnancy
Carpal tunnel syndrome in
all CTS cases; no
Dawson,W.J. 1999 instrumentalists: A review of 15 years' Medical Problems of Performing Artists
comparison group
clinical experience
Dayan,A.D.; Urich,H.;
1971 Peripheral neuropathy and myeloma J Neurol Sci case reports
Gardner-Thorpe,C.
de Campos,C.C.;
The relationship between symptoms and
Manzano,G.M.;
electrophysiological detected not best available
Leopoldino,J.F.; Nobrega,J.A.; 2004 Acta Neurol Scand.
compression of the median nerve at the evidence
Sanudo,A.; de Araujo,Peres C.;
wrist
Castelo,A.
de la Llave-Rincon AI;
Bilateral hand/wrist heat and cold
Fernandez-de-las-Penas,C.; insufficient data; very
2009 hyperalgesia, but not hypoesthesia, in Exp.Brain Res.
Fernandez-Carnero,J.; Padua,L.; low study design
unilateral carpal tunnel syndrome
Arendt-Nielsen,L.; Pareja,J.A.
de la Llave-Rincon AI;
Increased pain sensitivity is not
Fernandez-de-las-Penas,C.;
associated with electrodiagnostic insufficient data; very
Laguarta-Val,S.; Alonso- 2011 Clin J Pain
findings in women with carpal tunnel low study design
Blanco,C.; Martinez-Perez,A.;
syndrome
Arendt-Nielsen,L.; Pareja,J.A.
Influence of compensation status on
de Moraes,V.Y.; Godin,K.; Dos
time off work after carpal tunnel release
Santos,J.B.; Faloppa,F.; 2013 Patient Saf Surg meta-analysis
and rotator cuff surgery: a meta-
Bhandari,M.; Belloti,J.C.
analysis
Transcarpal median sensory
conduction: detection of latent insufficient data; very
De,Lean J. 1988 Can J Neurol Sci
abnormalities in mild carpal tunnel low study design
syndrome
the pupose of this article
is to study the
Responsiveness of the Dutch version of responsiveness of the
De,Smet L.; De,Kesel R.;
2007 the DASH as an outcome measure for J Hand Surg Eur.Vol. DASH. we could use
Degreef,I.; Debeer,P.
carpal tunnel syndrome results as a case series,
this would be not best
available evidence
832
Reason for
Exclusion
Retrospective case
Pedicled fat flap coverage of the median series/Incorrect patient
De,Smet L.; Vandeputte,G. 2002 nerve after failed carpal tunnel J Hand Surg Br population (existing
decompression invasive intervention
prior to study)
Dehghani,M.; Zarezadeh,A.;
Hour glass constriction in advanced
Shemshaki,H.; Moezi,M.; 2013 Int.J Prev.Med Not in English
Nourbakhsh,M.
Dejaco,C.; Stradner,M.;
Zauner,D.; Seel,W.; Ultrasound for diagnosis of carpal
Simmet,N.E.; Klammer,A.; tunnel syndrome - Comparison of
abstract; summary
Brickmann,K.; Gretler,J.; 2012 different methods to determine median Arthritis Rheum.
document
Moazedi-Furst,F.; nerve volume and value of power
Thonhofer,R.; Husic,R.; Doppler sonography
Hermann,J.; Quasthoff,S.
Not relevant,does not
Dekel,S.; Papaioannou,T.; Idiopathic carpal tunnel syndrome
1980 Br Med J answer the PICO
Rushworth,G.; Coates,R. caused by carpal stenosis
question
Endoscopic treatment of the carpal
Delaere,O.; Bouffioux,N.;
2000 tunnel syndrome: review of the recent Acta Chir Belg. Narrative review
Hoang,P.
literature
de-la-Llave-Rincon AI;
New advances in the mechanisms and
Puentedura,E.J.; Fernandez-de- 2012 Discov.Med Narrative review
etiology of carpal tunnel syndrome
las-Penas,C.
Carpal tunnel syndrome: role of insufficient data; no
Delgrosso,I.; Boillat,M.A. 1991 Int.Arch Occup.Environ.Health
occupation comparison group
Current guidelines for management of
review; background
Dellon,A.L. 1999 peripheral nerve problems using Journal of Orthopaedic Surgery
information
quantitative sensory testing
Clinical assessment of peripheral nerve
Dellon,A.L. 1993 Current Orthopaedics background
injuries
Demir,H.; Kirnap,M.; Utas,C.; Not relevant,does not
Carpal tunnel syndrome in hemodialysis European Journal of Physical Medicine
Ersoy,A.O.; Ozugul,Y.; 1998 answer the PICO
patients and Rehabilitation
Aksu,M. question
Comparison of sensory conduction insufficient data; very
Demirci,S.; Sonel,B. 2004 Rheumatol.Int.
techniques in the diagnosis of mild low study design
833
Reason for
Exclusion
idiopathic carpal tunnel syndrome:
which finger, which test?
Wrist postures and forces in tree Does not answer a
Denbeigh,K.; Slot,T.R.;
2013 planters during three tree unloading question of interest; not
Dumas,G.A.
conditions relevant to CTS
The effect of local corticosteroid
Deniz,O.; Aygul,R.; Kotan,D.;
injection on F-wave conduction velocity
Ozdemir,G.; Odabas,F.O.; 2012 Rheumatol.Int. Very Low Quality
and sympathetic skin response in carpal
Kaya,M.D.; Ulvi,H.
tunnel syndrome
Journal d'Echographie et de Medecine
Derchi,L.E.; Martinoli,C. 1998 High resolution US of peripheral nerves Commentary/review
par Ultrasons
Deryani,E.; Aki,S.; MR imaging and electrophysiological insufficient data; very
2003 Yonsei Med J
Muslumanoglu,L.; Rozanes,I. evaluation in carpal tunnel syndrome low study design
Diagnostic strategies using physical
Descatha,A.; Dale,A.M.;
examination are minimally useful in +not best available
Franzblau,A.; Coomes,J.; 2010 Occup.Environ.Med
defining carpal tunnel syndrome in evidence
Evanoff,B.
population-based research studies
the outcome is not CTS,
Natural history and predictors of long-
Descatha,A.; Dale,A.M.; but rather how baseline
2013 term pain and function among workers Arch Phys Med Rehabil.
Franzblau,A.; Evanoff,B. CTS predicts future
with hand symptoms
funcional limitation
Descatha,A.; Huard,L.; Meta-analysis on the performance of
Aubert,F.; Barbato,B.; 2012 sonography for the diagnosis of carpal Semin.Arthritis Rheum. meta-analysis
Gorand,O.; Chastang,J.F. tunnel syndrome
Desjacques,P.; Egloff-Baer,S.; Lumbrical muscles and the carpal doesn't answer question
Roth,G. tunnel syndrome of interest
Deutinger,M.; Girsch,W.; Clinical and electroneurographic
Burggasser,G.; Windisch,A.; 1993 evaluation of sensory/motor- J.Neurosurg. Retrospective case series
Mayr,N.; Freilinger,G. differentiated nerve repair in the hand
A retrospective insight into the roles of
Devany,A.J.; Musonda,P.; nerve conduction studies and symptom
2010 Rheumatology (Oxford). insufficient data
Blake,J.C. severity questionnaire scores in patients
Devathasan,G.; Teo,W.L.; Methylcobalamin (CH(3)-B(12); Incorrect patient
1986 Clin.Trials J.
Mylvaganam,A. Methycobal) in chronic diabetic population
834
Reason for
Exclusion
neuropathy. A double-blind clinical and
electrophysiological study
Measurement of skin capacitance: A
Dheerendra,S.K.; Ibrahim,I.W.;
novel method of diagnosing autonomic
Khan,W.S.; Smitham,P.; 2011 Journal of Hand Surgery summary document
dysfunction in carpal tunnel syndrome
Goddard,N.J.
level 3 evidence
Dhond,R.P.; Ruzich,E.;
Witzel,T.; Maeda,Y.; Spatio-temporal mapping cortical
Malatesta,C.; Morse,L.R.; 2012 neuroplasticity in carpal tunnel
low study design
Audette,J.; Hamalainen,M.; syndrome
Kettner,N.; Napadow,V.
Di,Guglielmo G.; Torrieri,F.; Conduction block and segmental insufficient data; very
1997 Electroencephalogr.Clin Neurophysiol.
Repaci,M.; Uncini,A. velocities in carpal tunnel syndrome low study design
Our experience with reoperations for
Diabalova,V. 1995 the diagnosis of the Carpal Tunel Acta Chir.Plast. Retrospective case series
Syndrome
Diamond,M.R. 1989 Carpal tunnel syndrome: A review Chiropractic Sports Medicine review
Carpal tunnel syndrome in female nurse
anesthetists versus operating room Not relevant, prevalence
Diaz,J.H. 2001 Anesth.Analg.
nurses: prevalence, laterality, and study
impact of handedness
Dick,E.A.; Burnett,C.; review; background
2008 MRI of the wrist
Gedroyc,W.M.W. information
Dick,F.D.; Graveling,R.A.; Workplace management of upper limb
2011 Occup.Med (Lond) systematic review
Munro,W.; Walker-Bone,K. disorders: a systematic review
A comparison of the functional Does not meet inclusion
Dickson,D.R.; Boddice,T.;
2013 difficulties in staged and simultaneous J Hand Surg Eur.Vol. criteria (follow-up<3
Collier,A.M.
open carpal tunnel decompression month minimum)
Dieleman,J.P.; Kerklaan,J.; Incidence rates and treatment of
Does not address
Huygen,F.J.; Bouma,P.A.; 2008 neuropathic pain conditions in the
Sturkenboom,M.C. general population
Improved tolerability of open carpal
Dillon,J.P.; Laing,A.;
2008 tunnel release under local anaesthetic: a Arch Orthop Trauma Surg Very low quality
Hussain,M.; Macey,A.
patient satisfaction survey
835
Reason for
Exclusion
Local effects of acupuncture on the
Dimitrova,A.; Lou,J.S.;
median and ulnar nerves in patients
Andrea,S.; Luo,Y.; 2014 J.Altern.Complement.Med. Conference poster
with carpal tunnel syndrome (CTS):
Murchison,C.; Oken,B.
Study design and preliminary results
Ditmars,D.M.,Jr.; Houin,H.P. 1986 Carpal tunnel syndrome Hand Clin background
A new technique of operation for Incorrect patient
Dlabal,K. 1989 opposition of the thumb in thenar Acta Chir.Plast. population (not exclusive
muscle paralysis to CTS patients)
Our long-term experience and results of
Dlabalova,V. 1995 surgical management of the carpal Acta Chir Plast. Background article
tunnel syndrome
Management of complications related to
Dodds,S.D.; Trumble,T.E. 2006 Techniques in Orthopaedics Background article
Median nerve deformation in
Doesburg,M.H.; Henderson,J.;
differential finger motions: Journal of orthopaedic research :
Yoshii,Y.; -Mink-van-der-
2012 ultrasonographic comparison of carpal official.publication.of the Orthopaedic duplicate
Molen-AB; Cha,S.S.; An,K.N.;
tunnel syndrome patients and healthy Research Society
Amadio,P.C.
controls
Adaptation of Turkish version of the
questionnaire Quick Disability of the
Dogan,S.K.; Ay,S.; Evcik,D.; +Does not answer a
2011 Arm, Shoulder, and Hand (Quick Clin.Rheumatol.
Baser,O. question of interest
DASH) in patients with carpal tunnel
syndrome
Effectiveness of Splinting for Carpal
Dolhanty,Dorothy 1986 Very low quality
Tunnel Syndrome
Unusual presentations of multiple Not relevant to CTS; case
Doll,D.C.; Weiss,R.B. 1977 Postgrad.Med
myeloma reports
Comparison of the diagnostic value of
Domanasiewicz,A.; insufficient data; very
2009 ultrasonography and neurography in Neurol Neurochir.Pol.
Koszewicz,M.; Jablecki,J. low study design
Erratum: Forearm velocity in Carpal
Tunnel syndrome: When is slow too
Donahue; Raynor; Rutkove 1998 Arch.Phys.Med.Rehabil. abstract; no text
slow? (Archives of Physical Medicine
and Rehabilitation (1998) 79 (181-183))
836
Reason for
Exclusion
Potential contributions of neck muscle
Donaldson,C.C.; Nelson,D.V.;
1998 dysfunctions to initiation and Appl Psychophysiol.Biofeedback biomechanical review
Skubick,D.L.; Clasby,R.G.
maintenance of carpal tunnel syndrome
Carpal tunnel syndrome associated with
Dorin,D.; Mann,R.J. 1984 South Med J case report
abnormal palmaris longus muscle
Dorwart,B.B. 1984 Carpal tunnel syndrome: a review Semin.Arthritis Rheum. review
Doyle,J.J.; Parry,G.J. 1995 Entrapment neuropathies Current Opinion in Orthopaedics Not relevant to CTS
The carpal tunnel syndrome. A review
Doyle,J.R.; Carroll,R.E. 1968 Calif.Med Retrospective case series
of 100 patients treated surgically
Clinical and radiologic features of
Dray,G.J.; Jablon,M. 1987 Hand Clin Background Information
primary osteoarthritis of the hand
Effectiveness of pyridoxine
Driskell,J.A.; Wesley,R.L.; Conference
1985 hydrochloride treatment on carpal Fed.Proc.
Hess,I.E. abstract/poster
tunnel syndrome patients
Drosos,G.I.; Ververidis,A.; Silicone ring tourniquet versus
Stavropoulos,N.I.; pneumatic cuff tourniquet in carpal
2013 J Orthop Traumatol. criteria (invasive follow-
Mavropoulos,R.; Tripsianis,G.; tunnel release: a randomized
up<3 month)
Kazakos,K. comparative study
A reliable technique for avoiding the
Does not address
Dubert,T.; Racasan,O. 2006 median nerve during carpal tunnel Joint Bone Spine
injections
The Canaletto(R) implant for
reconstructing transverse carpal
ligament in carpal tunnel surgery.
Duche,R.; Trabelsi,A. 2010 Surgical technique and cohort Chir Main very low quality
prospective study about 400 Canaletto
cases versus 400 cases with open carpal
tunnel surgery
Duckworth,A.D.; Jenkins,P.J.;
+Does not answer a
Roddam,P.; Watts,A.C.; 2013 Pain and carpal tunnel syndrome J Hand Surg Am
Ring,D.; McEachan,J.E.
Duman,I.; Aydemir,K.; Assessment of the efficacy of
2008 J Clin Rheumatol. Very Low Quality
Ozgul,A.; Kalyon,T.A. gabapentin in carpal tunnel syndrome
Soft tissue disorders: Women in the Orthopaedic Physical Therapy Clinics of
Dunbar,A.H.; Bauman,B.B. 1996 Background Information
work force North America
837
Reason for
Exclusion
Duncan,I.; Sullivan,P.; Sonography in the diagnosis of carpal insufficient data; very
1999 AJR Am J Roentgenol.
Lomas,F. tunnel syndrome low study design
Treatment of carpal tunnel syndrome by
Duncan,K.H.; Lewis,R.C.,Jr.; members of the American Society for
1987 J Hand Surg Am Irrelevant
Foreman,K.A.; Nordyke,M.D. Surgery of the Hand: results of a
questionnaire
Wrist flexion as an adjunct to the insufficient data; very
Dunnan,J.B.; Waylonis,G.W. 1991 Arch Phys Med Rehabil.
Dunne,C.A.; Thompson,P.W.;
Carpal tunnel syndrome: evaluation of a
Cole,J.; Dunning,J.; insufficient data; limited
1996 new method of assessing median nerve Ann.Rheum.Dis
Martyn,C.N.; Coggon,D.; control group
conduction at the wrist
Cooper,C.
Durakoglugil,M.E.; Cicek,Y.;
Increased pulse wave velocity and
Kocaman,S.A.; Sabri,Balik M.; Does not answer a
2013 carotid intima-media thickness in Muscle Nerve
Kirbas,S.; Cetin,M.; question of interest
Erdogan,T.; Canga,A.
The carpal-compression test. An
Durkan,J.A. 1994 instrumented device for diagnosing Orthop Rev.
low study design
A new diagnostic test for carpal tunnel insufficient data; very
Durkan,J.A. 1991 J Bone Joint Surg Am
Duymus,M.; Orman,G.; The association between bifid median
prevalence study; low
Ozben,S.; Huseyinoglu,N.; 2014 nerve and carpal tunnel syndrome: Is it Turkish Journal of Rheumatology
design
Ulasli,A.M. really a risk factor?
Dyck,P.J.; Kratz,K.M.;
Lehman,K.A.; Karnes,J.L.;
The Rochester Diabetic Neuropathy
Melton III,L.J.; O'Brien,P.C.; Does not answer a
Study: Design, criteria for types of
Litchy,W.J.; Windebank,A.J.; 1991 question of interest; not
neuropathy, selection bias, and
Smith,B.E.; Low,P.A.; relevant to CTS
reproducibility of neuropathic tests
Service,F.J.; Rizza,R.A.;
Zimmerman,B.R.
Therapy: Surgery or nonsurgical
Dyer,G.S.M.; Simmons,B.P. 2010 Nature Reviews Rheumatology Narrative review
therapy for carpal tunnel syndrome?
Carpal tunnel syndrome after brachial summary report;
Dyro,F.M. 1977 Electroencephalogr.Clin.Neurophysiol.
plexus lesions commentary
838
Reason for
Exclusion
Eason,S.Y.; Belsole,R.J.; Carpal tunnel release: analysis of
1985 J Hand Surg Br Retrospective case series
Greene,T.L. suboptimal results
Predictors identified for outcome of
Eaton,R.G. 1993 Am.Fam.Physician Commentary/review
Ebrahimzadeh,M.H.;
Carpal tunnel release in diabetic and Does not address
Mashhadinejad,H.; Moradi,A.; 2013 Arch Bone Jt.Surg
non-diabetic patients question of interest
Kachooei,A.R.
Carpal tunnel syndrome - an
Edgington,E. 1983 Can Dent.Hyg. Commentary/review
occupational risk
Phalen's test with carpal compression:
not best available
Edwards,A. 2002 testing in diabetics for the diagnosis of
evidence
Edwards,A.J.; Sill,B.J.; Carpal tunnel syndrome due to
1984 Aust.N.Z.J Surg case report
MacFarlane,I. dystrophic calcification
Square wrists and carpal tunnel
Edwards,K.S. 1990 Ohio Med Commentary
syndrome
The application of F-wave
Eisen,A.; Schomer,D.; measurements in the differentiation of insufficient data; very
1977
Melmed,C. proximal and distal upper limb low study design
entrapments
Ekenvall,L.; Nilsson,B.Y.; Temperature and vibration thresholds in not exclusive to CTS; no
1986 Br J Ind.Med
Gustavsson,P. vibration syndrome controls
Ekim,A.; Armagan,O.; Effect of low level laser therapy in
Tascioglu,F.; Oner,C.; 2007 rheumatoid arthritis patients with carpal Swiss Med Wkly. Very low quality
Colak,M. tunnel syndrome
A new electrodiagnostic procedure for
Eklund,G. 1975 measuring sensory nerve conduction Ups.J Med Sci
low study design
across the carpal tunnel
Ekman-Ordeberg,G.; Carpal tunnel syndrome in pregnancy.
1987 Acta Obstet.Gynecol.Scand. Very low quality
Salgeback,S.; Ordeberg,G. A prospective study
Ultrasonography versus nerve
El Miedany,Y.M.; Aty,S.A.; conduction study in patients with carpal insufficient data; very
2004 Rheumatology (Oxford)
Ashour,S. tunnel syndrome: substantive or low study design
complementary tests?
Elfar,J.C.; Yaseen,Z.; Individual finger sensibility in carpal +Does not answer a
2010 J Hand Surg Am
Stern,P.J.; Kiefhaber,T.R. tunnel syndrome question of interest
839
Reason for
Exclusion
Second Lumbrical versus abductor
Egyptian Journal of Neurology, insufficient data; very
El-Habashy,H.R.; Ahmed,A.F. 2010 pollicis brevis muscle's latency in carpal
Psychiatry and Neurosurgery low study design
tunnel syndrome diagnosis
Changes in electrophysiological
El-Hajj,T.; Tohme,R.;
2010 parameters after surgery for the carpal J Clin Neurophysiol. very low quality
Sawaya,R.
tunnel syndrome
Clinical utility of portable versus
Elkowitz,S.J.; Dubin,N.H.; traditional electrodiagnostic testing for +insufficient data; not
2005 Am J Orthop (Belle.Mead NJ)
Richards,B.E.; Wilgis,E.F. diagnosing, evaluating, and treating best evidence
Ultrasound evaluation of patients with
carpal tunnel syndrome before and after
Elliott,J.M. 2007 Clin.Radiol. Narrative review
endoscopic release of the transverse
carpal ligament
Massage therapy as an effective
Elliott,R.; Burkett,B. 2013 J Bodyw.Mov Ther Very Low Quality
treatment for carpal tunnel syndrome
Ellis,H. 2008 The carpal tunnel background info
Ellis,J.; Folkers,K.;
Clinical results of a cross-over
Watanabe,T.; Kaji,M.; Saji,S.;
1979 treatment with pyridoxine and placebo Am J Clin Nutr. Case report
Caldwell,J.W.; Temple,C.A.;
of the carpal tunnel syndrome
Wood,F.S.
Treatment of carpal tunnel syndrome Insufficient data (missing
Ellis,J.M. 1987 South Med J
with vitamin B6 methods & results)
Ellis,J.M.; Azuma,J.;
Survey and new data on treatment with Incorrect patient
Watanabe,T.; Fokers,K.;
pyridoxine of patients having a clinical population (intervention
Lowell,J.R.; Hurst,G.A.; 1977 Res.Commun.Chem.Pathol.Pharmacol.
syndrome including the carpal tunnel not exclusive to CTS
Ho,Ahn C.; Shuford,E.H.,Jr.;
and other defects patients)
Ulrich,R.F.
Ellis,J.M.; Folkers,K.;
Response of vitamin B-6 deficiency and Incorrect patient
Levy,M.; Shizukuishi,S.;
1982 the carpal tunnel syndrome to Proc.Natl.Acad Sci U.S.A population (<10
Lewandowski,J.; Nishii,S.;
pyridoxine patients)
Schubert,H.A.; Ulrich,R.
Ellis,J.M.; Kishi,T.; Azuma,J.; Therapy of the carpal tunnel syndrome
1976 IRCS Medical Science Very Low Quality
Folkers,K. with vitamin B(6)
Ellis,J.R.C.; Mcnally,E.G.;
2002 Ultrasound of peripheral nerves Imaging Background Information
Scott,P.M.
840
Reason for
Exclusion
Does not answer a
Is the benign joint hypermobility
El-Shahaly,H.A.; el-Sherif,A.K. 1991 Clin Rheumatol. question of interest; not
syndrome benign?
CTS exclusive
Elstraete,A.C.; Pastureau,F.; Neostigmine added to lidocaine axillary Deemed clinically
2001 Eur.J.Anaesthesiol.
Lebrun,T.; Mehdaoui,H. plexus block for postoperative analgesia irrelevant
The effect of provocative tests on
Emad,M.R.; Najafi,S.H.; insufficient data; very
2010 electrodiagnosis criteria in clinical Electromyogr.Clin Neurophysiol.
Sepehrian,M.H. low study design
The effect of provocative tests on
Emad,M.R.; Najafi,S.H.; insufficient data; very
2009 electrodiagnosis criteria in clinical J Electromyogr.Kinesiol.
Sepehrian,M.H. low study design
The carpal tunnel syndrome in family
Embury,S.P. 1980 Nebr.Med J background
practice
Entin,M.A. 1968 Carpal tunnel syndrome and its variants Surg Clin North Am background
The efficacy and safety of gabapentin in
Erdemoglu,A.K. 2009 Neurol India Insufficient data
carpal tunnel patients: open label trial
Endoscopic carpal tunnel
Erdmann,M.W. 1994 J Hand Surg Br Very low strength
decompression
Carpal tunnel release by the Agee
Erhard,L.; Ozalp,T.; Citron,N.;
1999 endoscopic technique. Results at 4 year J Hand Surg Br very low quality
Foucher,G.
follow-up
Erselcan,T.; Topalkara,K.; Carpal tunnel syndrome leads to Does not answer a
Nacitarhan,V.; Akyuz,A.; 2001 significant bone loss in metacarpal J Bone Miner.Metab question of interest; very
Dogan,D. bones low study design
Nerve conduction tests in patients with
<10 patients in CTS
Ersoz,M. 2003 fibromyalgia: comparison with normal Rheumatol.Int.
group; not CTS exclusive
controls
Carpal tunnel syndrome. Palmar insufficient data; very
Escobar,P.L.; Goka,R.S. 1985 Orthop.Rev.
sensory latencies to 3rd digit and wrist low study design
Eskandary,H.; Shahabi,M.; Evaluation of carpal tunnel syndrome no comparison group;
2002 Iranian Journal of Medical Sciences
Asadi,A.R. by laser Doppler flowmetry very low study design
Eslamian,F.; Bahrami,A.;
Aghamohammadzadeh,N.; Electrophysiologic changes in patients insufficient data; not
Niafar,M.; Salekzamani,Y.; with untreated primary hypothyroidism exclusive to CTS
Behkamrad,K.
841
Reason for
Exclusion
Estbe,J.P.; Gentili,M.E.; Lidocaine priming reduces tourniquet
Deemed clinically
Langlois,G.; Mouilleron,P.; 2003 pain during intravenous regional Reg.Anesth.Pain Med.
irrelevant
Bernard,F.; Ecoffey,C. anesthesia: A preliminary study
Estebe,J.P.; Gentili,M.E.; Lidocaine priming reduces tourniquet Duplicate study
Langlois,G.; Mouilleron,P.; 2003 pain during intravenous regional Reg Anesth.Pain Med (duplicate with AAOS ID
Bernard,F.; Ecoffey,C. anesthesia: A preliminary study 14055)
the study stratifies does a
good job stratifiying by
Ettema,A.M.; Amadio,P.C.; Surgery versus conservative therapy in symptom severity, but the
Cha,S.S.; Harrington,J.R.; 2006 carpal tunnel syndrome in people aged Plast.Reconstr.Surg stratification results in
Harris,A.M.; Offord,K.P. 70 years and older less than 10 patients per
group for each severity
level.
Carpal tunnel syndrome (CTS): An Journal of Neurological and
Faber,W.J. 1990 Background article
alternative view and treatment approach Orthopaedic Medicine and Surgery
Carpal tunnel syndrome due to International Journal of Industrial literature
Fagarasanu,M.; Kumar,S. 2003
keyboarding and mouse tasks: A review Ergonomics review/background
Faithfull,D.K.; Moir,D.H.; The micropathology of the typical +Does not answer a
1986 J Hand Surg Br
Ireland,J. carpal tunnel syndrome question of interest
Left-sided carpal tunnel syndrome in Not relevant, prevalence
Falck,B.; Aarnio,P. 1983 Scand.J Work Environ.Health
butchers study
Choosing hand splints to aid carpal
Falkenburg,S.A. 1987 Occup.Health Saf Background article
tunnel syndrome recovery
Carpal tunnel syndrome. Surgical
Fansa,M.R.; Helal,B. 1976 Nurs.Mirror Midwives J Background article
treatment
The long-term post-operative
Faour-Martin,O.; Martin-
electromyographic evaluation of
Ferrero,M.A.; Almaraz- 2012 J Bone Joint Surg Br Retrospective case series
patients who have undergone carpal
Gomez,A.; Vega-Castrillo,A.
tunnel decompression
Faour-Martin,O.; Martin-
Ferrero,M.A.; Vega,Castrillo
Long-term effects of preserving or
A.; Almaraz-Gomez,A.; Narrative review
2013 splitting the carpal ligament in carpal J Plast.Surg Hand Surg
Valverde-Garcia,J.A.; (analysis of prior study)
tunnel operation
Amigo,Linares L.; Red-
Gallego,M.A.
842
Reason for
Exclusion
Farhat,S.M.; Kahn,E.A.;
1974 The carpal tunnel syndrome Surg Neurol background
Child,M.A.
Farkkila,M.; Pyykko,I.;
Forestry workers exposed to vibration: Not relevant, prevalence
Jantti,V.; Aatola,S.; Starck,J.; 1988 Br J Ind.Med
a neurological study study
Korhonen,O.
Quality of lidocaine analgesia with and
Deemed clinically
Farouk,S.; Aly,A. 2010 without midazolam for intravenous Journal of Anesthesia
irrelevant
regional anesthesia
Alternative computer mouse designs:
Does not answer a
Feathers,D.J.; Rollings,K.; performance, posture, and subjective
2013 Work question of interest; no
Hedge,A. evaluations for college students aged
diagnosis of CTS
18-25
Regional use of steroids in the
Feffer,H.L. 1975 management of lumbar intervertebral Orthop.Clin.North Am. Background information
disc disease
The performance and usefulness of
review; background
Feierstein,M.S. 1988 nerve conduction studies in the Orthop Clin North Am
information
orthopedic office
Classical syndromes in occupational
Feldman,R.G.; Goldman,R.;
1983 medicine. Peripheral nerve entrapment Am J Ind.Med Background Information
Keyserling,W.M.
syndromes and ergonomic factors
Feldman,R.G.; Goldman; R.; Peripheral nerve entrapment syndromes
1983 Am.J.Ind.Med. Background Information
Keyserling,W.M. and ergonomic factors
Feldman,R.G.; Travers,P.H.; Does not answer a
Risk assessment in electronic assembly
Chirico-Post,J.; 1987 J Hand Surg Am question of interest; no
workers: carpal tunnel syndrome
Keyserling,W.M. diagnosis of CTS
Feldon,P.; Terrono,A.L. 2006 Techniques in Orthopaedics Background Information
arthritis
Comparison of evoked potentials in the
Felsenthal,G. 1978 same hand in normal subjects and in Am J Phys Med
low study design
Reappraisal of the electroneurographic Does not answer a
Felsenthal,G.; McIvor,M.E. 1984 and electromyographic diagnosis of Am J Phys Med question of interest; not
diabetic peripheral neuropathy CTS exclusive
843
Reason for
Exclusion
Palmar conduction time of median and
Felsenthal,G.; Spindler,H. 1979 ulnar nerves of normal subjects and Am J Phys Med
low study design
Fernandes,C.H.;
Carpal tunnel release using the Paine
Nakachima,L.R.;
2014 retinaculotome inserted through a Hand (N.Y) Background article
Hirakawa,C.K.; Gomes Dos
palmar incision
Santos,J.B.; Faloppa,F.
Fernandez,E.; Pallini,R.;
Lauretti,L.; Scogna,A.; 1997 Carpal tunnel syndrome Surg Neurol background
La,Marca F.
Central sensitization does not identify
Cleland,J.A.; Ortega-
patients with carpal tunnel syndrome all CTS cases; no
Santiago,R.; de-la-Llave-Rincon 2010 Exp.Brain Res.
who are likely to achieve short-term comparison group
AI; Martinez-Perez,A.;
success with physical therapy
Pareja,J.A.
Fernandez-de-las-Penas,C.; Pressure pain sensitivity topographical
+Does not answer a
Madeleine,P.; Martinez- maps reveal bilateral hyperalgesia of
2010 Arthritis Care Res.(Hoboken.) question of interest; very
Perez,A.; Arendt-Nielsen,L.; the hands in patients with unilateral
low study design
Jimenez-Garcia,R.; Pareja,J.A. carpal tunnel syndrome
Bilateral deficits in fine motor control
Perez-de-Heredia-Torres,M.; insufficient data; very
2009 and pinch grip force in patients with Exp.Brain Res.
Martinez-Piedrola,R.; de la low study design
unilateral carpal tunnel syndrome
Llave-Rincon AI; Cleland,J.A.
Fernndez-De-Las-Peas,C.; De Bilateral widespread mechanical pain
La Llave-Rincn,A.I.; Fernndez- sensitivity in carpal tunnel syndrome: insufficient data; very
2009
Carnero,J.; Cuadrado,M.L.; Evidence of central processing in low study design
Arendt-Nielsen,L.; Pareja,J.A. unilateral neuropathy
Continuing education: Ultrasound
Ferrara,M.A.; Marcelis,S. 1997 J.Belge Radiol. Background Information
examination of the wrist
Ferry,S.; Hannaford,P.; Carpal tunnel syndrome: a nested case-
2000 Am J Epidemiol. very low quality
Warskyj,M.; Lewis,M.; Croft,P. control study of risk factors in women
Is delayed nerve conduction associated
Ferry,S.; Pritchard,T.;
with increased self-reported disability in +Does not answer a
Keenan,J.; Croft,P.; 1998 J Rheumatol.
individuals with hand symptoms? A question of interest
Silman,A.J.
population based study
844
Reason for
Exclusion
The serial use of two provocative tests
Fertl,E.; Wober,C.; Zeitlhofer,J. 1998 in the clinical diagnosis of carpal tunel Acta Neurol Scand.
low study design
syndrome
Feuerstein,M.; Burrell,L.M.; Clinical management of carpal tunnel
Miller,V.I.; Lincoln,A.; 1999 syndrome: a 12-year review of Am J Ind.Med systematic review
Huang,G.D.; Berger,R. outcomes
Occupational upper extremity
Feuerstein,M.; Carosella,A.M.;
symptoms in sign language interpreters: Not relevant, prevalence
Burrell,L.M.; Marshall,L.; 1997 Journal of Occupational Rehabilitation
Prevalence and correlates of pain, study
DeCaro,J.
function, and work disability
Field,T.; Diego,M.; Cullen,C.;
Incorrect patient
Hartshorn,K.; Gruskin,A.; Carpal tunnel syndrome symptoms are Journal of Bodywork and Movement
2004 population (<10
Hernandez-Reif,M.; lessened following massage therapy Therapies
patients/group)
Sunshine,W.
Filius,A.; Korstanje,J.W.; Dynamic sonographic measurements at
only healthy study
Selles,R.W.; Hovius,S.E.; 2013 the carpal tunnel inlet: reliability and Muscle Nerve
subjects
Slijper,H.P. reference values in healthy wrists
Finestone,H.M.; Severe carpal tunnel syndrome: clinical
Woodbury,G.M.; Collavini,T.; 1996 and electrodiagnostic outcome of Muscle Nerve Retrospective case series
Marchuk,Y.; Maryniak,O. surgical and conservative treatment
Finger,D.; Vogel,P. 1998 Carpal tunnel syndrome Arthritis Rheum. background
The effects of repeated mechanical
Finkel,M.L. 1985 Am J Ind.Med Background Information
trauma in the meat industry
Neurophysiology not required before
not best available
Finsen,V.; Russwurm,H. 2001 surgery for typical carpal tunnel J Hand Surg Br
evidence
syndrome
Fisher,D.L.; Andres,R.O.; Repetitive motion disorders: The design Does not address
1993 Hum.Factors
Airth,D.; Smith,S.S. of optimal rate-rest profiles question of interest
Preventing upper extremity cumulative
Fisher,T.F. 1998 trauma disorders: An approach to AAOHN J. Background info
employee wellness
Fissette,J.; Onkelinx,A.; Carpal and Guyon tunnel syndrome in <10 patients per group;
1981 J Hand Surg Am
Fandi,N. burns at the wrist no comparison group
First lumbrical latency and amplitude. +Does not answer a
Fitz,W.R.; Mysiw,W.J.;
1990 Control values and findings in carpal Am J Phys Med Rehabil. question of interest; no
Johnson,E.W.
tunnel syndrome comparison of modalities
845
Reason for
Exclusion
Double crush syndrome evaluation in
Does not answer a
Flak,M.; Durmala,J.; the median nerve in clinical,
2006 Stud.Health Technol.Inform. question of interest; very
Czernicki,K.; Dobosiewicz,K. radiological and electrophysiological
low study design
examination
does not answer a
Flaschka,G.; Eder,H.; Follow-up results of surgery for carpal
1991 Zentralbl.Neurochir. question of interest; no
Mullegger,G.; Gindl,H.K. tunnel syndrome in local anesthesia
comparison group
Compression syndromes at wrist.
Fleck,H.; Feldman,M.E. 1982 N.Y State J Med background
Precise diagnostic procedures
+not exclusive to CTS;
Fleming,A.; Dodman,S.; Extra-articular features in early
1976 Br Med J not best available
Crown,J.M.; Corbett,M. rheumatoid disease
evidence
Fletcher,S.J.; Hulgur,M.D.; Use of a temporary forearm tourniquet Incorrect patient
Varma,S.; Lawrence,E.; 2011 for intravenous regional anaesthesia: A Eur.J.Anaesthesiol. population (not exclusive
Boome,R.S.; Oswal,S. randomised controlled trial to CTS patients)
Score reliability and construct validity
Flinn,S.R.; Pease,W.S.; of the Flinn Performance Screening
2012 Am J Occup.Ther insufficient data
Freimer,M.L. Tool for adults with symptoms of carpal
tunnel syndrome
Local steroid injection for moderately
severe idiopathic carpal tunnel
Flondell,M.; Hofer,M.; Study
2010 syndrome: protocol of a randomized BMC Musculoskelet.Disord.
Bjork,J.; Atroshi,I. protocol/insufficient data
double-blind placebo-controlled trial
(NCT 00806871)
Florack,T.M.; Miller,R.J.; The prevalence of carpal tunnel
no comparison group; not
Pellegrini,V.D.; Burton,R.I.; 1992 syndrome in patients with basal joint J Hand Surg Am
Dunn,M.G. arthritis of the thumb
Quantitative analysis of the variation in
Flores,L.P.; Cavalcante,T.F.; angles of the carpal arch after open and no patient oriented
2009 J Neurosurg.
Neto,O.R.; Alcantara,F.S. endoscopic carpal tunnel release. outcomes
Clinical article
Fodor,J.,III; Malott,J.C.; Carpal tunnel syndrome: the role of
1987 Radiol.Technol. Background Information
Merhar,G.L. radiography
Successful therapy with vitamin B6 and
Folkers,K.; Ellis,J. 1990 vitamin B2 of the carpal tunnel Ann.N.Y Acad Sci Narrative review
syndrome and need for determination of
846
Reason for
Exclusion
the RDAs for vitamins B6 and B2 for
disease states
Biochemical evidence for a deficiency

Folkers,K.; Saji,S.; Kaji,M.;
1977 of vitamin B(6) in the carpal tunnel Acta Pharm.Suec. Background article
Ellis,J.
syndrome
Biochemical correlations of a
Does not answer a
Folkers,K.; Willis,R.; deficiency of vitamin B(6), the carpal
1981 IRCS Medical Science question of interest; very
Takamura,K. tunnel syndrome and the Chinese
low study design
restaurant syndrome
Outcome of endoscopic carpal tunnel
Follmar,K.E.; Chetelat,M.D.; release in patients with chronic nonhand
Lifchez,S.D. pain compared with those without
chronic pain
Carpal tunnel syndrome: which
Foresti,C.; Quadri,S.;
electrodiagnostic path should we insufficient data; very
Rasella,M.; Tironi,F.; 1996 Electromyogr.Clin Neurophysiol.
follow? A prospective study of 100 low study design
Viscardi,M.; Ubiali,E.
consecutive patients
Preservation of the ulnar bursa within
Forward,D.P.; Singh,A.K.; Does not meet inclusion
the carpal tunnel: does it improve the
Lawrence,T.M.; Sithole,J.S.; 2006 J Bone Joint Surg Am criteria (invasive follow-
outcome of carpal tunnel surgery? A
Davis,T.R.; Oni,J.A. up<3 month)
randomized, controlled trial
Wrist pain. How to identify the cause
Foster,R.J. 1984 Postgrad.Med background
and treat it
Foulkes,G.D.; Atkinson,R.E.; Outcome following epineurotomy in
Not 10 patients in each
Beuchel,C.; Doyle,J.R.; 1994 carpal tunnel syndrome: a prospective, J Hand Surg Am
group at any follow up.
Singer,D.I. randomized clinical trial
The sensitivity and specificity of
Fowler,J.R.; Gaughan,J.P.;
2011 ultrasound for the diagnosis of carpal Clin Orthop Relat Res. meta-analysis
Ilyas,A.M.
tunnel syndrome: a meta-analysis
Franklin,G.M.; Haug,J.;
Occupational carpal tunnel syndrome in all CTS patients; no
Heyer,N.; Checkoway,H.; 1991 Am J Public Health
Washington State, 1984-1988 comparison group
Peck,N.
The relationship of vitamin B6 status to
Franzblau,A.; Rock,C.L.;
median nerve function and carpal tunnel Not relevant, not a risk
Werner,R.A.; Albers,J.W.; 1996 J Occup.Environ.Med
syndrome among active industrial study
Kelly,M.P.; Johnston,E.C.
workers
847
Reason for
Exclusion
Workplace surveillance for carpal not best available
Franzblau,A.; Werner,R.;
1993 tunnel syndrome: A comparison of J Occup.Rehabil. evidence; very low study
Valle,J.; Johnston,E.
methods design
The now popular and 'fashionable'
Freiberg,A. 2006 Can J Plast.Surg editorial
carpal tunnel syndrome - revisited
Diagnosis and pathophysiology of
Freilich,A.M.; Chhabra,A.B. 2007 Current Opinion in Orthopaedics background
was relevant to rec 8
because the treatment
The effect of various adjuncts on the group gets neurolysis, but
surgical treatment of carpal tunnel they also get concomitant
Freshwater,M.F.; Arons,M.S. 1978 Plast.Reconstr.Surg
syndrome secondary to chronic corticosteroids. would be
tenosynovitis unable to tell if the
neurolysis or steroids
cause the effect.
Frost,P.; Andersen,J.H.; Occurrence of carpal tunnel syndrome very low study design;
1998 Scand.J Work Environ.Health
Nielsen,V.K. among slaughterhouse workers not best evidence
Overuse syndromes in instrumental
Fry,H.J.H. 1989 Semin.Neurol. Background Information
musicians
Fuchs,P.C.; Nathan,P.A.; Synovial histology in carpal tunnel cadavers included in
1991 J Hand Surg Am
Myers,L.D. syndrome study
Fuhr,J.E.; Farrow,A.; Vitamin B6 levels in patients with +Does not answer a
1989 Arch Surg
Nelson,H.S.,Jr. carpal tunnel syndrome question of interest
Fung,B.K.; Chan,K.Y.;
Lam,L.Y.; Cheung,S.Y.; Study of wrist posture, loading and
Choy,N.K.; Chu,K.W.; 2007 repetitive motion as risk factors for Hand Surg very low quality
Chung,L.Y.; Liu,W.W.; developing carpal tunnel syndrome
Tai,K.C.; Yung,S.Y.; Yip,S.L.
Subcutaneous division of the transverse
Futami,T.; Kubodera,D.; Journal of the Western Pacific
1989 carpal ligament by the use of a teflon Retrospective case series
Tsumamoto,Y. Orthopaedic Association
tube and an arthroscopy
Evaluation of sympathetic vasomotor
Galea,L.A.; Mercieca,A.;
fibres in carpal tunnel syndrome using insufficient data; very
Sciberras,C.; Gatt,R.; 2006 J Hand Surg Br
continuous wave Doppler low study design
Schembri,M.
ultrasonography
848
Reason for
Exclusion
not best available
Ganeriwal,A.A.; Biswas,D.A.; The effects of working hours on nerve
2013 Malaysian Orthopaedic Journal evidence; no diagnosis of
Srivastava,T.K. conduction test in computer operators
CTS
An ergonomics study on the evaluation
Gangopadhyay,S.; no diagnosis of CTS;
of carpal tunnel syndrome among
Chakrabarty,S.; Sarkar,K.; 2014 Int J Occup Environ Health regression model for
Chikan embroidery workers of West
Dev,S.; Das,T.; Banerjee,S. wrist/forearm pain
Bengal, India
Gannon,C.; Baratz,K.; The Synovial Flap in Recurrent and
2007 Operative Techniques in Orthopaedics Retrospective case series
Baratz,M.E. Failed Carpal Tunnel Surgery
Gannon,C.R.; Harlan,J.; Safe limited-open carpal tunnel release
2011 Hand (N.Y) Retrospective case series
Baratz,M.E. in the presence of aberrant anatomy
Enlarged median nerve of macrodactyly
Ganske,J.G. 1986 Iowa Med case report
associated with carpal tunnel syndrome
Non-endoscopic double-incision
approach for median nerve
Garcia,Mas R.; Veja,J.;
2006 decompression in idiopathic carpal The Journal of Bone and Joint Surgery Insufficient data
Golano,P.
tunnel syndrome. A comparative study
of 155 hands
Garfinkel,M. 2006 Yoga as a complementary therapy Geriatrics and Aging Background article
Garg,A.; Hegmann,K.T.;
Wertsch,J.J.; Kapellusch,J.;
Thiese,M.S.; Bloswick,D.; The WISTAH hand study: a prospective
Merryweather,A.; Sesek,R.; 2012 cohort study of distal upper extremity BMC Musculoskelet.Disord. insufficient data
Deckow-Schaefer,G.; Foster,J.; musculoskeletal disorders
Wood,E.; Kendall,R.;
Sheng,X.; Holubkov,R.
Comparative responsiveness of the
disabilities of the arm, shoulder, and
Gay,R.E.; Amadio,P.C.; +not best available
2003 hand, the carpal tunnel questionnaire, J Hand Surg Am
Johnson,J.C. evidence
and the SF-36 to clinical change after
Distal nerve blocks at the wrist for
Gebhard,R.E.; Al-Samsam,T.; outpatient carpal tunnel surgery offer
2002 Anesth.Analg. Very low quality
Greger,J.; Khan,A.; Chelly,J.E. intraoperative cardiovascular stability
and reduce discharge time
849
Reason for
Exclusion
Gedizlioglu,M.; Arpaci,E.;
Carpal tunnel syndrome in the Turkish Not relevant, prevalence
Cevher,D.; Ce,P.; Kulan,C.A.; 2008 Occup.Med (Lond)
steel industry study
Colak,I.; Duzgun,B.
Power grip, pinch grip, manual muscle
testing or thenar atrophy - which should
Geere,J.; Chester,R.; Kale,S.;
2007 be assessed as a motor outcome after BMC Musculoskelet.Disord. systematic review
Jerosch-Herold,C.
carpal tunnel decompression? A
systematic review
Carpal-tunnel syndrome. Results of a
Gelberman,R.H.; Aronson,D.;
1980 prospective trial of steroid injection and J Bone Joint Surg Am Very Low Quality
Weisman,M.H.
splinting
Gelberman,R.H.;
+not best available
Hergenroeder,P.T.; The carpal tunnel syndrome. A study of
1981 J Bone Joint Surg Am evidence; confounding
Hargens,A.R.; Lundborg,G.N.; carpal canal pressures
comorbidities
Akeson,W.H.
Gelberman,R.H.; Rydevik,B.L.;
Carpal tunnel syndrome. A scientific
Pess,G.M.; Szabo,R.M.; 1988 Orthop Clin North Am Narrative review
basis for clinical care
Lundborg,G.
Gellman,H.; Chandler,D.R.;
Carpal tunnel syndrome in paraplegic
Petrasek,J.; Sie,I.; Adkins,R.; 1988 J Bone Joint Surg Am <10 patients per group
patients
Waters,R.L.
Gellman,H.; Gelberman,R.H.; Carpal tunnel syndrome. An evaluation insufficient data; very
1986 J Bone Joint Surg Am
Tan,A.M.; Botte,M.J. of the provocative diagnostic tests low study design
Primary carpal tunnel stenosis as a
insufficient data; baseline
Gelmers,H.J. 1981 cause of entrapment of the median Acta Neurochir.(Wien.)
patients with CTS
nerve
The significance of Tinel's sign in the insufficient data; very
Gelmers,H.J. 1979 Acta Neurochir.(Wien.)
Adding clonidine to lidocaine for
Gentili,M.; Bernard,J.-M.; Insufficient data (data
1999 intravenous regional anesthesia Anesth.Analg.
Bonnet,F. reported in medians)
prevents tourniquet pain
Georgiew,F.; Maciejczak,A.; Results of surgical treatment of carpal
2014 Ortop.Traumatol.Rehabil Foreign language
Florek,J. tunnel syndrome
Geronimo,G.; Caccese,A.F.; Duplicate article
Treatment of carpal tunnel syndrome
Caruso,L.; Soldati,A.; 2009 Eur.Rev.Med.Pharmacol.Sci. (duplicate with AAOS ID
with alpha-lipoic acid
Passaretti,U. 445)
850
Reason for
Exclusion
Gerr,F.; Letz,R.; Harris- Sensitivity and specificity of vibrometry insufficient data; very
Abbott,D.; Hopkins,L.C. for detection of carpal tunnel syndrome low study design
Gerr,F.; Marcus,M.; Ensor,C.; A prospective study of computer users:
Kleinbaum,D.; Cohen,S.; I. Study design and incidence of
2002 Am.J.Ind.Med. Not relevant to CTS
Edwards,A.; Gentry,E.; musculoskeletal symptoms and
Ortiz,D.J.; Monteilh,C. disorders
Gerritsen,A.A.; de Krom,M.C.; Conservative treatment options for
Struijs,M.A.; Scholten,R.J.; de 2002 carpal tunnel syndrome: a systematic J Neurol Systematic review
Vet,H.C.; Bouter,L.M. review of randomised controlled trials
Gerritsen,A.A.; Scholten,R.J.; Splinting or surgery for carpal tunnel Does not answer question
Assendelft,W.J.; Kuiper,H.; de 2001 syndrome? Design of a randomized BMC Neurol of interest (study
Vet,H.C.; Bouter,L.M. controlled trial [ISRCTN18853827] protocol)
Gerritsen,A.A.;
Systematic review of randomized
Uitdehaag,B.M.; van,Geldere
2001 clinical trials of surgical treatment for Br J Surg systematic review
D.; Scholten,R.J.; de Vet,H.C.;
Bouter,L.M.
Carpal tunnel syndrome. Risk factors
Gerwatowski,L.J.; McFall,D.B.; literature review;
1992 and preventive strategies for the dental J Dent.Hyg.
Stach,D.J. background information
hygienist
Ghaly,R.F.; Saban,K.L.; Endoscopic carpal tunnel release
2000 Neurol Res. Retrospective case series
Haley,D.A.; Ross,R.E. surgery: report of patient satisfaction
Ghasemi-Esfe,A.R.;
Combination of high-resolution and
Khalilzadeh,O.; Mazloumi,M.; insufficient data; very
2011 color Doppler ultrasound in diagnosis Acta Radiol.
Vaziri-Bozorg,S.M.; Niri,S.G.; low study design
Kahnouji,H.; Rahmani,M.
Ghasemi-Esfe,A.R.;
Color and power Doppler US for
Khalilzadeh,O.; Vaziri-
diagnosing carpal tunnel syndrome and insufficient data; very
Bozorg,S.M.; Jajroudi,M.; 2011
determining its severity: a quantitative low study design
Shakiba,M.; Mazloumi,M.;
image processing method
Rahmani,M.
Ghasemi-Esfe,A.R.;
Color Doppler ultrasound for evaluation
Morteza,A.; Khalilzadeh,O.; insufficient data; very
2012 of vasomotor activity in patients with Skeletal Radiol.
Mazloumi,M.; Ghasemi- low study design
Esfe,M.; Rahmani,M.
Carpal tunnel syndrome: reappraisal of insufficient data; very
Ghavanini,M.R.; Haghighat,M. 1998 Electromyogr.Clin Neurophysiol.
five clinical tests low study design
851
Reason for
Exclusion
Median-radial sensory latencies no comparison of
Ghavanini,M.R.; Kazemi,B.;
1996 comparison as a new test in carpal Electromyogr.Clin Neurophysiol. modalities; very low
Jazayeri,M.; Khosrawi,S.
tunnel syndrome study design
Hand disorders in pregnancy: De
Gheorghiu,N.; Orban,H.B.;
2010 Quervain's tenosynovitis and carpal Gineco.ro Background article
Adam,R.; Popescu,D.
tunnel syndrome
Giannini,F.; Cioni,R.; A new clinical scale of carpal tunnel
+Does not answer a
Mondelli,M.; Padua,R.; syndrome: validation of the
2002 Clin Neurophysiol. question of
Gregori,B.; D'Amico,P.; measurement and clinical-
interest/insufficient data
Padua,L. neurophysiological assessment
Giannini,F.; Passero,S.;
Electrophysiologic evaluation of local
Cioni,R.; Paradiso,C.;
1991 steroid injection in carpal tunnel Arch Phys Med Rehabil. Very Low Quality
Battistini,N.; Giordano,N.;
syndrome
Vaccai,D.; Marcolongo,R.
Gibbs,K.E.; Rand,W.; Open vs endoscopic carpal tunnel
1996 very low quality
Ruby,L.K. release
Outpatient carpal tunnel decompression
Gibson,M. 1990 without tourniquet: a simple local Ann.R Coll Surg Engl. Very low quality
anaesthetic technique
Evidence-based treatment of carpal
Giele,H. 2001 Current Orthopaedics background
tunnel syndrome
Gender differences in carpal tunnel
Giersiepen,K.; Eberle,A.; syndrome? occupational and non-
2000 Ann.Epidemiol. insufficient data
Pohlabeln,H. occupational risk factors in a
population-based case-control study
Carpal tunnel syndrome as an
Giersiepen,K.; Spallek,M. 2011 Dtsch.Arztebl.Int. systematic review
occupational disease
Gilbert,M.S.; Robinson,A.; Carpal tunnel syndrome in patients who
all CTS cases; no
Baez,A.; Gupta,S.; Glabman,S.; 1988 are receiving long-term renal J Bone Joint Surg Am
comparison group
Haimov,M. hemodialysis
no comparison of
The refractory period of transmission in
Gilliatt,R.W.; Meer,J. 1990 Muscle Nerve modalities; very low
study design
Evidence of altered motor axon
Ginanneschi,F.; Dominici,F.; insufficient data; very
2007 properties of the ulnar nerve in carpal Clin Neurophysiol.
Milani,P.; Biasella,A.; Rossi,A. low study design
tunnel syndrome
852
Reason for
Exclusion
Effects of Local Corticosteroid
Ginanneschi,F.; Filippou,G.;
Injection on Electrical Properties of
Bonifazi,M.; Frediani,B.; 2013 J Mol.Neurosci. Very Low Quality
Abeta-Fibers in Carpal Tunnel
Rossi,A.
Syndrome
Ginanneschi,F.; Filippou,G.; Effects of local corticosteroid injection
Bonifazi,M.; Frediani,B.; 2014 on electrical properties of A(beta)-fibers J.Mol.Neurosci. Very low quality
Rossi,A. in carpal tunnel syndrome
Ginanneschi,F.; Milani,P.;
Evidences for antinociceptive effect of Incorrect patient
Filippou,G.; Mondelli,M.;
2012 17-alpha-hydroxyprogesterone caproate J Mol.Neurosci. population (<10
Frediani,B.; Melcangi,R.C.;
in carpal tunnel syndrome patients/group)
Rossi,A.
Ginanneschi,F.; Milani,P.;
Ulnar sensory nerve impairment at the +Does not answer a
Mondelli,M.; Dominici,F.; 2008 Muscle Nerve
wrist in carpal tunnel syndrome question of interest
Biasella,A.; Rossi,A.
Changes in motor axon recruitment in
Ginanneschi,F.; Mondelli,M.; insufficient data; very
2006 the median nerve in mild carpal tunnel Clin Neurophysiol.
Dominici,F.; Rossi,A. low study design
syndrome
Giordano,N.; Battisti,E.;
Franci,A.; Magaro,L.; Telethermographic assessment of carpal insufficient data; very
1992 Scand.J Rheumatol.
Marcucci,P.; Cecconami,L.; tunnel syndrome low study design
Marcolongo,R.
Girlanda,P.; Quartarone,A.;
Sinicropi,S.; Pronesti,C.; Electrophysiological studies in mild insufficient data; very
1998 Electroencephalogr.Clin Neurophysiol.
Nicolosi,C.; Macaione,V.; idiopathic carpal tunnel syndrome low study design
Picciolo,G.; Messina,C.
Median nerve conduction tests and +not best available
Glass,I.; Ring,H. 1995 Electromyogr.Clin Neurophysiol.
Phalen's sign in carpal tunnel syndrome evidence
Glynn,A.; Strunk,S.; Reidy,D.; Carpal tunnel release using local
2005 Ir.Med J Retrospective case series
Hynes,D.E. anaesthetic and a forearm tourniquet
The role of needle electromyography in
the evaluation of patients with carpal background information;
Gnatz,S.M. 1999 Muscle Nerve
tunnel syndrome: Needle EMG is commentary
important
The role of needle electromyography in
Gnatz,S.M.; Conway,R.R. 1999 the evaluation of patients with carpal Muscle Nerve Commentary/review
tunnel syndrome
853
Reason for
Exclusion
Deficits in the function of small and
Goadsby,P.J.; Burke,D. 1994 large afferent fibers in confirmed cases Muscle Nerve
low study design
Measurement of nerve conduction--a
Goddard,D.H.; Barnes,C.G.; insufficient data; very
1983 comparison of orthodromic and Clin Rheumatol.
Berry,H.; Evans,S. low study design
antidromic methods
Goetz,J.E.; Kunze,N.M.;
MRI-apparent localized deformation of
Main,E.K.; Thedens,D.R.; insufficient data; very
2013 the median nerve within the carpal Ann.Biomed Eng
Baer,T.E.; Lawler,E.A.; low study design
tunnel during functional hand loading
Brown,T.D.
Gohl,A.P.; Clayton,S.Z.;
Median and ulnar neuropathies in insufficient data; no
Strickland,K.; Bufford,Y.D.; 2006 Medical Problems of Performing Artists
University Pianists comparison group
Halle,J.S.; Greathouse,D.G.
Effect of amplifier gain setting on distal
Goldfarb,A.R.; Saadeh,P.B.; insufficient data; very
2005 motor latency in normal subjects and Clin Neurophysiol.
Sander,H.W. low study design
CTS patients
Golding,D.; Wilson,P. 1989 Rheumatism and the menopause Background Information
Vibration white finger associated with
Golding,D.N. 1990 Journal of Orthopaedic Rheumatology case report
Golding,D.N.; Rose,D.M.; Clinical tests for carpal tunnel not best available
1986 Br J Rheumatol.
Selvarajah,K. syndrome: an evaluation evidence
Amyloidosis and silicone synovitis:
Updated classification, updated
Goldman,A.B.; Bansal,M. 1996 Radiol.Clin.North Am. Background Information
pathophysiology, and synovial articular
abnormalities
Amyloidosis and carpal-tunnel
Goldman,R.L. 1970 N.Engl.J Med letter to the editor
syndrome
Golik,A.; Modai,D.; Pervin,R.; Autosomal dominant carpal tunnel
1988 Isr.J Med Sci Not relevant
Marcus,E.L.; Fried,K. syndrome in a Karaite family
Provocative test for carpal tunnel insufficient data; very
Goloborod'ko,S.A. 2004 J Hand Ther
Gomes,I.; Becker,J.; Seasonal distribution and
all CTS cases; no
Ehlers,J.A.; Kapczinski,F.; 2004 demographical characteristics of carpal Arq Neuropsiquiatr.
comparison group
Nora,D.B. tunnel syndrome in 1039 patients
Gominak,S.; Cros,D.; insufficient data; very
1990 Magnetic stimulation F-responses Electromyogr.Clin Neurophysiol.
Shahani,B. low study design
854
Reason for
Exclusion
Gong,H.S.; Oh,J.H.; Bin,S.W.; Clinical features influencing the patient-
Kim,W.S.; Chung,M.S.; 2008 based outcome after carpal tunnel J Hand Surg Am
comparison group
Baek,G.H. release
The effect of dividing muscles
Gong,H.S.; Oh,J.H.; Kim,W.S.;
superficial to the transverse carpal
Kim,S.H.; Rhee,S.H.; 2011 J Hand Surg Am very low quality
ligament on carpal tunnel release
Baek,G.H.
outcomes
Gonzalez del,Pino J.; Delgado-
Value of the carpal compression test in insufficient data; very
Martinez,A.D.; 1997 J Hand Surg Br
the diagnosis of carpal tunnel syndrome low study design
Gonzalez,Gonzalez,I; Lovic,A.
Steroid injection and splinting in the
Gonzalez,M.H.; Bylak,J. 2001 Very Low Quality
treatment of carpal tunnel syndrome
Goodman,C.M.;
Comparison of carpal canal pressure in
Steadman,A.K.; Meade,R.A.; <10 patients per group;
2001 paraplegic and nonparaplegic subjects: Plast.Reconstr.Surg
Bodenheimer,C.; Thornby,J.; very low study design
clinical implications
Netscher,D.T.
What can family physicians offer
Goodyear-Smith,F.; Arroll,B. 2004 Ann.Fam Med Systematic review
other than surgery? A systematic review
of nonsurgical management
Gordon,C.; Bowyer,B.L.; Electrodiagnostic characteristics of insufficient data; no
Johnson,E.W. acute carpal tunnel syndrome comparison group
Brief post-surgical electrical stimulation
accelerates axon regeneration and
Gordon,T.; Amirjani,N.;
2010 muscle reinnervation without affecting Exp.Neurol Very low strength
Edwards,D.C.; Chan,K.M.
the functional measures in carpal tunnel
syndrome patients
Gorsche,R.G.; Wiley,J.P.; Comparison of outcomes of untreated
+Does not answer a
Brant,R.; Renger,R.F.; 2002 carpal tunnel syndrome and Occup.Med (Lond)
Sasyniuk,T.M.; Burke,N. asymptomatic controls in meat packers
Is there a familial carpal tunnel
Gossett,J.G.; Chance,P.F. 1998 syndrome? An evaluation and literature Muscle Nerve literature review
review
Does not address
Gould,J.S.; Wissinger,H.A. 1978 Carpal tunnel syndrome in pregnancy South Med J
855
Reason for
Exclusion
Association between carpel tunnel
Gousheh,J.; Iranpour,A. 2005 syndrome and arteriovenous fistula in Plast.Reconstr.Surg very low study design
hemodialysis patients
Goyal,V.; Bhatia,M.;
Electrophysiological evaluation of 140 insufficient data; no
Padma,M.V.; Jain,S.; 2001 J Assoc Physicians India
hands with carpal tunnel syndrome comparison of modalities
Maheshwari,M.C.
Management of pregnancy related
Graeber,M.C.; Lucas,A.B. 2000 J Miss.State Med Assoc Case reports
Nonsurgical treatment of carpal tunnel
Graham,B. 2009 J Hand Surg Am Background article
syndrome
Variations in diagnostic criteria for
Graham,B.; Dvali,L.; Does not answer a
2006 carpal tunnel syndrome among Ontario Am J Ind.Med
Regehr,G.; Wright,J.G. question of interest
specialists
Development and validation of
Graham,B.; Regehr,G.;
2006 diagnostic criteria for carpal tunnel J Hand Surg Am case series; expert panel
Naglie,G.; Wright,J.G.
syndrome
Graham,B.; Regehr,G.; Delphi as a method to establish
2003 J Clin Epidemiol. background
Wright,J.G. consensus for diagnostic criteria
Two weeks of prednisolone was as
Graham,B.A. 2003 effective as four weeks in improving J Bone Joint Surg Am Review
carpal tunnel syndrome symptoms
Neurological complications of
Graham,J.G. 1982 Clin Obstet.Gynaecol. Background article
pregnancy and anaesthesia
Carpal tunnel syndrome. A statistical
Graham,R.A. 1983 Retrospective case series
analysis of 214 cases
Symptomatic carpal tunnel syndrome
Grant,A.J.; Buckels,J.A.; no comparison group;
1998 after orthotopic liver transplantation: a
Neuberger,J. very low study design
retrospective analysis
MR neurography: Diagnostic utility in
Grant,G.A.; Goodkin,R.; review; background
2004 the surgical treatment of peripheral Neuroimaging Clin.N.Am.
Maravilla,K.R.; Kliot,M. information
nerve disorders
Use of motor nerve conduction testing
Grant,K.A.; Congleton,J.J.;
and vibration sensitivity testing as insufficient data; very
Koppa,R.J.; Lessard,C.S.; 1992 J Hand Surg Am
screening tools for carpal tunnel low study design
Huchingson,R.D.
syndrome in industry
Hand flexor tenosynovitis in
Gray,R.G.; Gottlieb,N.L. 1977 Arthritis Rheum. Not relevant to CTS
rheumatoid arthritis. Prevalence,
856
Reason for
Exclusion
distribution, and associated rheumatic
features
Rheumatic disorders associated with
Gray,R.G.; Gottlieb,N.L. 1976 Semin.Arthritis Rheum. literature review
diabetes mellitus: literature review
Gray,R.G.; Poppo,M.J.; Primary familial bilateral carpal tunnel
1979 Ann.Intern.Med Not relevant
Gottlieb,N.L. syndrome
Incorrect patient
Grayzel,E.F.; Finegan,A.M.;
1997 The value of in-house physical therapy J.Occup.Environ.Med. population (<10
Ponchak,R.E.
patients/CTS group)
The relationship of pre- and
Green,T.P.; Tolonen,E.U.;
postoperative median and ulnar nerve
Clarke,M.R.; Pathak,P.;
2012 conduction measures to a self- Neurophysiol.Clin very low quality
Newey,M.L.; Kershaw,C.J.;
administered questionnaire in carpal
Kallio,M.A.
tunnel syndrome
Magnetic resonance imaging of the
Greenan,T.; Zlatkin,M.B. 1990 Seminars in Ultrasound CT and MRI Background Information
wrist
The carpal tunnel syndrome in
Greenhouse,A.H. 1981 Nebr.Med J background
neurologic practice
Carpal tunnel syndrome. A common but
Greenspan,J. 1988 Postgrad.Med Background article
treatable cause of wrist pain
Effective surgical treatment of cubital
Greenwald,D.; Blum,L.C.,III;
tunnel syndrome based on provocative
Adams,D.; Mercantonio,C.; 2006 Plast.Reconstr.Surg Not relevant to CTS
clinical testing without
Moffit,M.; Cooper,B.
electrodiagnostics
A study of wrist pain in industry -
Grieve,E.F. 1993 Clin.Rehabil. Not relevant to CTS
Theories of causation
Gross,A.S.; Louis,D.S.; Carpal tunnel syndrome: a
1995 J Occup.Environ.Med bio-study/ biopsy
Carr,K.A.; Weiss,S.A. clinicopathologic study
Grossman,R.S. 1991 CTS Dent.Off background
Grossman,R.S. 1990 CTS background
Restoration of strong opposition after
Journal of Bone and Joint Surgery - Does not address
Groves,R.J.; Goldner,J.L. 1975 median nerve or brachial plexus
Series A question of interest
paralysis
Carpal tunnel decompression in spite of Does not address
Grundberg,A.B. 1983 J Hand Surg Am
normal electromyography question of interest
857
Reason for
Exclusion
Grundberg,A.B. 1979 Atypical carpal tunnel syndrome J Iowa Med Soc. case report
Surgical Multimedia Academic,
Research and Training (S.M.A.R.T.)
tool: a comparative analysis of
Grunwald,T.; Corsbie-
2006 cognitive efficiency for two multimedia Stud.Health Technol.Inform. background info
Massay,C.
learning interfaces that teach the pre-
procedural processes for carpal tunnel
release
Sonographic and electrophysiological insufficient comparison
Guan,J.; Ji,F.; Chen,W.;
2011 detection in patients with carpal tunnel Neurol Res. data; very low study
Chu,H.; Lu,Z.
syndrome design
Carpal tunnel release in patients with
Gulabi,D.; Cecen,G.; Guclu,B.;
2014 diabetes result in poorer outcome in Eur.J Orthop Surg Traumatol. very low quality
Cecen,A.
long-term study
Carpal tunnel decompression. The
Gulati,A.; Whitaker,I.S.;
impact of tourniquet, anaesthesia type,
Jaggard,M.; Arch,B.N.; 2005 Br J Plast.Surg Retrospective case series
and operating team on patient
Hopkinson-Woolley,J.
satisfaction scores
Guldmann,R.; Pourtales,M.C.; Is it possible to use robots for carpal
2010 J Orthop Sci Case report
Liverneaux,P. tunnel release?
Peri- and postoperative pain valutation
Gunetti,R.; Bonicalzi,V.;
2000 in carpal tunnel release of median nerve J Neurosurg.Sci Very low quality
Riolo,C.; Pagni,C.A.
compression
The diagnosis of carpal tunnel
Gunnarsson,L.G.; Amilon,A.;
syndrome. Sensitivity and specificity of not best available
Hellstrand,P.; Leissner,P.; 1997 J Hand Surg Br
some clinical and electrophysiological evidence
Philipson,L.
tests
Lack of peripheral analgesic effect of
Gupta,A.; Bjornsson,A.; Deemed clinically
1993 low-dose morphine during intravenous Reg Anesth.
Sjoberg,F.; Bengtsson,M. irrelevant
regional anesthesia
Patient controlled regional analgesia
Gupta,A.; Rawal,N.;
after carpal tunnel release: a double- Does not address
Magnuson,A.; Alnehill,H.; 2011 J Hand Surg Eur.Vol.
blind study using distal perineural question of interest
Pettersson,K.
catheters
858
Reason for
Exclusion
Reliability of motor parameters for
Gupta,S.; Tewari,A.K.;
2013 follow-up after local steroid injection in J Neurosci.Rural Pract. Not in English
Nair,V.; Gupta,A.
Cross-sectional
Yoga for stress reduction and injury
Gura,Taylor S. 2002 Work study/background
prevention at work
information
Relationship between electrodiagnostic
Gursoy,A.E.; Kolukisa,M.;
severity and neuropathic pain assessed insufficient data; very
Yildiz,G.B.; Kocaman,G.; 2013 Neuropsychiatr.Dis Treat.
by the LANSS pain scale in carpal low study design
Celebi,A.; Kocer,A.
tunnel syndrome
Relationship between electrodiagnostic
Gursoy,A.E.; Kolukisa,M.;
severity and neuropathic pain assessed +Does not answer a
Yildiz,G.B.; Kocaman,G.; 2012 Neuropsychiatric Disease and Treatment
by the LANSS pain scale in carpal question of interest
Celebi,A.; Kocer,A.
tunnel syndrome
Median--ulnar nerve communications insufficient data; no
Gutmann,L. 1977 J Neurol Neurosurg.Psychiatry
and carpal tunnel syndrome comparison group
The illusion of severe carpal tunnel
Gutmann,L.; Nance,C. 2010 Muscle Nerve case report
syndrome (CTS)
Carpal tunnel syndrome--a
Haase,J. 2007 Adv.Tech.Stand.Neurosurg. background
comprehensive review
Impact of occupations and job tasks on
Hagberg,M.; Morgenstern,H.;
1992 the prevalence of carpal tunnel Scand.J Work Environ.Health systematic review
Kelsh,M.
syndrome
Clinical and electrophysiological
Hagebeuk,E.E.; de Weerd,A.W. 2004 follow-up after local steroid injection in Clin Neurophysiol. Very Low Quality
the carpal tunnel syndrome
Haghighat,A.; Khosrawi,S.;
Prevalence of clinical findings of carpal Prevalence study; no
Kelishadi,A.; Sajadieh,S.; 2012 Adv.Biomed Res.
tunnel syndrome in Isfahanian dentists comparison group
Badrian,H.
Carpal tunnel syndrome associated with
Hale,M.S.; Ruderman,J.E. 1973 Am J Phys Med case report
rubella immunization
Management of upper extremity
Hales,T.R.; Bertsche,P.K. 1992 AAOHN J. background
cumulative trauma disorders
Rheumatologic manifestations of
Hall,S.; Luthra,H.S. 1983 Minn.Med background information
amyloid disease
859
Reason for
Exclusion
Electrophysiologic approaches to the
Hallett,M. 1985 Neurol Clin Background Information
diagnosis of entrapment neuropathies
Halperin,J.J.; Volkman,D.J.; Carpal tunnel syndrome in Lyme
1989 Muscle Nerve answer the PICO
Luft,B.J.; Dattwyler,R.J. borreliosis
question
Hamamoto Filho,P.T.; A systematic review of anti-
Leite,F.V.; Ruiz,T.; 2009 inflammatories for mild to moderate J Clin Neuromuscul.Dis systematic review
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Hamann,C.; Werner,R.A.; Prevalence of carpal tunnel syndrome
Not relevant, prevalence
Franzblau,A.; Rodgers,P.A.; 2001 and median mononeuropathy among J Am Dent.Assoc
study
Siew,C.; Gruninger,S. dentists
Ultrasonography shows increased cross-
+not best available
Hammer,H.B.; Hovden,I.A.; sectional area of the median nerve in
2006 Rheumatology (Oxford) evidence; not CTS
Haavardsholm,E.A.; Kvien,T.K. patients with arthritis and carpal tunnel
exclusive
syndrome
Hand-arm vibration isolation materials: Applied Occupational and
Hampel,G.A. 1992 Background Information
A range of performance evaluation Environmental Hygiene
Symptomatic relief following carpal
Hankin,F.M.; Louis,D.S. 1988 tunnel decompression with normal letter
electroneuromyographic studies
A 12-year experience using the brown
two-portal endoscopic procedure of
transverse carpal ligament release in
14,722 patients: Defining a new
Hankins,C.L. 2008 Plast.Reconstr.Surg. Insufficient data
paradigm in the treatment of carpal
tunnel syndrome (Plastic and
Reconstructive Surgery (2007) 120,
(1911))
A 12-year experience using the Brown
two-portal endoscopic procedure of
Hankins,C.L.; Brown,M.G.;
transverse carpal ligament release in
Lopez,R.A.; Lee,A.K.; Dang,J.; 2007 Plast.Reconstr.Surg Retrospective case series
14,722 patients: defining a new
Harper,R.D.
paradigm in the treatment of carpal
tunnel syndrome
Hanrahan,L.P.; Higgins,D.; Project SENSOR: Wisconsin
Anderson,H.; Haskins,L.; 1991 surveillance of occupational carpal Wis.Med J review; commentary
Tai,S. tunnel syndrome
860
Reason for
Exclusion
A prospective study of prognostic
Hansen,T.B.; Dalsgaard,J.;
2009 factors for duration of sick leave after BMC Musculoskelet.Disord. very low quality
Meldgaard,A.; Larsen,K.
Randomised controlled study of two
Hansen,T.B.; Kirkeby,L.;
2009 different techniques of skin suture in Scand.J Plast.Reconstr.Surg Hand Surg Insufficient data
Fisker,H.; Larsen,K.
endoscopic release of carpal tunnel
Insufficient data
Hanssen,A.D.; Amadio,P.C.; Deep postoperative wound infection
1989 J Hand Surg Am (antibiotic prophylaxis
DeSilva,S.P.; Ilstrup,D.M. after carpal tunnel release
not stratified)
Segmental median nerve conduction
Does not answer a
measurements discriminate carpal
Hansson,S. 1995 Muscle Nerve question of interest; no
tunnel syndrome from diabetic
assessment of risk factors
polyneuropathy
Median sensory nerve conduction block no comparison of
Hansson,S.; Nilsson,B.Y. 1995 during wrist flexion in the carpal tunnel Electromyogr.Clin Neurophysiol. modalities; very low
syndrome study design
Harber,P.; Pena,L.; Bland,G.; Upper extremity symptoms in Not relevant, CTS
1992 Am.J.Ind.Med.
Beck,J. supermarket workers diagnosis not made
Harle,J.-R.; Aubert,J.-P.;
Andrac,L.; Disdier,P.; Weiller- Carpal tunnel syndrome with scar-
1991 European Journal of Internal Medicine case report
Merli,C.; Pellissier,J.-F.; sarcoidosis of median nerve
Magalon,G.
Harrell,L.E.; Massey,E.W. 1983 Hand weakness in the elderly J.Am.Geriatr.Soc. background
The surgical treatment of the carpal-
Harris,C.M.; Tanner,E.; insufficient data; not best
1979 tunnel syndrome correlated with J Bone Joint Surg Am
Goldstein,M.N.; Pettee,D.S. evidence
preoperative nerve-conduction studies
Harris-Adamson,C.; Eisen,E.A.;
Dale,A.M.; Evanoff,B.;
Personal and workplace psychosocial pooled data and varying
Hegmann,K.T.; Thiese,M.S.;
2013 risk factors for carpal tunnel syndrome: Occup.Environ.Med methods, designs, and
Kapellusch,J.M.; Garg,A.;
a pooled study cohort data types
Burt,S.; Bao,S.; Silverstein,B.;
Gerr,F.; Merlino,L.; Rempel,D.
Biomechanical risk factors for carpal pooled data and varying
Kapellusch,J.; Garg,A.;
2014 tunnel syndrome: A pooled study of Occup.Environ.Med. methods, designs, and
Hegmann,K.T.; Thiese,M.S.;
2474 workers data types
Dale,A.M.; Evanoff,B.; Burt,S.;
861
Reason for
Exclusion
Bao,S.; Silverstein,B.;
Merlino,L.; Gerr,F.; Rempel,D.
Kapellusch,J.; Garg,A.;
Biomechanical risk factors for carpal
Hegmann,K.T.; Thiese,M.S.; duplicate of AAOS ID
2015 tunnel syndrome: a pooled study of Occup Environ Med
Dale,A.M.; Evanoff,B.; Burt,S.; 15187
2474 workers
Bao,S.; Silverstein,B.;
Merlino,L.; Gerr,F.; Rempel,D.
Lack of evidence of generalised sensory no comparison of
Harrison,M.J. 1978 neuropathy in patients with carpal J Neurol Neurosurg.Psychiatry modalities; very low
tunnel syndrome study design
Retrospective
Harter,B.T.,Jr.;
comparative. Very Low
McKiernan,J.E.,Jr.; Carpal tunnel syndrome: surgical and
1993 J Hand Surg Am Quality. Comparison
Kirzinger,S.S.; Archer,F.W.; nonsurgical treatment
groups not relevant for
Peters,C.K.; Harter,K.C.
any questions of interest.
Carpal tunnel syndrome caused by an
Harwin,S.F.; Stern,R.E. 1980 Orthop.Rev. case report
anomolous muscle belly
Effect of Linum usitatissimum L.
Hashempur,M.H.;
(linseed) oil on mild and moderate
Homayouni,K.; Ashraf,A.; Lack of dosage
2014 carpal tunnel syndrome: a randomized, Daru
Salehi,A.; Taghizadeh,M.; standardization
double-blind, placebo-controlled
Heydari,M.
clinical trial
Mycobacterium tuberculosis-induced
Hassanpour,S.E.; Gousheh,J. 2006 carpal tunnel syndrome: management J Hand Surg Am Retrospective case series
and follow-up evaluation
Hayashig,M.; Makoto,M.; Carpal tunnel syndrome associated with
2013 J Hand Surg Eur.Vol. letter/summary document
Kato,H. underlying Kienbock's disease
Neurological complications of the
Heathfield,K. 1973 Rheumatol.Rehabil. review
rheumatic diseases
Does not answer a
Wrist postures while keyboarding:
Hedge,A.; Powers,J.R. 1995 question of interest; no
effects of a negative slope keyboard
comparison group
862
Reason for
Exclusion
system and full motion forearm
supports
Heidarian,A.; Abbasi,H.; Comparison of Knifelight Surgery

Hasanzadeh,Hoseinabadi M.; versus Conventional Open Surgery in
2013 Iran Red Crescent Med J criteria (invasive follow-
Hajialibeyg,A.; Kalantar the Treatment of Carpal Tunnel
up<3 month)
Motamedi,S.M.; Seifirad,S. Syndrome
Evaluation of carpal tunnel release
Helm,R.H.; Vaziri,S. 2003 J Hand Surg Br criteria (invasive follow-
using the Knifelight instrument
up<3 month)
Evaluation of carpal tunnel release
duplicate of
Helm,R.H.; Vaziri,S. 2003 using the Knifelight(registered Journal of Hand Surgery
PM:12809659
trademark) instrument
Helwig,A.L. 2000 Treating carpal tunnel syndrome J Fam Pract. Insufficient data
The anatomy, symptoms, and signs of
Hennessey,W.J.; Kuhlman,K.A. 1997 Phys.Med.Rehabil.Clin.N.Am. background
Splinting after carpal tunnel release:
Henry,S.L.; Hubbard,B.A.;
2008 current practice, scientific evidence, and Plast.Reconstr.Surg survey
Concannon,M.J.
trends
Hentz,V.R. 1977 Common hand problems Surg Clin North Am background
Herbison,G.J.; Teng,C.; Carpal tunnel syndrome in rheumatoid insufficient data; very
1973 Am J Phys Med
Martin,J.H.; Ditunno,J.F.,Jr. arthritis low study design
Histologists, microtomy, chronic
repetitive trauma, and techniques to
Herman,G.E.; Schork,M.A.; not exclusive to CTS;
1995 avoid injury: I. A statistical evaluation Journal of Histotechnology
Shyr,Y.; Elfont,E.A.; Arbit,S. very low study design
of the job functions performed by
histologists
Thermography in the detection of carpal
Herrick,R.T.; Herrick,S.K. 1987 tunnel syndrome and other compressive J Hand Surg Am
confounded design
neuropathies
Electrodiagnostic approach to the
background information;
Herrmann,D.N.; Logigian,E.L. 2002 patient with suspected mononeuropathy Neurol.Clin.
commentary
of the upper extremity
863
Reason for
Exclusion
Incorrect patient
Herskovitz,S.; Berger,A.R.; Low-dose, short-term oral prednisone in
1995 population (<10
Lipton,R.B. the treatment of carpal tunnel syndrome
patients/group)
Assessment of outcome of carpal tunnel
Heybeli,N.; Kutluhan,S.;
syndrome: a comparison of Does not answer any
Demirci,S.; Kerman,M.; 2002 J Hand Surg Br
electrophysiological findings and a self- question of interest.
Mumcu,E.F.
administered Boston questionnaire
Texture discrimination in carpal tunnel +Does not answer a
Heywood,J.T.; Morley,J.W. 1992
syndrome question of interest
Higgs,P.E.; Young,V.L. 1996 Cumulative trauma disorders Clin.Plast.Surg. background
Hiltunen,J.; Kirveskari,E.; Pre- and post-operative diffusion tensor
Numminen,J.; Lindfors,N.; 2012 imaging of the median nerve in carpal Eur.Radiol.
low study design
Goransson,H.; Hari,R. tunnel syndrome
inadequate presentation
of the effect of
Carpal tunnel syndrome in patients on
Hirasawa,Y.; Ogura,T. 2000 Scand.J Plast.Reconstr.Surg Hand Surg haemodialysis length on
long-term haemodialysis
CTS to permit use for this
pico question
Hirooka,T.; Hashizume,H.;
Adequacy and long-term prognosis of
Senda,M.; Nagoshi,M.; 1999 Acta Med Okayama very low quality
Inoue,H.; Nagashima,H.
The effect of age and gender upon
Hobby,J.L.; Venkatesh,R.; Does not address
2005 symptoms and surgical outcomes in J Hand Surg Br
Motkur,P. question of interest
Hobson-Webb,L.D.; The ultrasonographic wrist-to-forearm
Massey,J.M.; Juel,V.C.; 2008 median nerve area ratio in carpal tunnel Clin Neurophysiol.
low study design
Sanders,D.B. syndrome
A randomized prospective study to
assess the efficacy of two cold-therapy deemed clinically
Hochberg,J. 2001 J Hand Ther
treatments following carpal tunnel irrelevant
release
Carpal tunnel syndrome. Importance of
Hoffman,D.E. 1975 sensory nerve conduction studies in case report
diagnosis
Hoffman,J.; Hoffman,P.L. 1985 Staple gun carpal tunnel syndrome J Occup.Med case report
864
Reason for
Exclusion
Internal neurolysis or ligament division
only in carpal tunnel syndrome. II. A 3
Holmgren,H.; Rabow,L. 1987 year follow-up with an evaluation of Acta Neurochir.(Wien.)
various neurophysiological parameters
for diagnosis
Holmgren-Larsson,H.; Internal neurolysis or ligament division
Leszniewski,W.; Linden,U.; 1985 only in carpal tunnel syndrome--results Acta Neurochir.(Wien.) No outcomes of interest.
Rabow,L.; Thorling,J. of a randomized study
Holt,J.B.; Van Heest,A.E.; Hand disorders in children with
2013 Journal of Hand Surgery Background Information
Shah,A.S. mucopolysaccharide storage diseases
Carpal tunnel syndrome: a "new"
Holtzhausen,T. 1985 occupational hazard for the oral J Dent.Assoc S.Afr. Background Information
hygienist
Agreement between symptom surveys,
Homan,M.M.; Franzblau,A.;
physical examination procedures and +not best available
Werner,R.A.; Albers,J.W.; 1999 Scand.J Work Environ.Health
electrodiagnostic findings for the carpal evidence
Armstrong,T.J.; Bromberg,M.B.
tunnel syndrome
Characteristics of the
electrophysiological activity of muscles insufficient data; very
Horiguchi,G.; Aoki,T.; Ito,H. 2011 J Nippon Med Sch
attached to the transverse carpal low study design
ligament in carpal tunnel syndrome
Horiuchi,Y. 1991 Entrapment neuropathy Asian Medical Journal background
Accuracy of ultrasonography and
Horng,Y.S.; Chang,H.C.; magnetic resonance imaging in
Lin,K.E.; Guo,Y.L.; Liu,D.H.; 2012 diagnosing carpal tunnel syndrome J Hand Surg Am
low study design
Wang,J.D. using rest and grasp positions of the
hands
Hough,A.D.; Moore,A.P.; Reduced longitudinal excursion of the insufficient data; very
Jones,M.P. median nerve in carpal tunnel syndrome low study design
Compression neuropathies in the
Howard,F.M. 1986 Hand Clin Narrative review
anterior forearm
Ultrasonography of median nerve
Hsieh,Y.-H.; Shih,J.-T.; Formosan Journal of Musculoskeletal insufficient data; very
2010 mobility in the diagnosis of carpal
Lee,H.-M.; Ho,Y.-J. Disorders low study design
tunnel syndrome
865
Reason for
Exclusion
Establishment of a proper manual
Hsu,H.Y.; Kuo,L.C.; Jou,I.M.; insufficient data; very
2013 tactile test for hands with sensory Arch Phys Med Rehabil.
Chen,S.M.; Chiu,H.Y.; Su,F.C. low study design
deficits
Feasibility of a novel functional
Hsu,H.Y.; Kuo,L.C.; Kuo,Y.L.; sensibility test as an assisted
Chiu,H.Y.; Jou,I.M.; Wu,P.T.; 2013 examination for determining precision PLoS One
low study design
Su,F.C. pinch performance in patients with
Diagnosis From Functional
Perspectives: Usefulness of a Manual
Hsu,H.Y.; Kuo,Y.L.; Jou,I.M.; Tactile Test for Predicting Precision insufficient data; very
Su,F.C.; Chiu,H.Y.; Kuo,L.C. Pinch Performance and Disease low study design
Severity in Subjects With Carpal
Tunnel Syndrome
Limited open carpal tunnel syndrome
Hughes,Jr; Baratz,M. 2006 Techniques in Orthopaedics Narrative review
using the safeguard system
Treating nerves: from anecdote to
Hughes,R.A. 2003 J R Soc.Med systematic review
systematic review
Hui,A.C.; Wong,S.M.;
Oral steroid in the treatment of carpal
Wong,K.S.; Li,E.; Kay,R.; 2001 Ann.Rheum.Dis background
tunnel syndrome
Yung,P.; Hung,L.K.; Yu,L.M.
Carpal tunnel syndrome. Part I:
Huisstede,B.M. 2010 effectiveness of nonsurgical treatments systematic review
-- a systematic review
Huisstede,B.M.;
Carpal tunnel syndrome. Part II:
Randsdorp,M.S.; Coert,J.H.;
2010 effectiveness of surgical treatments--a Arch Phys Med Rehabil. systematic review
Glerum,S.; van,Middelkoop M.;
systematic review
Koes,B.W.
Hunderfund,A.N.; Boon,A.J.; insufficient data; very
2011 Sonography in carpal tunnel syndrome Muscle Nerve
Mandrekar,J.N.; Sorenson,E.J. low study design
Chiropractic manipulation for carpal
Hunt,K.J.; Hung,S.K.;
2009 tunnel syndrome: a systematic review Hand Therapy systematic review
Boddy,K.; Ernst,E.
(Provisional abstract)
Physical symptoms and signs and
Hunter,J. 2001 Clin J Pain literature review
chronic pain
866
Reason for
Exclusion
Recurrent carpal tunnel syndrome,
Hunter,J.M. 1991 epineural fibrous fixation, and traction Hand Clin Background article
neuropathy
Carpal tunnel syndrome: a review of the
Huntley,D.E.; Shannon,S.A. 1988 Dent.Hyg.(Chic.) literature review
literature
Recovery after carpal tunnel syndrome
Huracek,J.; Heising,T.;
2001 operation: the influence of the opposite Arch Orthop Trauma Surg Very low quality
Wanner,M.; Troeger,H.
hand, if operated on in the same session
The relationship of the double crush to
Hurst,L.C.; Weissberg,D.; insufficient data; very
1985 carpal tunnel syndrome (an analysis of J Hand Surg Br
Carroll,R.E. low study design
1,000 cases of carpal tunnel syndrome)
Husain,A.; Omar,S.A.;
F-ratio, a surrogate marker of carpal insufficient data; very
Habib,S.S.; Al-Drees,A.M.; 2009 Neurosciences (Riyadh.)
Hammad,D.
Huskisson,E.C. 1974 Arthritis as a sign of another disease Curr.Med Res.Opin. not relevant
Releasing the tourniquet in carpal
Hutchinson,D.T.; Wang,A.A. 2010 Hand (N.Y) Very low quality
tunnel surgery
The carpal tunnel syndrome. A
Hybbinette,C.H.; Mannerfelt,L. 1975 retrospective study of 400 operated Acta Orthop Scand. Retrospective case series
patients
Iannicelli,E.; Chianta,G.A.;
Evaluation of bifid median nerve with
Salvini,V.; Almberger,M.; 2000 J Ultrasound Med <10 patients per group
sonography and MR imaging
Monacelli,G.; Passariello,R.
Ibrahim,I.; Khan,W.S.; A novel method of diagnosing
Dheerendra,S.; Smitham,P.; 2012 autonomic dysfunction in carpal tunnel Ortop.Traumatol.Rehabil.
low study design
Goddard,N. syndrome: measuring skin capacitance
Outcome of carpal tunnel
Ibrahim,T.; Majid,I.;
2009 decompression: the influence of age, Int.Orthop very low quality
Clarke,M.; Kershaw,C.J.
gender, and occupation
Persistence of symptoms after surgical
Idler,R.S. 1996 release of compressive neuropathies and Orthop.Clin.North Am. Background article
subsequent management
Idler,R.S.; Strickland,J.W.;
1990 Flexor carpi radialis tunnel syndrome Indiana Med background
Creighton,J.J.,Jr.
867
Reason for
Exclusion
Recurrent neural networks for diagnosis not best available
Ilbay,K.; Ubeyli,E.D.; Ilbay,G.;
2010 of carpal tunnel syndrome using J Med Syst. evidence; retrospective
Budak,F.
electrophysiologic findings data review
Ilkhani,M.; Jahanbakhsh,S.M.; Accuracy of somatosensory evoked
Eghtesadi-Araghi,P.; 2005 potentials in diagnosis of mild Clin Neurol Neurosurg.
low study design
Moayyeri,A. idiopathic carpal tunnel syndrome
Imaeda,T.; Uchiyama,S.;
Validation of the Japanese Society for
Toh,S.; Wada,T.; Okinaga,S.; +Does not answer a
2007 Surgery of the Hand version of the J Orthop Sci
Sawaizumi,T.; Nishida,J.; question of interest
Carpal Tunnel Syndrome Instrument
Kusunose,K.; Omokawa,S.
Interpretation of cutaneous pressure
threshold (Semmes-Weinstein
Does not address
Imai,H.; Tajima,T.; Natsuma,Y. 1989 monofilament measurement) following
median nerve repair and sensory
reeducation in the adult
Imai,T.; Matsumoto,H.; Asymptomatic ulnar neuropathy in insufficient data; very
Minami,R. carpal tunnel syndrome low study design
Imaoka,H.; Yorifuji,S.; Improved inching method for the
Takahashi,M.; Nakamura,Y.; 1992 diagnosis and prognosis of carpal tunnel Muscle Nerve
low study design
Kitaguchi,M.; Tarui,S. syndrome
Incorrect patient
Impelmans,B.E.; Miles,J.; The use of free fat grafts in recalcitrant population (patients
2001 European Journal of Plastic Surgery
Burke,F.D. carpal tunnel: A retrospective study received previous
invasive treatment)
Impink,B.G.; Gagnon,D.; Repeatability of ultrasonographic +Does not answer a
2010 Muscle Nerve
Collinger,J.L.; Boninger,M.L. median nerve measures question of interest
Short-term effectiveness of short-wave
diathermy treatment on pain, clinical Does not meet inclusion
Incebiyik,S.; Boyaci,A.;
2014 symptoms, and hand function in J Back Musculoskelet.Rehabil criteria (follow-up<1
Tutoglu,A.
patients with mild or moderate month)
idiopathic carpal tunnel syndrome
Incoll,I.W.; Bateman,E.; Endoscopic vs. open carpal tunnel
2004 The Journal of Bone and Joint Surgery Insufficient data
Myers,A. release
Ingram,D.A.; Davis,G.R.; The double collision technique: A new only healthy study
1987 Electroencephalogr.Clin.Neurophysiol.
Swash,M. method for measurement of the motor subjects
868
Reason for
Exclusion
nerve refractory period distribution in
man
Motor nerve conduction velocity
Ingram,D.A.; Davis,G.R.; only healthy study
1987 distributions in man: Results of a new Electroencephalogr.Clin.Neurophysiol.
Swash,M. subjects
computer-based collision technique
Inukai,T.; Uchida,K.; Second lumbrical-interossei nerve test
+Does not answer a
Kubota,C.; Takamura,T.; 2013 predicts clinical severity and surgical J Clin Neurosci.
Nakajima,H.; Baba,H. outcome of carpal tunnel syndrome
Additional method for diagnosis of
Inukai,T.; Uchida,K.;
carpal tunnel syndrome: value of the
Kubota,C.; Takamura,T.; 2013 Hand Surg insufficient data
second lumbrical-interossei test (2L-
Nakajima,H.; Baba,H.
INT)
Iob,I.; Battaggia,C.; The carpal tunnel syndrome. Anatomo- Retrospective case series;
2000 Neurochirurgie
Rossetto,L.; Ermani,M. clinical correlations clinical review
Results of microsurgical suture in 200
Ionescu,D.; Ionescu,A. 1984 Acta Chir.Plast. Retrospective case series
nerves
Ireland,D.C. 1986 The hand. Part one Aust.Fam Physician background
Double-blind randomized controlled Incorrect patient
Irvine,J.; Chong,S.L.;
2004 trial of low-level laser therapy in carpal Muscle Nerve population (<10
Amirjani,N.; Chan,K.M.
tunnel syndrome patients/group)
Grip related upper extremity cumulative Background Information;
Isernhagen,S. 2000 Work
trauma: New information review
Ishikawa,K.; Kondo,M.; Atrophy of the thumb web space in
Vainio,K.; Patiala,H.; 1987 rheumatoid arthritis: clinical and Arch Orthop Trauma Surg Not relevant to CTS
Lehtimaki,M.; Raunio,P. electrodiagnostic studies
Isik,C.; Uslu,M.; The effects of diabetes on symptoms of
Does not address
Inanmaz,M.E.; 2013 carpal tunnel syndrome treated with Acta Orthop Belg.
Karabekmez,F.E.; Kose,K.C. mini-open surgery
Experience of Carpal Tunnel Syndrome
Isik,H.S.; Bostanci,U. 2011 that operated using a limited uni skin Turk Neurosurg. Retrospective case series
incision
Isoardo,G.; Stella,M.;
Cocito,D.; Risso,D.; Neuropathic pain in post-burn
<10 patients per group;
Migliaretti,G.; Cauda,F.; 2012 hypertrophic scars: a psychophysical Muscle Nerve
insufficient data
Palmitessa,A.; Faccani,G.; and neurophysiological study
Ciaramitaro,P.
869
Reason for
Exclusion
Different case definitions to describe
Isolani,L.; Bonfiglioli,R.; the prevalence of occupational carpal Not relevant, prevalence
2002 Int.Arch Occup.Environ.Health
Raffi,G.B.; Violante,F.S. tunnel syndrome in meat industry study
workers
Electrophysiological responsiveness
Itsubo,T.; Uchiyama,S.;
and quality of life (QuickDASH, CTSI)
Momose,T.; Yasutomi,T.; 2009 J Orthop Sci Retrospective case series
evaluation of surgically treated carpal
Imaeda,T.; Kato,H.
tunnel syndrome
Clonidine as an adjunct to intravenous
Ivie,C.S.; Viscomi,C.M.;
regional anesthesia: A randomized, Deemed clinically
Adams,D.C.; Friend,A.F.; 2011 J Anaesthesiol.Clin Pharmacol.
double-blind, placebo-controlled dose irrelevant
Murphy,T.R.; Parker,C.
ranging study
Comparative responsiveness of the
Iwatsuki,K.; Nishikawa,K.;
Hand 20 and the DASH-JSSH
Chaki,M.; Sato,A.; Morita,A.; 2014 J Hand Surg Eur.Vol.
questionnaires to clinical changes after
Hirata,H.
Mechanosensitivity of the median nerve
+Does not answer a
Jaberzadeh,S.; Zoghi,M. 2013 in patients with chronic carpal tunnel J Bodyw.Mov Ther
syndrome
Jablecki,C.K.; Andary,M.T.;
Ball,R.D.; Cherington,M.;
Fisher,M.A.; Phillips,L.H.;
So,Y.T.; Tulloch,J.W.;
Practice parameter for electrodiagnostic
Turk,M.A.; Wiechers,D.O.;
1993 studies in carpal tunnel syndrome: Muscle Nerve summary document
Wilbourn,A.J.; Williams,F.H.;
Summary statement
Ysla,R.G.; Rosenberg,J.H.;
Alter,M.; Daube,J.R.;
Franklin,G.; Frishberg,B.M.;
Greenberg,M.K.
Practice parameter: Electrodiagnostic
studies in carpal tunnel syndrome.
Report of the American Association of
Floeter,M.K.; Miller,R.G.;
2002 Electrodiagnostic Medicine, American summary document
Quartly,C.A.; Vennix,M.J.;
Academy of Neurology, and the
Wilson,J.R.
American Academy of Physical
Medicine and Rehabilitation
870
Reason for
Exclusion
Literature review of the usefulness of
nerve conduction studies and
So,Y.T.; Wilkins,D.E.; 1993 Muscle Nerve review
electromyography for the evaluation of
Williams,F.H.
So,Y.T.; Wilkins,D.E.;
Literature review of the usefulness of
Williams,F.H.; Ball,R.D.;
nerve conduction studies and needle
Cherington,M.; Fisher,M.A.; 1999 Muscle Nerve literature review
electromyography for the evaluation of
Phillips II,L.H.; Tulloch,J.W.;
Turk,M.A.; Wiechers,D.O.;
Wilbourn,A.J.; Ysla,R.G.
Electrodiagnosis of mild carpal tunnel insufficient data; very
Jackson,D.A.; Clifford,J.C. 1989 Arch Phys Med Rehabil.
Jacobson,M.D.; Plancher,K.D.; Vitamin B6 (pyridoxine) therapy for
1996 Hand Clin Narrative review
Kleinman,W.B. carpal tunnel syndrome
Transverse carpal ligament
Case series. Very Low
Jakab,E.; Ganos,D.; Cook,F.W. 1991 reconstruction in surgery for carpal J Hand Surg Am
Quality.
tunnel syndrome: a new technique
The effect of (gamma)-linolenic acid on Incorrect patient
Jamal,G.A.; Carmichael,H. 1990 human diabetic peripheral neuropathy: Diabet.Med. population (Not inclusive
A double-blind placebo-controlled trial of CTS patients)
A randomized controlled study of
Janssen,R.G.; Schwartz,D.A.;
2009 contrast baths on patients with carpal J Hand Ther Insufficient data
Velleman,P.F.
tunnel syndrome
Carpal tunnel syndrome: A review of
Janz,C.; Hammersen,S.; endoscopic release of the transverse
2001 Neurosurgery Quarterly Narrative review
Brock,M. carpal ligament compared with open
Magnetic resonance imaging compared
Jarvik,J.G.; Comstock,B.A.; Does not specify what
with electrodiagnostic studies in
Heagerty,P.J.; Haynor,D.R.; kind of surgery or
2008 patients with suspected carpal tunnel J Neurosurg.
Fulton-Kehoe,D.; Kliot,M.; nonsurgical treatment is
syndrome: predicting symptoms,
Franklin,G.M. given.
function, and surgical benefit at 1 year
Jazayeri,S.M.; Azizi,S.; Autologous blood injection in carpal
2009 Electromyogr.Clin Neurophysiol. Very Low Quality
Moghtaderi,A.R. tunnel syndrome (CTS)
871
Reason for
Exclusion
Use of Arnica to relieve pain after
Jeffrey,S.L.; Belcher,H.J. 2002 Altern.Ther Health Med Not relevant
carpal-tunnel release surgery
Jeng,O.J.; Radwin,R.G.; Functional psychomotor deficits +Does not answer a
1994
Rodriquez,A.A. associated with carpal tunnel syndrome question of interest
The outcome of carpal tunnel
Jenkins,P.J.; Duckworth,A.D.; Does not address
2012 decompression in patients with diabetes J Bone Joint Surg Br
Watts,A.C.; McEachan,J.E. question of interest
mellitus
does not answer the
question. it is a survival
analysis of time to
Corticosteroid injection for carpal
Jenkins,P.J.; Duckworth,A.D.; reintervention for patients
2012 tunnel syndrome: a 5-year survivorship Hand (N.Y)
Watts,A.C.; McEachan,J.E. who get steroid treatment.
analysis
it could be used as a case
series, but would be very
low quality evidence
Jensen,M.P.; Gammaitoni,A.R.; The pain quality assessment scale:
+Does not answer a
Olaleye,D.O.; Oleka,N.; 2006 assessment of pain quality in carpal J Pain
Nalamachu,S.R.; Galer,B.S. tunnel syndrome
The quantitative relationship between
physical examinations and the nerve
>10 patients per group;
Jeong,D.H.; Kim,C.H. 2014 conduction of the carpal tunnel Ann Rehabil Med
only 9 non-CTS hands
syndrome in patients with and without a
diabetic polyneuropathy
Jeong,J.S.; Yoon,J.S.; Kim,S.J.; Usefulness of ultrasonography to
Park,B.K.; Won,S.J.; Cho,J.M.; 2011 predict response to injection therapy in Ann.Rehabil.Med Very Low Quality
Byun,C.W. carpal tunnel syndrome
A systematic review of outcomes
assessed in randomized controlled trials
Jerosch,Herold C.; Carvalho- of surgical interventions for carpal
2006 systematic review
Leite,J.C.; Song,F. tunnel syndrome using the International
Classification of Functioning, Disability
and Health (ICF) as a reference tool
872
Reason for
Exclusion
A systematic review of outcomes
assessed in randomized controlled trials
Jerosch-Herold,C.; Leite,J.C.; of surgical interventions for carpal
2006 BMC Musculoskelet.Disord. systematic review
Song,F. tunnel syndrome using the International
Classification of Functioning, Disability
and Health (ICF) as a reference tool
Clinical course, costs and predictive
Jerosch-Herold,C.;
factors for response to treatment in +Does not answer a
Shepstone,L.; Wilson,E.C.; 2014 BMC Musculoskelet.Disord.
carpal tunnel syndrome: the PALMS question of interest
Dyer,T.; Blake,J.
study protocol
Infrared thermography based on
Jesensek,Papez B.; Palfy,M.; artificial intelligence as a screening insufficient data; very
2009 J Int.Med Res.
Mertik,M.; Turk,Z. method for carpal tunnel syndrome low study design
diagnosis
The use of PSSD testing in comparison +not best available
Jetzer,T.; Dellon,L.A.;
1995 to vibrotactile testing of vibration Cent.Eur.J Public Health evidence; very low study
Mitterhauser,M.D.
exposed workers design
Effective intervention with ergonomics,
Does not answer a
Jetzer,T.; Haydon,P.; antivibration gloves, and medical
2003 J Occup.Environ.Med question of interest; not
Reynolds,D. surveillance to minimize hand-arm
CTS exclusive
vibration hazards in the workplace
Use of vibration testing in the early
+Does not answer a
Jetzer,T.C. 1991 evaluation of workers with carpal J Occup.Med
tunnel syndrome
Jhattu,H.; Klaassen,S.; Ying,C.;
2012 Acute carpal tunnel syndrome in trauma European Journal of Plastic Surgery systematic review
Ali,Hussain M.
Jhee,W.H.; Oryshkevich,R.S.; Severe carpal tunnel syndrome with
1986 Orthop Rev. case reports
Wilcox,R. sparing of sensory fibers
Jimenez,D.F.; Gibbs,S.R.; Endoscopic treatment of carpal tunnel
1998 J Neurosurg. systematic review
Clapper,A.T. syndrome: a critical review
Jimenez,D.F.; Gibbs,S.R.; Endoscopic treatment of carpal tunnel
1997 Neurosurg.Focus Narrative review
Clapper,A.T. syndrome: a critical review
Jimenez,J.; Carson,G. 1970 The carpal tunnel syndrome Appl Ther background
Jitpraphai,C.;
Subclinical carpal tunnel syndrome in insufficient data; no
Prachathomrong,P.; Chira- 1994 J Med Assoc Thai.
hospital staff comparison group
Adisai,W.
873
Reason for
Exclusion
Low-level laser therapy in the treatment
Johnson,D.S. 2003 Athletic Therapy Today Background article
Should immediate surgery be done for
Johnson,E.W. 1995 Muscle Nerve opinion
carpal tunnel syndrome?--no!
insufficient data;
Johnson,E.W.; Gatens,T.; Wrist dimensions: correlation with
1983 Arch Phys Med Rehabil. summary of trend
Poindexter,D.; Bowers,D. median sensory latencies
evaluation
Sensory latencies to the ring finger:
Johnson,E.W.; Kukla,R.D.; insufficient data; very
1981 normal values and relation to carpal Arch Phys Med Rehabil.
Wongsam,P.E.; Piedmont,A. low study design
tunnel syndrome
Median and radial sensory latencies to
Johnson,E.W.; Sipski,M.; only healthy study
1987 digit I: normal values and usefulness in Arch Phys Med Rehabil.
Lammertse,T. subjects
Sensory and mixed nerve conduction
Johnson,E.W.; Terebuh,B.M. 1997 Phys.Med.Rehabil.Clin.N.Am. Background Information
studies in carpal tunnel syndrome
Johnson,J.; Kilgore,E.; +Does not answer a
1985 Tumorous lesions of the hand J Hand Surg Am
Newmeyer,W. question of interest
Relieving your patient's peripheral
Johnson,R. 1987 Current Therapeutics background
neuropathy
When pain brings no gain: Repetition,
Johnston,V. 1997 force, pressure: Culprits in work- Laboratory Medicine Background Information
related pain
Joist,A.; Joosten,U.; Anterior interosseous nerve
Wetterkamp,D.; Neuber,M.; 1999 compression after supracondylar J Neurosurg. Not relevant to CTS
Probst,A.; Rieger,H. fracture of the humerus: a metaanalysis
Jones,K.G. 1978 Carpal tunnel syndrome J Ark.Med Soc. background
Open carpal tunnel release. Does a
Jones,S.M.; Stuart,P.R.;
1997 vascularized hypothenar fat pad reduce J Hand Surg Br Very low quality
Stothard,J.
wound tenderness?
A systematic review of the utility of
Jordan,R.; Carter,T.;
2002 electrodiagnostic testing in carpal Br J Gen.Pract. systematic review
Cummins,C.
tunnel syndrome
Autonomic activity in the carpal tunnel insufficient data; very
Jordan,S.E.; Greider,J.L.,Jr. 1987 Orthop Rev.
874
Reason for
Exclusion
Increased prevalence of carpal tunnel Does not answer a
Joseph,A.W.; Shoemaker,A.H.;
2011 syndrome in albright hereditary J Clin Endocrinol.Metab question of interest;
Germain-Lee,E.L.
osteodystrophy prevalence study
Diagnostic utility of F waves in
Joshi,A.G.; Gargate,A.R. 2013 clinically diagnosed patients of carpal Indian J.Physiol.Pharmacol.
low study design
tunnel syndrome
Patient satisfaction following carpal-
Joshy,S.; Thomas,B.; Ghosh,S.; tunnel decompression: a comparison of
2007 Int.Orthop
Haidar,S.G.; Deshmukh,S.C. patients with and without osteoarthritis
of the wrist
Design of a myo-seismic transducer for
non-invasive transcutaneous vectorial review; background
Journee,H.L.; De Jonge,A.B. 1995 Electromyogr.Clin.Neurophysiol.
recording of locally fast muscle-fibre information
micro-contractions
Ultrasound myography: Application in
only healthy study
Journee,H.L.; De Jonge,A.B. 1993 nerve conduction velocity assessment Ultrasound Med.Biol.
subjects
and muscle cooling
Kabiraj,M.M.; al-Rajeh,S.; al-
Motor terminal latency index in carpal insufficient data; very
Tahan,A.R.; Abdulijabbar,M.; 1999 East Mediterr.Health J
al-Bunyan,M.
Kabiraj,M.M.U.; Al,Rajeh S.;
records review; does not
Al Tahan,A.R.; Abduljabbar,M.; Carpel tunnel syndrome: A clinico-
1998 Medical Science Research answer a question of
Al,Bunyan M.; Daif,A.K.; electrophysiological study
interest
Awada,A.
Kachel,H.G.; Altmeyer,P.; Deposition of nonamyloid material in
1984 Blood Purif. Not relevant
Kuhn,K.W. connective tissue in uraemia
Comparison of local steroid injection
Incorrect patient
Kamanli,A.; Bezgincan,M.; into carpal tunnel via proximal and
2011 Bratisl.Lek.Listy population (<10
Kaya,A. distal approach in patients with carpal
patients/group)
tunnel syndrome
Kamil,Oge H.;
Carpal tunnel cross sectional area
Basaran,Demirkazik F.; 1994 Turkish Neurosurgery <10 patients per group
measurement in carpal tunnel syndrome
Nurlu,G.; Inci,S.; Erbengi,A.
Delayed electrophysiological recovery
Kanatani,T.; Fujioka,H.;
after carpal tunnel release for advanced
Kurosaka,M.; Nagura,I.; 2013 J Clin Neurophysiol. Retrospective case series
carpal tunnel syndrome: a two-year
Sumi,M.
follow-up study
875
Reason for
Exclusion
Does carpal tunnel release provide
Kang,H.J.; Koh,I.H.; Lee,W.Y.; long-term relief in patients with Does not address
2012 Clin Orthop Relat Res.
Choi,Y.R.; Hahn,S.B. hemodialysis-associated carpal tunnel question of interest
syndrome?
Ultrasonography of median nerve and
Kang,S.; Kwon,H.K.; insufficient data; very
2012 electrophysiologic severity in carpal Ann.Rehabil.Med
Kim,K.H.; Yun,H.S. low study design
tunnel syndrome
Tenelectrodes: a new stimulator for
Kang,Y.K.; Kim,D.H.; insufficient data; very
2003 inching technique in the diagnosis of Yonsei Med J
Lee,S.H.; Hwang,M.; Han,M.S. low study design
Kantarci,F.; Ustabasioglu,F.E.;
Median nerve stiffness measurement by
Delil,S.; Olgun,D.C.;
shear wave elastography: a potential insufficient data; very
Korkmazer,B.; Dikici,A.S.; 2014 Eur.Radiol.
sonographic method in the diagnosis of low study design
Tutar,O.; Nalbantoglu,M.;
Uzun,N.; Mihmanli,I.
Preserved sympathetic skin response at
Kanzato,N.; Komine,Y.; insufficient data; very
2000 the distal phalanx in patients with carpal Clin Neurophysiol.
Kanaya,F.; Fukiyama,K. low study design
tunnel syndrome
Kapellusch Jm,J.M.; Gerr,F.E.;
Malloy,E.J.; Garg,A.; Harris-
Adamson,C.; Bao,S.S.; Exposure-response relationships for the
pooled data and varying
Burt,S.E.; Dale,A.M.; ACGIH threshold limit value for hand-
2014 Scand.J Work Environ Health methods, designs, and
Eisen,E.A.; Evanoff,B.A.; activity level: results from a pooled data
data types
Hegmann,K.T.; study of carpal tunnel syndrome
Silverstein,B.A.; Theise,M.S.;
Rempel,D.M.
Residual latency: new applications of <10 patients per group;
Kaplan,P.; Sahgal,V. 1978 Arch Phys Med Rehabil.
an old technique very low study design
Kaplan,S.J.; Glickel,S.Z.; Predictive factors in the non-surgical
1990 J Hand Surg Br Very Low Quality
Eaton,R.G. treatment of carpal tunnel syndrome
Sonographic assessment of transverse
Karabay,N.; Kayalar,M.; Does not address
2013 carpal ligament after open surgical Acta Orthop Traumatol.Turc.
Ada,S. question of interest
release of the carpal tunnel
876
Reason for
Exclusion
Triamcinolone acetonide vs procaine Journal of rehabilitation medicine :
-Karada?-?; Tok,F.; Duplicate study
hydrochloride injection in the official.journal of the UEMS.European
Akarsu,S.; Tekin,L.; 2012 (duplicate with AAOS ID
management of carpal tunnel syndrome: Board of Physical and Rehabilitation
Balaban,B. 236)
randomized placebo-controlled study Medicine
The effectiveness of triamcinolone
acetonide vs. procaine hydrochloride American journal of physical medicine Duplicate study
-Karada?-O; Tok,F.; -Ula?-UH;
2011 injection in the management of carpal & rehabilitation / Association of (duplicate with AAOSID
-Odaba?i-Z
tunnel syndrome: a double-blind Academic Physiatrists 313)
randomized clinical trial
Karadag,Y.S.; Karadag,O.;
Severity of Carpal tunnel syndrome not best evidence; does
Cicekli,E.; Ozturk,S.; Kiraz,S.;
2010 assessed with high frequency Rheumatol.Int. not answer question of
Ozbakir,S.; Filippucci,E.;
ultrasonography interest
Grassi,W.
Effects of steroid with repetitive
Karadas,O.; Omac,O.K.; procaine HCl injection in the
2012 J Neurol Sci Very Low Quality
Tok,F.; Ozgul,A.; Odabasi,Z. management of carpal tunnel syndrome:
an ultrasonographic study
Occupational soft-tissue and tendon
Kasdan,M.L.; Millender,L.H. 1996 Orthop.Clin.North Am. Background Information
disorders
Kasdan,M.L.; Wolens,D.;
Carpal tunnel syndrome not always medical records review;
Leis,V.M.; Kasdan,A.S.; 1994 J Ky.Med Assoc
work related insufficient data
Stallings,S.P.
Comparison of peak versus onset
Kasius,K.M.; Claes,F.;
latency measurements in all CTS confirmed;
Meulstee,J.; Weinstein,H.C.; 2014 J Clin Neurophysiol
electrodiagnostic tests for carpal tunnel comparing digits
Verhagen,W.I.
syndrome
The segmental palmar test in
Kasius,K.M.; Claes,F.; insufficient data; very
2012 diagnosing carpal tunnel syndrome Clin Neurophysiol.
Verhagen,W.I.; Meulstee,J. low study design
reassessed
Kasius,K.M.; Claes,F.; Ultrasonography in severe carpal tunnel insufficient data; very
2012 Muscle Nerve
Verhagen,W.I.; Meulstee,J. syndrome low study design
Elasticity of the median nerve in carpal
Kastlunger,M.; Miyamoto,H.;
2013 tunnel syndrome: Sonoelastography Skeletal Radiol. summary document
Jaschke,W.; Klauser,A.
findings
Katims,J.J.; Rouvelas,P.; Current perception threshold. insufficient data; not best
1989 ASAIO Trans
Sadler,B.T.; Weseley,S.A. Reproducibility and comparison with evidence for CPT
877
Reason for
Exclusion
nerve conduction in evaluation of carpal
tunnel syndrome
Katirji,B.; Preston,D.C. 2003 Vibration-induced median neuropathy case report
the study measures the
responsiveness of the the
Katz,J.N.; Gelberman,R.H.; Responsiveness of self-reported and
outcome instrument,
Wright,E.A.; Lew,R.A.; 1994 objective measures of disease severity Med Care
without showing how
Liang,M.H. in carpal tunnel syndrome
outcomes differ between
treatment groups.
Katz,J.N.; Keller,R.B.; Maine Carpal Tunnel Study: outcomes
Simmons,B.P.; Rogers,W.D.; of operative and nonoperative therapy
1998 J Hand Surg Am Very low strength
Bessette,L.; Fossel,A.H.; for carpal tunnel syndrome in a
Mooney,N.A. community-based cohort
Katz,J.N.; Punnett,L.; Workers' compensation recipients with
+Does not answer a
Simmons,B.P.; Fossel,A.H.; 1996 carpal tunnel syndrome: the validity of Am J Public Health
Mooney,N.; Keller,R.B. self-reported health measures
Katz,J.N.; Simmons,B.P. 2002 Carpal tunnel syndrome N.Engl.J.Med. background
Carpal tunnel syndrome: a practical
Katz,R.T. 1994 Am Fam Physician background
review
Median sensory nonresponders in carpal insufficient data; no
Kaul,M.P.; Pagel,K.J. 2002 Arch Phys Med Rehabil.
tunnel syndrome workup comparison of modalities
Electrophysiological study of chronic
Kayamori,R. 1987 Nihon Seikeigeka Gakkai Zasshi answer the PICO
intractable shoulder pain
question
Carpal tunnel syndrome: using self- +Does not answer a
Kaye,J.J.; Reynolds,J.M. 2007 report measures of disease to predict Am J Orthop (Belle.Mead NJ) question of interest/not
treatment response best available evidence
A comparison of the benefits of
Kaymak,B.; Ozcakar,L.; sonography and electrophysiologic
Cetin,A.; Candan,Cetin M.; 2008 measurements as predictors of symptom Arch Phys Med Rehabil.
low study design
Akinci,A.; Hascelik,Z. severity and functional status in patients
878
Reason for
Exclusion
Does not answer a
Kearns,J.; Gresch,E.E.; Pre- and post-employment median
question of interest; no
Weichel,C.Y.; Eby,P.; 2000 nerve latency in pork processing J.Occup.Environ.Med.
diagnosis of CTS or
Pallapothu,S.R. employees
comparison group
Keberle,M.; Jenett,M.;
Technical advances in ultrasound and <10 patients per group;
Kenn,W.; Reiners,K.; Peter,M.; 2000 Eur.Radiol.
MR imaging of carpal tunnel syndrome very low study design
Haerten,R.; Hahn,D.
Long-term follow-up of dual-portal
Keiner,D.; Gaab,M.R.; endoscopic release of the transverse
Schroeder,H.W.; Oertel,J. ligament in carpal tunnel syndrome: an
analysis of 94 cases
Keith,M.W.; Masear,V.;
Chung,K.C.; Amadio,P.C.;
Andary,M.; Barth,R.W.;
American Academy of Orthopaedic
Maupin,K.; Graham,B.;
2010 Surgeons clinical practice guideline on J Bone Joint Surg Am recommendations
Watters,W.C.,III;
Turkelson,C.M.;
Haralson,R.H.,III; Wies,J.L.;
McGowan,R.
Keith,M.W.; Masear,V.;
Chung,K.C.; Maupin,K.;
Andary,M.; Amadio,P.C.;
American Academy of Orthopaedic
Watters,W.C.,III; summary of
2009 Surgeons Clinical Practice Guideline on J Bone Joint Surg Am
Goldberg,M.J.; recommendations
Haralson,R.H.,III;
Turkelson,C.M.; Wies,J.L.;
McGowan,R.
The potential value of ultrasonography
Kele,H.; Verheggen,R.; insufficient data; very
2003 in the evaluation of carpal tunnel
Bittermann,H.J.; Reimers,C.D. low study design
syndrome
Keles,I.; Karagulle Kendi,A.T.; Diagnostic precision of ultrasonography insufficient data; very
2005 Am J Phys Med Rehabil.
Aydin,G.; Zog,S.G.; Orkun,S. in patients with carpal tunnel syndrome low study design
Electrodiagnosis of the carpal tunnel insufficient data; very
Kemble,F. 1968 J Neurol Neurosurg.Psychiatry
879
Reason for
Exclusion
Clinical manifestations related to
all CTS cases; no
Kemble,F. 1968 electro-physiological measurements in
comparison group
Microsurgical open mini uniskin
Keramettin,A.; Cengiz,C.;
2006 incision technique in the surgical Neurol India very low quality
Nilgun,C.; Ayhan,B.
Incorrect patient
Kern,B.C.; Brock,M.;
1993 The recurrent carpal tunnel syndrome Zentralbl.Neurochir. population (previous
Rudolph,K.H.; Logemann,H.
invasive treatment)
Kerr,C.D.; Gittins,M.E.; Endoscopic versus open carpal tunnel
1994
Sybert,D.R. release: clinical results
Kerrigan,J.J.; Bertoni,J.M.; Ganglion cysts and carpal tunnel case reports. no control
1988 J Hand Surg Am
Jaeger,S.H. syndrome groups
Complications of the management of
Kessler,F.B. 1986 Hand Clin background
Dialysis-associated arthropathy: a
Kessler,M.; Netter,P.; multicentre survey of 171 patients
Azoulay,E.; Mayeux,D.; 1992 receiving haemodialysis for over 10 Br J Rheumatol. Not relevant
Pere,P.; Gaucher,A. years. The Co-operative Group on
Dialysis-associated Arthropathy
A comparison of flexor
tenosynovectomy, open carpal tunnel
Ketchum,L.D. 2004 release, and open carpal tunnel release Plast.Reconstr.Surg Very Low Quality
with flexor tenosynovectomy in the
Ergonomic job analysis: A structured
Keyserling,W.M.; approach for identifying risk factors Applied Occupational and not exclusive to CTS; no
1991
Armstrong,T.J.; Punnett,L. associated with overexertion injuries Environmental Hygiene comparisongroups
and disorders
Diffusion tensor imaging and
Khalil,C.; Hancart,C.;
tractography of the median nerve in insufficient data; very
Le,Thuc,V; Chantelot,C.; 2008 Eur.Radiol.
carpal tunnel syndrome: preliminary low study design
Chechin,D.; Cotten,A.
results
Open carpal tunnel release under local
Khan,R.; Macey,A. 2000 anaesthesia: a patient satisfaction Ir.Med J Retrospective case series
survey
880
Reason for
Exclusion
An assessment of symptomatic relief
Khan,U.D. 2008 after carpal tunnel release in patients on Nephron Clin Pract. very low quality
haemodialysis
Determination of the median nerve
residual latency values in the diagnosis
Khosrawi,S.; Dehghan,F. 2013 of carpal tunnel syndrome in J Res.Med Sci
low study design
comparison with other electrodiagnostic
parameters
Hand-arm symptoms related to impact not exclusive to CTS; no
Kihlberg,S.; Hagberg,M. 1997 Int.Arch.Occup.Environ.Health
and nonimpact hand-held power tools diagnosis of CTS
An investigation of cumulative trauma International Journal of Industrial
Killough,M.K.; Crumpton,L.L. 1996 Not relevant to CTS
disorders in the construction industry Ergonomics
Anatomical basis of ulnar approach in Does not address
Kim,D.H.; Jang,J.E.; Park,B.K. 2013 Pain Physician
carpal tunnel injection question of interest
Carpal tunnel syndrome caused by
Kim,H.S. 2014 Korean J Intern.Med case report
tophaceous gout
Comparison of proximal and distal
cross-sectional areas of the median
Kim,H.S.; Joo,S.H.; Cho,H.K.; <10 patients per group;
2013 nerve, carpal tunnel, and nerve/tunnel Arch Phys Med Rehabil.
Kim,Y.W. insufficient data
index in subjects with carpal tunnel
syndrome
Minimal clinically important
Kim,J.K.; Jeon,S.H. 2013 differences in the Carpal Tunnel J Hand Surg Eur.Vol.
Questionnaire after carpal tunnel release
Predictors of scar pain after open carpal Does not address
Kim,J.K.; Kim,Y.K. 2011 J Hand Surg Am
tunnel release question of interest
The minimal clinical important
difference of the carpal tunnel Abstract/conference
Kim,J.K.; Yi,J.W.; Kook,S.H. 2011 Journal of Hand Surgery
syndrome questionnaire in surgically poster
treated patients level 1 evidence
Correlating ultrasound findings of
Kim,J.M.; Kim,M.W.; Ko,Y.J. 2013 carpal tunnel syndrome with nerve Muscle Nerve
low study design
conduction studies
Kim,J.Y.; Kim,J.I.; Son,J.E.; Prevalence of carpal tunnel syndrome in
2004 J Occup.Health very low quality
Yun,S.K. meat and fish processing plants
881
Reason for
Exclusion
Carpal tunnel syndrome: Clinical,
Kim,J.Y.; Yoon,J.S.; Kim,S.J.;
2012 electrophysiological, and Muscle Nerve very low quality
Won,S.J.; Jeong,J.S.
ultrasonographic ratio after surgery
no comparison of
Palmar digital nerve stimulation to
Kim,L.Y.S. 1983 Orthop.Rev. modalities; very low
diagnose Carpal Tunnel Syndrome
study design
Asymptomatic electrophysiologic
Kim,W.K.; Kwon,S.H.; insufficient data;
2000 carpal tunnel syndrome in diabetics: Yonsei Med J
Lee,S.H.; Sunwoo,I.N. insufficient comparisons
entrapment or polyneuropathy
The carpal tunnel syndrome:
Kimura,I.; Ayyar,D.R. 1985 electrophysiological aspects of 639 Electromyogr.Clin Neurophysiol.
low study design
symptomatic extremities
The carpal tunnel syndrome:
no comparison of
localization of conduction abnormalities
Kimura,J. 1979 modalities; very low
within the distal segment of the median
study design
nerve
A method for determining median nerve
Does not answer a
Kimura,J. 1978 conduction velocity across the carpal J Neurol Sci
tunnel
Antibodies to Borrelia burgdorferi in insufficient data; very
Kindstrand,E. 1992 Acta Neurol Scand.
patients with carpal tunnel syndrome low study design
Sensory function assessment. A pilot
+Does not answer a
comparison study of touch pressure
King,P.M. 1997 J Hand Ther question of interest; very
threshold with texture and tactile
low study design
discrimination
King,T. 1976 Carpal tunnel syndrome. Nursing care Nurs.Mirror Midwives J background
Evaluation of beta 2-microglobulin
Kinugasa,E.; Akizawa,T.;
1988 removal with high-performance Artif.Organs Not relevant to CTS
Kitaoka,T.; Koshikawa,S.
hemodiafiltration
Carpal tunnel syndrome: A critical Critical Reviews in Physical and
Kipp,D.E.; Wilson,J.K. 2001 background
review Rehabilitation Medicine
Kitsis,C.K.; Savvidou,O.; Carpal tunnel syndrome despite
2002 Acta Orthop Belg. very low quality
Alam,A.; Cherry,R.J. negative neurophysiological studies
Carpal tunnel syndrome and ulnar
Kiylioglu,N.; Akyildiz,U.O.; Does not answer a
2011 neuropathy at the wrist: comorbid J Clin Neurophysiol.
Ozkul,A.; Akyol,A. question of interest
disease or not?
882
Reason for
Exclusion
Natural course and treatment efficacy:
Kiylioglu,N.; Bicerol,B.;
2009 one-year observation in diabetic and J Clin Neurophysiol.
Ozkul,A.; Akyol,A.
Kjuus,H.; Goffeng,L.O.;
Heier,M.S.; Sjoholm,H.; Effects on the peripheral nervous
+Does not answer a
Ovrebo,S.; Skaug,V.; 2004 system of tunnel workers exposed to Scand.J.Work.Environ.Health
Paulsson,B.; Tornqvist,M.; acrylamide and N-methylolacrylamide
Brudal,S.
Klauser,A.S.; Halpern,E.J.;
Faschingbauer,R.; Guerra,F.; Bifid median nerve in carpal tunnel Does not answer a
Martinoli,C.; Gabl,M.F.; 2011 syndrome: assessment with US cross- question of interest; very
Arora,R.; Bauer,T.; Sojer,M.; sectional area measurement low study design
Loscher,W.N.; Jaschke,W.R.
Diagnosis and staging of carpal tunnel
not best available
Kleindienst,A.; Hamm,B.; syndrome: comparison of magnetic
1996 Acta Neurochir.(Wien.) evidence; insufficient
Hildebrandt,G.; Klug,N. resonance imaging and intra-operative
data
findings
Carpal tunnel syndrome: staging of
Kleindienst,A.; Hamm,B.;
1998 median nerve compression by MR J Magn Reson.Imaging Insufficient data
Lanksch,W.R.
imaging
Clinical images: Kienbock disease
Ko,H.J.; Kim,Y.R.; Park,K.S.;
2009 resulting from local corticosteroid Arthritis Rheum. Case report
Cho,C.S.; Kim,H.Y.
injections
Kobayashi,S.; Hayakawa,K.;
Nakane,T.; Meir,A.; Visualization of intraneural edema
Mwaka,E.S.; Yayama,T.; using gadolinium-enhanced magnetic insufficient data; very
2009 J Orthop Sci
Uchida,K.; Shimada,S.; resonance imaging of carpal tunnel low study design
Inukai,T.; Nakajima,H.; syndrome
Baba,H.
Koc,F.; Yerdelen,D.; Sarica,Y.; Motor unit number estimation in cases insufficient data; very
2006 Int.J Neurosci.
Sertdemir,Y. with Carpal Tunnel Syndrome low study design
Kocer,A.; Gozke,E.; A comparison of F waves in peripheral no comparison group;
Dortcan,N.; Us,O. nerve disorders very low study design
Kocer,B.; Sucak,G.; Clinical and electrophysiological
Kuruoglu,R.; Aki,Z.; 2009 evaluation of patients with thalidomide- Acta Neurol Belg. Not relevant to CTS
Haznedar,R.; Erdogmus,N.I. induced neuropathy
883
Reason for
Exclusion
Kodama,M.; Tochikura,M.;
Sasao,Y.; Kasahara,T.;
What is the most sensitive test for case control; very low
Koyama,Y.; Aono,K.; Fujii,C.; 2014 Tokai J Exp.Clin Med
diagnosing carpal tunnel syndrome? design
Shimoda,N.; Kurihara,Y.;
Masakado,Y.
Kohanzadeh,S.; Herrera,F.A.; Outcomes of open and endoscopic
2012 Hand (N.Y) meta-analysis
Dobke,M. carpal tunnel release: a meta-analysis
study was downgraded to
very low quality because
it is unclear if their CTS
severity scale is validated
Relationship of age, body mass index,
Komurcu,H.F.; Kilic,S.; and lack of statistical
2014 wrist and waist circumferences to carpal Neurol.Med.Chir.(Tokyo).
Anlar,O. adjustment for other
tunnel syndrome severity
factors (beyond BMI)
that could confound
results (such as
comorbidities)
Vibrometry in carpal tunnel syndrome:
Konchalard,K.; Suputtitada,A.; +Does not answer a
2011 correlations with electrodiagnositic J Med Assoc Thai.
Sastravaha,N. question of interest
parameters and disease severity
Compression neuropathies of the Journal of the American Society for
Koo,J.T.; Szabo,R.M. 2004 background
median nerve Surgery of the Hand
Koo,Y.S.; Park,H.R.; Joo,B.E.; Utility of the cutaneous silent period in +Does not answer a
Choi,J.Y.; Jung,K.Y.; 2010 the evaluation of carpal tunnel Clin Neurophysiol. question of
Park,K.W.; Cho,S.C.; Kim,B.J. syndrome interest/insufficient data
Clinical and electrodiagnostic features
Kopell,H.P.; Goodgold,J. 1968 Arch Phys Med Rehabil. records review
Koris,M.; Gelberman,R.H.; Carpal tunnel syndrome. Evaluation of
Duncan,K.; Boublick,M.; 1990 a quantitative provocational diagnostic Clin Orthop Relat Res.
low study design
Smith,B. test
Korkmaz,M.; Ekici,M.A.; Mini transverse versus longitudinal
2013 J Coll Physicians Surg Pak. very low quality
Cepoglu,M.C.; Ozturk,H. incision in carpal tunnel syndrome
Use of state workers' compensation data
Korrick,S.A.; Rest,K.M.; for occupational carpal tunnel syndrome Does not answer a
1994 Am J Ind.Med
Davis,L.K.; Christiani,D.C. surveillance: a feasibility study in question of interest
Massachusetts
884
Reason for
Exclusion
Korstanje,J.W.; Van,Balen R.;
Assessment of transverse
Scheltens-De,Boer M.;
ultrasonographic parameters to optimize insufficient data; very
Blok,J.H.; Slijper,H.P.; 2013 Muscle Nerve
carpal tunnel syndrome diagnosis in a low study design
Stam,H.J.; Hovius,S.E.;
case-control study
Selles,R.W.
Korthals,de Bos,I; Surgery is more cost-effective than
Gerritsen,A.A.; Tulder,M.W.; splinting for carpal tunnel syndrome in Extension of study.
Rutten-van-Mlken,M.P.; 2006 the Netherlands: results of an economic BMC Musculoskeletal Disorders PM:12215131 already
Adr,H.J.; Vet,H.C.; evaluation alongside a randomized included.
Bouter,L.M. controlled trial
Koskimies,K.; Farkkila,M.;
Carpal tunnel syndrome in vibration Not relevant, prevalence
Pyykko,I.; Jantti,V.; Aatola,S.; 1990 Br J Ind.Med
disease study
Starck,J.; Inaba,R.
Treatment of carpal tunnel syndrome: A
Journal of Bodywork and Movement
Kostopoulos,D. 2004 review of the non-surgical approaches background
Therapies
with emphasis in neural mobilization
Ultrasound imaging in the diagnosis of
Kotevoglu,N.; Gulbahce- insufficient data; very
2005 carpal tunnel syndrome and its Joint Bone Spine
Saglam,S. low study design
relevance to clinical evaluation
Kothari,M.J.; Blakeslee,M.A.;
Electrodiagnostic studies: Are they
Reichwein,R.; Simmons,Z.; 1998 Arch.Phys.Med.Rehabil. not exclusive to CTS
useful in clinical practice?
Logigian,E.L.
Kothari,M.J.; Rutkove,S.B.;
Comparison of digital sensory studies in +Does not answer a
Caress,J.B.; Hinchey,J.; 1995 Muscle Nerve
patients with carpal tunnel syndrome question of interest
Logigian,E.L.; Preston,D.C.
Coexistent entrapment neuropathies in
Kothari,M.J.; Rutkove,S.B.;
1996 patients with amyotrophic lateral Arch.Phys.Med.Rehabil. Not relevant to CTS
Logigian,E.L.; Shefner,J.M.
sclerosis
Carpal tunnel syndrome and manual not best available
Kouyoumdjian,J.A.; de
2006 milking: nerve conduction studies in 43 Arq Neuropsiquiatr. evidence; no comparison
Araujo,R.G.
cases group
Kouyoumdjian,J.A.;
Body mass index and carpal tunnel not best available
Morita,M.D.; Rocha,P.R.; 2000 Arq Neuropsiquiatr.
syndrome evidence
Miranda,R.C.; Gouveia,G.M.
Usefulness of additional nerve
Kouyoumdjian,J.A.; insufficient data; not best
2002 conduction techniques in mild carpal Arq Neuropsiquiatr.
Morita,M.P.; Molina,A.F. evidence
tunnel syndrome
885
Reason for
Exclusion
Kouyoumdjian,J.A.;
Wrist and palm indexes in carpal tunnel insufficient data; very
Morita,M.P.; Rocha,P.R.; 2000 Arq Neuropsiquiatr.
Miranda,R.C.; Gouveia,G.M.
Comparison of nerve conduction
Kouyoumdjian,J.A.;
1999 techniques in 95 mild carpal tunnel Arq Neuropsiquiatr. insufficient information
Morita,Mda P.
syndrome hands
The 17p11.2 locus in hereditary
Kownacki,J.; Fellenberg,J.V.;
neuropathy with liability to pressure
Rosler,K.; Schneider,V.; biopsy study; insufficient
1996 palsies, in juvenile and familial carnal Eur.J.Neurol.
Bettecken,T.; Moser,H.; data
tunnel syndrome and in hereditary
Burgunder,J.-M.
neuralgic amyotrophy
The value of ultrasonographic
Koyuncuoglu,H.R.;
measurement in carpal tunnel syndrome insufficient data; very
Kutluhan,S.; Yesildag,A.; 2005 Eur.J Radiol.
in patients with negative low study design
Oyar,O.; Guler,K.; Ozden,A.
electrodiagnostic tests
Quantitative testing and thermography
Kozakiewicz,R.T.; Bowyer,B.L. 1997 Phys.Med.Rehabil.Clin.N.Am. Background Information
in carpal tunnel syndrome
Carpal tunnel syndrome in patients with
Kraft,G.H. 1997 peripheral neuropathy: It can be Phys.Med.Rehabil.Clin.N.Am.
review
evaluated and treated
Anomalous hand innervation in carpal
+Does not answer a
Krasteva,W. 2001 tunnel syndrome: Electromyographic Acta Medica Bulgarica
studies
Complications after a carpal tunnel
Krieg,N.A. 1989 Plast.Surg Nurs. case report
release
Cumulative trauma disorders: their
Kroemer,K.H.E. 1989 recognition and ergonomics measures to Appl.Ergon. background
avoid them
Kruger,V.L.; Kraft,G.H.;
Carpal tunnel syndrome: objective
Deitz,J.C.; Ameis,A.; 1991 Arch Phys Med Rehabil. Retrospective case series
measures and splint use
Polissar,L.
insufficient data;
Idiopathic carpal tunnel syndrome and
Kumar,P.; Chakrabarti,I. 2009 J Hand Surg Eur.Vol. assessing prevalence
trigger finger: is there an association?
rather than risk factors
886
Reason for
Exclusion
+Does not answer a
Shoulder pain as the presenting
Kummel,B.M.; Zazanis,G.A. 1973 Clin Orthop Relat Res. question of interest; very
complaint in carpal tunnel syndrome
low study design
Carpal tunnel syndrome in 100 patients:
sensitivity, specificity of multi-
neurophysiological procedures and insufficient data; very
Kuntzer,T. 1994 J Neurol Sci
estimation of axonal loss of motor, low study design
sensory and sympathetic median nerve
fibers
Single parameter wrist ultrasonography
Kurca,E.; Nosal,V.; Grofik,M.;
as a first-line screening examination in insufficient data; very
Sivak,S.; Turcanova- 2008 Bratisl.Lek.Listy
suspected carpal tunnel syndrome low study design
Koprusakova,M.; Kucera,P.
patients
Kurt,S.; Kisacik,B.; Kaplan,Y.;
Obesity and carpal tunnel syndrome: is
Yildirim,B.; Etikan,I.; 2008 Eur.Neurol Very Low Quality
there a causal relationship?
Karaer,H.
Kuschner,S.H.; Brien,W.W.; Complications associated with carpal
1991 Orthop Rev. Narrative review
Johnson,D.; Gellman,H. tunnel release
Endoscopic versus open carpal tunnel
Kuschner,S.H.; Lane,C.S. 1997 release: big deal or much ado about Am J Orthop (Belle.Mead NJ) Narrative review
nothing?
Kutluhan,S.; Akhan,G.;
Demirci,S.; Duru,S.; Carpal tunnel syndrome in carpet Not relevant, prevalence
2001 Int.Arch Occup.Environ.Health
Koyuncuoglu,H.R.; Ozturk,M.; workers study
Cirak,B.
Kutluhan,S.; Tufekci,A.;
Manual milking: A risk factor for carpal Not relevant, prevalence
Kilbas,S.; Erten,N.; 2009 Biomedical Research
tunnel syndrome study of manual milking
Koyuncuoglu,H.R.; Ozturk,M.
Comparison of sonography and
Kwon,B.C.; Jung,K.I.; insufficient data; very
2008 electrodiagnostic testing in the J Hand Surg Am
Baek,G.H. low study design
Frequency and severity of carpal tunnel
Kwon,H.K.; Hwang,M.; +Does not answer a
2006 syndrome according to level of cervical Clin Neurophysiol.
Yoon,D.W. question of interest
radiculopathy: double crush syndrome?
887
Reason for
Exclusion
High prevalence of carpal tunnel
Kwon,J.Y.; Ko,K.; Sohn,Y.B.; Does not answer a
syndrome in children with
Kim,S.J.; Park,S.W.; Kim,S.H.; 2011 Am J Med Genet.A question of interest;
mucopolysaccharidosis type II (Hunter
Cho,S.Y.; Jin,D.K. prevalence study
syndrome)
Does not answer a
Amyloid localized to tenosynovium at
Kyle,R.A.; Eilers,S.G.; question of interest;
1989 carpal tunnel release. Natural history of Am J Clin Pathol.
Linscheid,R.L.; Gaffey,T.A. biostudy not relevant to
124 cases
CTS
summary document; no
LaBan,M.M.; Friedman,N.A.; "Tethered" median nerve stress test in
1986 Arch Phys Med Rehabil. comparison group or risk
Zemenick,G.A. chronic carpal tunnel syndrome
assessment
Anatomic observations in carpal tunnel
LaBan,M.M.; MacKenzie,J.R.;
1989 syndrome as they relate to the tethered Arch Phys Med Rehabil. cadaver study
Zemenick,G.A.
median nerve stress test
History and differential diagnosis of
LaBan,M.M.; Spiteri,D.J. 1997 Phys.Med.Rehabil.Clin.N.Am. background
LaBan,M.M.; Zemenick,G.A.; Neck and shoulder pain. Presenting
1975 Mich.Med insufficient data
Meerschaert,J.R. symptoms of carpal tunnel syndrome
Lagos,J.C. 1971 Compression neuropathy in childhood Dev.Med Child Neurol not relevant
Lahiri,A.; Liong,K.; Chia,D.; Functional compartmental space: The
Computer Methods in Biomechanics insufficient data; very
Lee,S.; Lim,A.; Biswas,A.; 2013 missing link in the pathogenesis of
and Biomedical Engineering low study design
Lee,H.P. carpal tunnel syndrome
Determining the sensitivity and
LaJoie,A.S.; McCabe,S.J.; specificity of common diagnostic tests +not best available
2005 Plast.Reconstr.Surg
Thomas,B.; Edgell,S.E. for carpal tunnel syndrome using latent evidence
class analysis
Lakhanpal,S.; Ginsburg,W.W.; Does not answer a
Eosinophilic fasciitis: clinical spectrum
Michet,C.J.; Doyle,J.A.; 1988 Semin.Arthritis Rheum. question of interest; not
and therapeutic response in 52 cases
Moore,S.B. relevant to CTS
Prevalence and risk factors of hand
Lalumandier,J.A.; McPhee,S.D. 2001 problems and carpal tunnel syndrome J Dent.Hyg.
study
among dental hygienists
Lalumandier,J.A.; McPhee,S.D.;
Carpal tunnel syndrome: effect on Not relevant, prevalence
Riddle,S.; Shulman,J.D.; 2000 Mil.Med
Army dental personnel study
Daigle,W.W.
888
Reason for
Exclusion
Endoscopic carpal tunnel release:
Lam,C.H.; Yeung,S.H.;
2010 experience of surgical outcome in a Hong Kong Med J Retrospective case series
Wong,T.C.
Chinese population
Electromyographic monitoring of review; background
Lam,H.S.; Cass,N.M.; Ng,K.C. 1981 Br.J.Anaesth.
neuromuscular block information
Association of obesity, gender, age and not best available
Lam,N.; Thurston,A. 1998 Aust.N.Z.J Surg
occupation with carpal tunnel syndrome evidence
Lamberti,P.M.; Light,T.R. 2002 Carpal tunnel syndrome in children Hand Clin background
Hereditary amyloidosis, the flexor
Lambird,P.A.; Hartmann,W.H. 1969 retinaculum, and the carpal tunnel Am J Clin Pathol. records review
syndrome
bio-study; does not
Landi,A.; Luchetti,R.; Metabolic and neurophysiological Journal of the Western Pacific
1989 answer a question of
Schoenhuber,R. correlations in carpal tunnel syndrome Orthopaedic Association
interest
Lang,E.; Claus,D.; Parameters of thick and thin nerve-fiber
Neundorfer,B.; 1995 functions as predictors of pain in carpal
low study design
Handwerker,H.O. tunnel syndrome
Carpal tunnel syndrome caused by the
Lange,H. 1999 Scand.J.Plast.Reconstr.Surg.Hand Surg. case report
palmaris profundus muscle
Carpal tunnel syndrome diagnosed
Lange,J. 2013 using ultrasound as a first-line exam by J Hand Surg Eur.Vol.
low study design
the surgeon
The addition of tramadol to lidocaine
Langlois,G.; Estebe,J.P.;
does not reduce tourniquet and Deemed clinically
Gentili,M.E.; Kerdiles,L.; 2002 Can J Anaesth.
postoperative pain during iv regional irrelevant
Mouilleron,P.; Ecoffey,C.
anesthesia
Anatomical variations of the median Does not address
Lanz,U. 1977 J Hand Surg Am
nerve in the carpal tunnel question of interest
Comparison of 2 surgical approaches Incorrect patient
Lattmann,T.; Dietrich,M.;
2008 for volar locking plate osteosynthesis of J Hand Surg Am population (not exclusive
Meier,C.; Kilgus,M.; Platz,A.
the distal radius to CTS patients)
Neurologic manifestations of thyroid Background Information;
Laureno,R. 1996 Endocrinologist
disease review
889
Reason for
Exclusion
Orthodromic sensory conduction along
Lauritzen,M.; Liguori,R.; insufficient data; very
1991 the ring finger in normal subjects and in Electroencephalogr.Clin Neurophysiol.
Trojaborg,W. low study design
patients with a carpal tunnel syndrome
Vibrotactile sense in patients with
Laursen,L.H.; Jepsen,J.R.; not exclusive to CTS;
2006 different upper limb disorders compared Int.Arch.Occup.Environ.Health
Sjogaard,G. very low study design
with a control group
Topical anaesthesia to reduce pain Deemed clinically
Lawrence,T.M.; Desai,V.V. 2002 J Hand Surg Br
associated with carpal tunnel surgery irrelevant
'Causalgic' median mononeuropathies:
Lax,H.; Zochodne,D.W. 1995 Muscle Nerve case reports
Segmental rubror and edema
Le Quesne,P.M. 1978 The carpal tunnel syndrome Br J Hosp.Med background
Recovery of conduction velocity distal Does not answer any
Le Quesne,P.M.; Casey,E.B. 1974 J Neurol Neurosurg.Psychiatry
to a compressive lesion question of interest.
Systemic causes of carpal tunnel
Leach,R.E.; Odom,J.A.,Jr. 1968 Postgrad.Med Background Information
syndrome
Improved treatments for carpal tunnel
Leahy,P.M. 1995 Chiropractic Sports Medicine Background article
and related syndromes
Myofascial release technique and
Leahy,P.M.; Mock III,L.E. 1992 mechanical compromise of peripheral Chiropractic Sports Medicine Background article
nerves of the upper extremity
Carpal tunnel syndrome: neurographical
Leblhuber,F.; Reisecker,F.; comparison group or
1986 parameters in different stages of median Acta Neurochir.(Wien.)
Witzmann,A. consistent reference
nerve compression
standard
Leden,I.; Svensson,B.; 'Rheumatic' hand symptoms as a clue to
1980 Scand.J.Rheumatol. preliminary report
Sturfelt,G.; Schersten,B. undiagnosed diabetes mellitus
Postoperative morphologic analysis of
Lee,C.H.; Kim,T.K.; Does not answer a
2005 carpal tunnel syndrome using high- Ann.Plast.Surg
Yoon,E.S.; Dhong,E.S. question of interest
resolution ultrasonography
Correlation of high-resolution
Lee,C.H.; Kim,T.K.; ultrasonographic findings with the
2005 Ann.Plast.Surg insufficient information
Yoon,E.S.; Dhong,E.S. clinical symptoms and electrodiagnostic
data in carpal tunnel syndrome
890
Reason for
Exclusion
Lee,D.; van Holsbeeck,M.T.;
Diagnosis of carpal tunnel syndrome.
Janevski,P.K.; Ganos,D.L.; 1999 Radiol.Clin North Am cadaver study
Ultrasound versus electromyography
Ditmars,D.M.; Darian,V.B.
Measuring peripheral nerve function:
Lee,Dellon A. 2005 Electrodiagnostic versus neurosensory Atlas of Hand Clinics Background Information
testing
Carpal tunnel release through a limited
Lee,H.; Jackson,T.A.;
2002 skin incision under direct visualization Plast.Reconstr.Surg Narrative review
Wood,D.J.
using a new instrument, the carposcope
Nerve conduction studies of median
Lee,H.J.; Kwon,H.K.; motor nerve and median sensory insufficient data; very
2013 Ann.Rehabil.Med
Kim,D.H.; Pyun,S.B. branches according to the severity of low study design
Effectiveness of steroid injection in
treating patients with moderate and
Lee,J.H.; An,J.H.; Lee,S.H.;
2009 severe degree of carpal tunnel Clin J Pain Very Low Quality
Hwang,E.Y.
syndrome measured by clinical and
electrodiagnostic assessment
Lee,J.J.; Hwang,S.M.; Remifentanil-propofol sedation as an
Deemed clinically
Jang,J.S.; Lim,S.Y.; Heo,D.H.; 2010 ambulatory anesthesia for carpal tunnel J Korean Neurosurg.Soc.
irrelevant
Cho,Y.J. release
Usefulness of the median terminal
Lee,K.Y.; Lee,Y.J.; Koh,S.H. 2009 latency ratio in the diagnosis of carpal Clin Neurophysiol.
comparison group
tunnel syndrome
Lee,L.H.; Al-Maiyah,M.; Al- Outcome of carpal tunnel release -
Does not address
Bahrani,R.Z.; Bhargava,A.; 2014 Correlation with wrist and wrist-palm J Hand Surg Eur.Vol.
question
Auyeung,J.; Stothard,J. anthropomorphic measurements
How to make electrodiagnosis of carpal
Lee,W.J.; Liao,Y.C.; Wei,S.J.; insufficient data; very
2011 tunnel syndrome with normal distal J Clin Neurophysiol.
Tsai,C.W.; Chang,M.H. low study design
conductions?
Lefebvre,J.; de,Seze S.;
Lerique,J.L.; Hamonet,C.; Aetiology of the carpal tunnel
1969 Electroencephalogr.Clin Neurophysiol. not relevant
Chaumont,P.; Bigot,B.; syndrome
Dreyfus,P.
An automated electrodiagnostic
Leffler,C.T.; Gozani,S.N.; Neurology and Clinical insufficient data; very
2000 technique for detection of carpal tunnel
Nguyen,Z.Q.; Cros,D. Neurophysiology low study design
syndrome
891
Reason for
Exclusion
Neurographic analysis of trains of
frequent electric stimuli in the diagnosis
Lehmann,H.J.; Tackmann,W. 1974 of peripheral nerve diseases. Eur.Neurol
Investigations in the carpal tunnel
syndrome
A systematic review of the
Leite,J.C.; Jerosch-Herold,C.;
2006 psychometric properties of the Boston BMC Musculoskelet.Disord. systematic review
Song,F.
Carpal Tunnel Questionnaire
Leklem,J.E.; Roe,D.;
Smith,J.C.; Raiten,D.;
Vitamin B(6): Reservoirs, receptors,
Forlano,A.J.; Colby,F.; 1992 Ann.N.Y.Acad.Sci. Background article
and red-cell reactions
Kooss,D.H.; Curtay,J.-P.;
Hawrylewicz,E.J.
Carpal tunnel syndrome - is high-
Leonard,L.; Rangan,A.; insufficient data; very
2003 frequency ultrasound a useful J Hand Surg Br
Doyle,G.; Taylor,G. low study design
diagnostic tool?
Electromyography (EMG) in surgery of case series; review of
Leonard,M.H.; Stern,J.E. 1970
the hand <10 patients
Recommended standards for short-
review; background
Lesser,R.P. 1986 latency somatosensory evoked J.Clin.Neurophysiol.
information
potentials
The mini palm incision for carpal tunnel
Lester,D.K.; Helm,Jr 1995 Journal of Orthopaedic Techniques Background article
release
Levine,D.W.; Simmons,B.P.; A self-administered questionnaire for
Koris,M.J.; Daltroy,L.H.; the assessment of severity of symptoms +Does not answer a
Hohl,G.G.; Fossel,A.H.; and functional status in carpal tunnel question of interest
Katz,J.N. syndrome
Sensitivity, specificity, and variability
Lew,H.L.; Date,E.S.; Pan,S.S.;
of nerve conduction velocity insufficient data; very
Wu,P.; Ware,P.F.; 2005 Arch Phys Med Rehabil.
measurements in carpal tunnel low study design
Kingery,W.S.
syndrome
Test-retest reliability of combined
Lew,H.L.; Wang,L.;
2000 sensory index: implications for Muscle Nerve <10 patients per group
Robinson,L.R.
diagnosing carpal tunnel syndrome
Endoscopic carpal tunnel release: the
Lewicky,R.T. 1994
guide tube technique
892
Reason for
Exclusion
Does not answer a
Gender difference in carpal tunnel
Li,Z.-M. 2005 Journal of Musculoskeletal Research question of interest; no
compliance
diagnosis of CTS
Clinical profile, electrodiagnosis and
Lian,B.T.; Urkude,R.;
2006 outcome in patients with carpal tunnel Singapore Med.J. Retrospective case series
Verma,K.K.
syndrome: A Singapore perspective
CT-scanning study of cross-sectional +Does not answer a
Liang,C.L. 1987 area of the carpal tunnel in cases of Nihon Seikeigeka Gakkai Zasshi question of interest; very
Carpal tunnel syndrome diagnosis by a
Liao,Y.Y.; Wu,C.C.; Kuo,T.T.; insufficient data; very
2012 self-normalization process and Med Phys
Chen,J.P.; Hsu,Y.W.; Yeh,C.K. low study design
ultrasound compound imaging
Carpal tunnel release under local
Lichtman,D.M.; Florio,R.L.;
1979 anesthesia: evaluation of the outpatient J Hand Surg Am Retrospective case series
Mack,G.R.
procedure
Physical medicine and rehabilitation-
Lieberman,J.S.; Taylor,R.G. 1982 epitomes of progress: electrodiagnostic West J Med Commentary/review
evaluation of carpal tunnel syndrome
Endoscopic carpal tunnel release
Lifchez,S.D.; Murphy,M.S. 2006 Techniques in Orthopaedics Background article
through a single distal portal
A review of the management of
Lillehei,K.O. 1996 Neurosurgery Quarterly background
peripheral nerve entrapment syndromes
Long-term on-line hemodiafiltration
Lin,C.L.; Yang,C.W.;
reduces predialysis beta-2-
Chiang,C.C.; Chang,C.T.; 2001 Blood Purif. Not relevant
microglobulin levels in chronic
Huang,C.C.
hemodialysis patients
Microsurgical decompression of the
Incorrect patient
Lin,P.; Zhang,L.; Yu,Y.B.; median nerves for treating diabetic
2007 Neural Regeneration Research population (not exclusive
Xu,X.L.; Liu,J.; Li,F.; Xu,J. peripheral neuropathy in the upper
to CTS)
limbs: A 21-month follow-up
Linscheid,R.L.; Peterson,L.F.; Carpal-tunnel syndrome associated with
1967 J Bone Joint Surg Am very low quality
Juergens,J.L. vasospasm
The carpal tunnel syndrome in the African Journal of Neurological Confounding
Lisk,D.R. 1989
Sierra Leonean African Sciences comorbidities
893
Reason for
Exclusion
Use of provincial health insurance plan retrospective records
Liss,G.M.; Armstrong,C.;
1992 billing data to estimate carpal tunnel Am J Ind.Med review; no comparison
Kusiak,R.A.; Gailitis,M.M.
syndrome morbidity and surgery rates group
Litchman,H.M.;
The carpal tunnel syndrome. A clinical
Triedman,M.H.; Silver,C.M.; 1968 Int.Surg background
and electrodiagnostic study
Simon,S.D.
Efficacy of ultrasound-guided axillary
Liu,F.-C.; Liou,J.-T.; Tsai,Y.- Incorrect patient
brachial plexus block: A comparative
F.; Li,A.H.; Day,Y.-Y.; 2005 Chang Gung Medical Journal population (not exclusive
study with nerve stimulator-guided
Hui,Y.-L.; Lui,P.-W. to CTS patients)
method
Lo,Y.L.; Lim,S.H.; Fook- Outcome prediction value of nerve
Chong,S.; Lum,S.Y.; 2012 conduction studies for endoscopic J Clin Neuromuscul.Dis very low quality
Teoh,L.C.; Yong,F.C. carpal tunnel surgery
Symptomatic restrictive thumb-index
Lobardi,R.M.; Wood,M.B.; flexor tenosynovitis: Incidence of
1988 Journal of Hand Surgery Not relevant to CTS
Linscheid,R.L. musculotendinous anomalies and results
of treatment
Logigian,E.L.; Busis,N.A.;
Lumbrical sparing in carpal tunnel
Berger,A.R.; Bruyninckx,F.; insufficient data; very
1987 syndrome: anatomic, physiologic, and
Khalil,N.; Shahani,B.T.; low study design
diagnostic implications
Young,R.R.
Logue,E.J.; Bluhm,S.;
Median and ulnar neuropathies in Not relevant, prevalence
Johnson,M.C.; Mazer,R.; 2005 Medical Problems of Performing Artists
university cellists study
Halle,J.S.; Greathouse,D.G.
Carpal tunnel syndrome: the correlation
Longstaff,L.; Milner,R.H.;
2001 between outcome, symptoms and nerve J Hand Surg Br Retrospective case series
O'Sullivan,S.; Fawcett,P.
conduction study findings
The carpal tunnel syndrome: a clinical
Loong,S.C. 1977 and electrophysiological study of 250 Clin Exp.Neurol
diagnosis of CTS
patients
Comparison of median and ulnar
Loong,S.C.; Seah,C.S. 1971 sensory nerve action potentials in the J Neurol Neurosurg.Psychiatry
low study design
diagnosis of the carpal tunnel syndrome
A sensitive diagnostic test for carpal insufficient data; no
Loong,S.C.; Seah,C.S. 1973 Neurol.India
tunnel syndrome comparison group
894
Reason for
Exclusion
How accurate are the history and
Lord,R.W.,Jr. 2000 physical examination in diagnosing J Fam Pract. summary document
carpal tunnel syndrome (CTS)?
Comparison of second lumbrical and
Loscher,W.N.; Auer- interosseus latencies with standard
Grumbach,M.; Trinka,E.; 2000 measures of median nerve function J Neurol
low study design
Ladurner,G.; Hartung,H.P. across the carpal tunnel: a prospective
study of 450 hands
Louda,L.; Hartlova,D.;
<10 patients in CTS
Muff,V.; Smolikova,L.; 1994 Impulsive vibration and exposure limit Nagoya J Med Sci
Svoboda,L.
Louis,D.S.; Greene,T.L.;
1985 Complications of carpal tunnel surgery J Neurosurg. Retrospective case series
Noellert,R.C.
Symptomatic relief following carpal not best available
Louis,D.S.; Hankin,F.M. 1987 tunnel decompression with normal evidence; very low study
electroneuromyographic studies design
Obstetrics, Gynaecology and
Lowe,S.A.; Sen,R.C. 2008 Neurological disease in pregnancy Background article
Reproductive Medicine
Suggested variations on standard carpal
Lowe,W. 2008 J Bodyw.Mov Ther background
tunnel syndrome assessment tests
Sudden joint and extremity pain in
Lowery,C.L. 1995 Obstet.Gynecol.Clin.North Am. Background article
pregnancy
Patient satisfaction after open carpal
Lozano Calderon,S.A.;
2008 tunnel release correlates with J Hand Surg Am Retrospective case series
Paiva,A.; Ring,D.
depression
Evaluation of iontophoresis and local American journal of physical medicine Duplicate study
lu,F.; lu,G.; lu,Z.R.; -Okumu?-
2005 corticosteroid injection in the treatment & rehabilitation / Association of (duplicate with AAOSID
M; Ceceli,E.; Lu,S.
of carpal tunnel syndrome Academic Physiatrists 697)
Carpal tunnel syndrome: A review of
Lublin,J.C.; Rojer,D.E.;
1998 initial diagnosis and treatment for the Primary Care Update for Ob/Gyns background
Barron,O.A.
ob/gyn
Luchetti,R.; Alfarano,M.; Short palmar incision: a new surgical
1996 Chir Organi Mov Background article
Montagna,G.; Soragni,O. approach for carpal tunnel syndrome
895
Reason for
Exclusion
Serial overnight recordings of
Luchetti,R.; Schoenhuber,R.; Incorrect patients
intracarpal canal pressure in carpal
Alfarano,M.; Deluca,S.; 1994 J Hand Surg Br population (<10
tunnel syndrome patients with and
De,Cicco G.; Landi,A. patients/group)
without wrist splinting
Luchetti,R.; Schoenhuber,R.;
De,Cicco G.; Alfarano,M.; 1989 Carpal-tunnel pressure Acta Orthop Scand. <10 patients per group
Deluca,S.; Landi,A.
Localized nerve damage recorded
Luchetti,R.; Schoenhuber,R.; insufficient data; very
1988 intraoperatively in carpal tunnel Electromyogr.Clin Neurophysiol.
Landi,A. low study design
syndrome
Assessment of sensory nerve
Luchetti,R.; Schoenhuber,R.;
1988 conduction in carpal tunnel syndrome J Hand Surg Br <10 patients per group
Landi,A.
before, during and after operation
Correlation of segmental carpal tunnel
Luchetti,R.; Schoenhuber,R.; pressures with changes in hand and +Does not answer a
1998 J Hand Surg Br
Nathan,P. wrist positions in patients with carpal question of interest
tunnel syndrome and controls
Luciano,C.A.; Gilliatt,R.W.; Mixed nerve action potentials in
1995 Muscle Nerve not exclusive to CTS
Conwit,R.A. acquired demyelinating polyneuropathy
+Does not answer a
Lue,Y.J.; Lu,Y.M.; Lin,G.T.; Validation of the chinese version of the
2014 J Occup.Rehabil. question of interest; very
Liu,Y.F. Boston carpal tunnel questionnaire
low study design
Conduction of the palmar cutaneous only healthy study
Lum,P.B.; Kanakamedala,R. 1986 Arch.Phys.Med.Rehabil.
branch of the median nerve subjects
Anatomy, function, and
Lundborg,G.; Dahlin,L.B. 1996 pathophysiology of peripheral nerves Hand Clin. background
and nerve compression
Lundborg,G.; Lie- Digital vibrogram: a new diagnostic
Stenstrom,A.K.; Sollerman,C.; 1986 tool for sensory testing in compression J Hand Surg Am
low study design
Stromberg,T.; Pyykko,I. neuropathy
Charcot-Marie-Tooth disease: a gene-
Lupski,J.R. 1997 Hosp.Pract.(1995.) Background Information
dosage effect
Incorrect patient
Luria,S.; Waitayawinyu,T.; Endoscopic revision of carpal tunnel
2008 Plast.Reconstr.Surg population (prior invasive
Trumble,T.E. release
intervention)
896
Reason for
Exclusion
The carpal tunnel syndrome. The role of
Luyendijk,W. 1986 Acta Neurochir.(Wien.) Background Information
a persistent median artery
Comparison of surgical decompression
Ly,Pen D.; Andru,J.L.; and local steroid injection in the
Milln,I.; Blas,G.; 2012 treatment of carpal tunnel syndrome: 2- Rheumatology (Oxford). duplicate reference
Snchez,Olaso A. year clinical results from a randomized
trial
Treatment of worker's compensation
Lyall,J.M.; Gliner,J.;
2002 cases of carpal tunnel syndrome: an J Hand Ther Retrospective case series
Hubbell,M.K.
outcome study
Lynch,R.M.; Mohr,S.N.; Prediction of tendinitis and carpal Applied Occupational and
1997 Not relevant
Gochfeld,M. tunnel syndrome among solderers Environmental Hygiene
Surgical decompression versus local
Ly-Pen,D.; Andreu,J.L.; steroid injection in carpal tunnel Duplicate patient cohort
de,Blas G.; Sanchez-Olaso,A.; 2005 syndrome: a one-year, prospective, Arthritis Rheum. and data. Extracted from
Millan,I. randomized, open, controlled clinical PMID:24321619.
trial
Using item response theory improved
responsiveness of patient-reported
Lyren,P.E.; Atroshi,I. 2012 J Clin Epidemiol. very low quality
outcomes measures in carpal tunnel
syndrome
The diagnostic assessment of hand insufficient data; very
Ma,H.; Kim,I. 2012 J Korean Neurosurg.Soc.
elevation test in carpal tunnel syndrome low study design
Peripheral neuropathies during
Mabie,W.C. 2005 Clin.Obstet.Gynecol. Background article
pregnancy
Nerve blocks at the wrist for carpal
Macaire,P.; Choquet,O.;
tunnel release revisited: the use of
Jochum,D.; Travers,V.; 2005 Reg Anesth.Pain Med Very low quality
sensory-nerve and motor-nerve
Capdevila,X.
stimulation techniques
Ultrasound- or nerve stimulation-guided
Insufficient data (data
Macaire,P.; Singelyn,F.; wrist blocks for carpal tunnel release: a
2008 Reg Anesth.Pain Med reported in medians and
Narchi,P.; Paqueron,X. randomized prospective comparative
ranges)
study
A hand brace improve symptoms and
MacDermid,J. 2002 Aust.J Physiother. Insufficient data
function in carpal tunnel syndrome
897
Reason for
Exclusion
Decision making in detecting abnormal
MacDermid,J.C.; Kramer,J.F.; +Does not answer a
1994 Semmes-Weinstein monofilament J Hand Ther
Roth,J.H. question of interest
thresholds in carpal tunnel syndrome
A blinded placebo-controlled
Deemed clinically
MacDermid,J.C.; Vincent,J.I.; randomized trial on the use of
2012 Hand (N.Y) irrelevant (multimodal
Gan,B.S.; Grewal,R. astaxanthin as an adjunct to splinting in
approach utilized)
Clinical diagnosis of carpal tunnel
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syndrome: a systematic review
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1988 Dent.Hyg.(Chic.)
Robertson,M.M.; Erickson,J.A. California dental hygienists study
MacDonald,R.I.;
Complications of surgical release for
Lichtman,D.M.; Hanlon,J.J.; 1978 J Hand Surg Am Retrospective case series
Wilson,J.N.
Carpal tunnel syndrome: which finger
Macdonell,R.A.; should be tested? An analysis of insufficient data; very
1990 Muscle Nerve
Schwartz,M.S.; Swash,M. sensory conduction in digital branches low study design
of the median nerve
Identification and prevention of work-
Macfarlane,G.J. 2001 commentary
related carpal-tunnel syndrome
Mackinnon,S.E. 1991 Secondary carpal tunnel surgery Neurosurg.Clin N.Am Narrative review
Anatomic investigations of nerves at the
wrist: I. Orientation of the motor
Mackinnon,S.E.; Dellon,A.L. 1988 Ann.Plast.Surg cadaver study
fascicle of the median nerve in the
carpal tunnel
Repeater F waves: a comparison of
sensitivity with sensory antidromic
Macleod,W.N. 1987 wrist-to-palm latency and distal motor
low study design
latency in the diagnosis of carpal tunnel
syndrome
Maddali,Bongi S.; Signorini,M.; A manual therapy intervention
Bassetti,M.; Del,Rosso A.; 2013 improves symptoms in patients with Rheumatol.Int. Very Low Quality
Orlandi,M.; De,Scisciolo G. carpal tunnel syndrome: a pilot study
898
Reason for
Exclusion
Maeda,Y.; Kettner,N.; Lee,J.;
Kim,J.; Cina,S.; Malatesta,C.; Acupuncture evoked response in
Gerber,J.; McManus,C.; Im,J.; contralateral somatosensory cortex insufficient data; very
2013 Medical Acupuncture
Libby,A.; Mezzacappa,P.; reflects peripheral nerve pathology of low study design
Morse,L.R.; Park,K.; carpal tunnel syndrome
Audette,J.; Napadow,V.
Maeda,Y.; Kettner,N.;
Sheehan,J.; Kim,J.; Cina,S.;
Altered brain morphometry in carpal
Malatesta,C.; Gerber,J.; +Does not answer a
2013 tunnel syndrome is associated with Neuroimage Clin
McManus,C.; Mezzacappa,P.; question of interest
median nerve pathology
Morse,L.R.; Audette,J.;
Napadow,V.
Maeda,Y.; Kim,J.; Cina,S.;
McManus,C.; Malatesta,C.;
Altered brain response to acupuncture
Mezzacappa,P.; Morse,L.;
2013 after a course of acupuncture therapy J.Altern.Complement.Med. Insufficient data
Gerber,J.; Ogn-Sutherland,R.;
for CTS is associated with analgesia
Kuttner,N.; Audette,J.;
Napadow,V.
Magee,K.R.; Kahn,E.A. 1967 The carpal tunnel syndrome Mich.Med case reports
Maggard,M.A.; Harness,N.G.;
Indications for performing carpal tunnel
Chang,W.T.; Parikh,J.A.; 2010 Plast.Reconstr.Surg expert panel review
surgery: clinical quality measures
Asch,S.M.; Nuckols,T.K.
Association of occupational and non-
Maghsoudipour,M.; not best evidence for
occupational risk factors with the
Moghimi,S.; Dehghaan,F.; 2008 J Occup.Rehabil. work and demographic
prevalence of work related carpal tunnel
Rahimpanah,A. exposures
syndrome
Motor nerve conduction in intravenous Incorrect patient
Magora,F.; Stern,L.; Magora,A. 1980 regional anaesthesia with bupivacaine Br.J.Anaesth. population (non-CTS
hydrochloride patients)
Maher,H.K. 2007 Carpal tunnel syndrome: an update AAOHN J background
Mahoney,J.L.; Dagum,A.B. 1992 Carpal tunnel syndrome Can.Fam.Physician background
Correspondence between clinical
Makanji,H.S.; Zhao,M.; not best available
presentation and electrophysiological
Mudgal,C.S.; Jupiter,J.B.; 2013 J Hand Surg Eur.Vol. evidence; insufficient
testing for potential carpal tunnel
Ring,D. data
syndrome
899
Reason for
Exclusion
Associations between hand-wrist
musculoskeletal and sensorineural
Malchaire,J.; Piette,A.; Cock,N. 2001 Ann.Occup.Hyg. Not relevant to CTS
complaints and biomechanical and
vibration work constraints
Ultrasound-guided percutaneous
Malone,D.G.; Clark,T.B.; injection, hydrodissection, and
2010 Journal of Applied Research Retrospective case series
Wei,N. fenestration for carpal tunnel syndrome:
Description of a new technique
Congestive heart failure and carpal
Mandawat,M.K. 1985 J Indian Med Assoc case report
tunnel syndrome: a rare association
Neurologic syndromes from repetitive
Mandel,S. 1987 Postgrad.Med Background Information
trauma at work
Prevalence of carpal tunnel syndrome in Not relevant, prevalence
Manes,H.R. 2012
motorcyclists study
Mangonon,M.L.; Moy,O.J.; Effects of corticosteroid injection on
Kelly,J.J.; Cowan,T.B.; 2014 nerve conduction testing for the Am J Orthop (Belle.Mead NJ) Very Low Quality
Wheeler,D.R. diagnosis of carpal tunnel syndrome
Mangus,B.C. 1988 Medical care for wheelchair athletes Adapted Physical Activity Quarterly Background Information
Manktelow,R.T.;
Carpal tunnel syndrome: cross-sectional
Binhammer,P.; Tomat,L.R.; 2004 J Hand Surg Am Not relevant
and outcome study in Ontario workers
Bril,V.; Szalai,J.P.
The prevalence of carpal tunnel
Margolis,W.; Kraus,J.F. 1987 syndrome symptoms in female J Occup.Med
study
supermarket checkers
Choice of loco-regional anesthetic
Mariano,E.R.; Lehr,M.K.;
2013 technique affects operating room J Anesth. Very low quality
Loland,V.J.; Bishop,M.L.
efficiency for carpal tunnel release
Marin,E.L.; Vernick,S.; Carpal tunnel syndrome: median nerve <10 patients per group;
Friedmann,L.W. stress test insufficient data
Marras,W.S.; Marklin,R.W.; Quantification of wrist motions during
1995 Hum.Factors <10 patients per group
Greenspan,G.J.; Lehman,K.R. scanning
Use of a wheel aesthesiometer for +Does not answer a
Marsh,D.R. 1986 testing sensibility in the hand. Results J Hand Surg Br question of interest;
in patients with carpal tunnel syndrome insufficient data
900
Reason for
Exclusion
Marshall,E.A.; Listinsky,J.J.;
Magnetic resonance imaging using a Background Information;
Ceckler,T.L.; Szumowski,J.; 1989 Magn.Reson.Med.
ribbonator: Hand and wrist review
Bryant,R.G.; Hornak,J.P.
Marshall,G.; Edelstein,G.; Median nerve compression following
1980 Anesth.Analg. case report
Hirshman,C.A. radial arterial puncture
Marshall,S.; Tardif,G.; Local corticosteroid injection for carpal
2007 Cochrane Database Syst.Rev. Systematic review
Ashworth,N. tunnel syndrome
Martin,B.I.; Levenson,L.M.;
Randomized clinical trial of surgery Not a completed study.
Hollingworth,W.; Kliot,M.;
2005 versus conservative therapy for carpal BMC Musculoskelet.Disord. Methodology only. No
Heagerty,P.J.; Turner,J.A.;
tunnel syndrome [ISRCTN84286481] results.
Jarvik,J.G.
Martin,K.D.; Dutzmann,S.; Retractor-Endoscopic Nerve
Sobottka,S.B.; Rambow,S.; Decompression in Carpal and Cubital
2013 World Neurosurg. very low quality
Mellerowicz,H.A.; Pinzer,T.; Tunnel Syndromes: Outcomes in a
Schackert,G.; Krishnan,K.G. Small Series
Martin,K.-D.; Dutzmann,S.; Retractor-endoscopic nerve
Sobottka,S.B.; Rambow,S.; decompression in carpal and cubital
2014 World Neurosurgery Very low quality
Mellerowicz,H.A.; Pinzer,T.; tunnel syndromes: Outcomes in a small
Schackert,G.; Krishnan,K.G. series
Carpal tunnel syndrome: a job-related
Martin,S. 1991 Am Pharm. Commentary/review
risk
Magnetic resonance imaging of
Martins,R.S.; Siqueira,M.G.;
idiopathic carpal tunnel syndrome:
Simplicio,H.; Agapito,D.; 2008 Clin Neurol Neurosurg. insufficient information
correlation with clinical findings and
Medeiros,M.
electrophysiological investigation
Journal of Neurology Neurosurgery and
Martyn,C.N.; Hughes,R.A.C. 1997 Epidemiology of peripheral neuropathy background
Psychiatry
Marx,R.G.; Hudak,P.L.;
The reliability of physical examination
Bombardier,C.; Graham,B.; 1998 J Hand Surg Br <10 patients per group
for carpal tunnel syndrome
Goldsmith,C.; Wright,J.G.
Masear,V.R.; Hayes,J.M.; An industrial cause of carpal tunnel
1986 J Hand Surg Am very low study design
Hyde,A.G. syndrome
The carpal tunnel syndrome a
comparative study of conventional and
Masini,M.; Tavares-da,Silva R. 1998 Zentralbl.Neurochir. Conference abstract
endoscopic surgical treatment: analysis
of 50 cases
901
Reason for
Exclusion
Masmejean,E.H.; Chavane,H.;
Chantegret,A.; Issermann,J.J.; 1999 The wrist of the formula 1 driver Br J Sports Med
study
Alnot,J.Y.
Rectal biopsy in carpal tunnel syndrome
Massey,E.W. 1980 N.C Med J case reports
in amyloidosis
Massey,E.W. 1978 Carpal tunnel syndrome in pregnancy Obstet.Gynecol.Surv. Narrative review
Massey,E.W. 1988 Mononeuropathies in pregnancy Semin.Neurol. Background article
Nontraumatic mononeuropathies: a
Massey,E.W.; Riley,T.L. 1981 Mil.Med review
review
Coexistent carpal tunnel syndrome and
Massey,E.W.; Riley,T.L.;
1981 cervical radiculopathy (double crush South Med J case reports
Pleet,A.B.
syndrome)
A systematic review of the clinical
Massy-Westropp,N.;
2000 diagnostic tests for carpal tunnel J Hand Surg Am systematic review
Grimmer,K.; Bain,G.
syndrome
Matricali,B.; Mechelse,K.;
1969 Carpal-tunnel syndrome letter
Staal,A.
Mattioli,S.; Baldasseroni,A.;
Bovenzi,M.; Curti,S.;
Cooke,R.M.; Campo,G.;
Barbieri,P.G.; Ghersi,R.;
Broccoli,M.; Cancellieri,M.P.;
Colao,A.M.; Dell'omo,M.; Risk factors for operated carpal tunnel
Does not address
Fateh-Moghadam,P.; 2009 syndrome: a multicenter population- BMC Public Health
Franceschini,F.; Fucksia,S.; based case-control study
Galli,P.; Gobba,F.; Lucchini,R.;
Mandes,A.; Marras,T.;
Sgarrella,C.; Borghesi,S.;
Fierro,M.; Zanardi,F.;
Mancini,G.; Violante,F.S.
Maxwell,J.A.; Clough,C.A.; Carpal tunnel syndrome. A review of
1973 J Kans.Med Soc. Retrospective case series
Reckling,F.W.; Kelly,C.R. cases treated surgically
Results of an OSHA ergonomic
Does not answer a
May,D.C. 2002 intervention program in New Appl Occup.Environ.Hyg.
Hampshire
902
Reason for
Exclusion
Acroparaesthesiae and Carpal Tunnel European Journal of Physical Medicine not best available
Mayr,H. 1996
Syndrome - A re-evaluation and Rehabilitation evidence
Carpal tunnel syndrome, diabetes and Does not answer a
McCann,V.J.; Davis,R.E. 1978 Aust.N.Z.J Med
pyridoxal question of interest
Professional golfers and the price they insufficient data; no
McCarroll,J.R.; Gioe,T.J. 1982 Physician and Sportsmedicine
pay comparison group
McCartan,B.; Ashby,E.;
2012 Carpal tunnel syndrome Br J Hosp.Med (Lond) background
Taylor,E.J.; Haddad,F.S.
McColl,G.J.; Dolezal,H.; Common corticosteroid injections. An
2000 Aust.Fam Physician Narrative review
Eizenberg,N. anatomical and evidence based review
McDeavitt,J.T.; Graziani,V.; Neuromuscular disease: Rehabilitation
1995 Arch.Phys.Med.Rehabil. background
Kowalske,K.J.; Hays,R.M. and electrodiagnosis. 2. Nerve disease
Male and female rate differences in
McDiarmid,M.; Oliver,M.;
2000 carpal tunnel syndrome injuries: Environ.Res. Prevalence study
Ruser,J.; Gucer,P.
personal attributes or job tasks?
McDonough,J.W.; A comparison of endoscopic and open
1993 Wis.Med J Retrospective case series
Gruenloh,T.J. carpal tunnel release
McGorry,R.W.; Fallentin,N.;
Effect of grip type, wrist motion, and
Andersen,J.H.; Keir,P.J.; +Does not answer a
2014 resistance level on pressures within the J Orthop Res.
Hansen,T.B.; Pransky,G.; question of interest
carpal tunnel of normal wrists
Lin,J.H.
Posttraumatic median neuroma: a cause
McGrath,M.H.; Polayes,I.M. 1979 Ann.Plast.Surg case reports
McLennan,H.G.; Oats,J.N.;
1987 Survey of hand symptoms in pregnancy Med J Aust. Survey
Walstab,J.E.
Carpal tunnel syndrome caused by a
McMinn,D.J. 1985 J R Coll Surg Edinb. case report
simple ganglion
Results of 1245 endoscopic carpal
McNally,S.A.; Hales,P.F. 2003 Hand Surg Retrospective case series
tunnel decompressions
A study of the diseased nerve in the
Mechelse,K.; Matricali,B. 1970 Electroencephalogr.Clin Neurophysiol. not relevant
A study of the diseased nerve in carpal not relevant, one page
Mechelse,K.; Matricali,B. 1969 Electroencephalogr.Clin Neurophysiol.
tunnel syndrome full text
903
Reason for
Exclusion
Proximal stimulus confirms carpal
+Does not answer a
Meder,M.A.; Lange,R.; tunnel syndrome--a new test? --a
2012 J Clin Neurophysiol. question of interest; very
Amtage,F.; Rijntjes,M. clinical and electrophysiologic,
low study design
multiple-blind, controlled study
Neural gliding techniques for the
Medina McKeon,J.M.;
2008 treatment of carpal tunnel syndrome: a J Sport Rehabil. systematic review
Yancosek,K.E.
systematic review
Mediouni,Z.; de,Roquemaurel
Is carpal tunnel syndrome related to
A.; Dumontier,C.; Becour,B.;
2014 computer exposure at work? A review J Occup.Environ.Med meta-analysis
Garrabe,H.; Roquelaure,Y.;
and meta-analysis
Descatha,A.
Effectiveness of mechanical traction as
a non-surgical treatment for carpal
Meems,M.; Den,Oudsten B.;
2014 tunnel syndrome compared to care as Trials Insufficient data
Meems,B.J.; Pop,V.
usual: study protocol for a randomized
controlled trial
Meena,A.K.; Srinivasa,Rao B.; confounding
Second lumbrical and interossei latency
Sailaja,S.; Mallikarjuna,M.; 2008 Clin Neurophysiol. comorbidities; very low
difference in Carpal Tunnel Syndrome
Borgohain,R. study design
Utility of nerve conduction studies for
+Does not answer a
Megerian,J.T.; Kong,X.; carpal tunnel syndrome by family
2007 J Am Board Fam Med question of interest; not
Gozani,S.N. medicine, primary care, and internal
medicine physicians
CTD: carpal tunnel syndrome, the facts
Melhorn,J.M. 1994 Kans.Med Background Information
and myths
Melli,G.; Chaudhry,V.; Perioperative bilateral median
2002 Case report
Dorman,T.; Cornblath,D.R. neuropathy
Melvin,J.L.; Burnett,C.N.; Does not address
1969 Median nerve conduction in pregnancy Arch Phys Med Rehabil.
Johnson,E.W. question of interest
Melvin,J.L.; Johnson,E.W.; Electrodiagnosis after surgery for the
1968 Arch Phys Med Rehabil. Retrospective case series
Duran,R. carpal tunnel syndrome
Diagnostic specificity of motor and
Melvin,J.L.; Schuchmann,J.A.; insufficient data; very
1973 sensory nerve conduction variables in Arch Phys Med Rehabil.
Lanese,R.R. low study design
904
Reason for
Exclusion
Memis,D.; Turan,A.;
Adding Dexmedetomidine to Lidocaine Deemed clinically
Karamanlioglu,B.; Pamukcu,Z.; 2004 Anesth.Analg.
for Intravenous Regional Anesthesia irrelevant
Kurt,I.
Erratum to "Carpal tunnel syndrome in
Parkinson's disease" [Eur. J. Radiol. 67
Mengi-Ozsarac,G. 2008 Eur.J.Radiol. letter to the editor
(3) (2008) 550]
(DOI:10.1016/j.ejrad.2008.02.017)
Endoscopic carpal tunnel release: a
Menon,J. 1993 Contemp Orthop Retrospective case series
single-portal technique
Endoscopic carpal tunnel release--
Menon,J.; Etter,C. 1993 J Hand Ther Background article
current status
Skin closure in carpal tunnel surgery: a
Menovsky,T.; Bartels,R.H.; van prospective comparative study between
2004 Hand Surg criteria (invasive follow-
Lindert,E.L.; Grotenhuis,J.A. nylon, polyglactin 910 and stainless
up<3 month)
steel sutures
Merchut,M.P.; Kelly,M.A.; Quantitative sensory thresholds in insufficient data; very
Toleikis,S.C. carpal tunnel syndrome low study design
High-resolution computed tomography
Merhar,G.L.; Clark,R.A.; insufficient data; very
1986 of the wrist in patients with carpal Skeletal Radiol.
Schneider,H.J.; Stern,P.J. low study design
tunnel syndrome
Abnormal post-operative
Merolli,A.; Lo,Monaco M.;
electrophysiological findings after Journal of Orthopaedics and
Masciangelo,M.; Del,Regno C.; 2011 Insufficient data
carpal tunnel release: One-year follow- Traumatology
Catalano,F.
up
Merolli,A.; Luigetti,M.; Persistence of abnormal
Does not address
Modoni,A.; Masciullo,M.; 2013 electrophysiological findings after J Reconstr.Microsurg.
Lucia,Mereu M.; Lo,Monaco M. carpal tunnel release
Musculoskeletal concerns in Down International Journal of Adolescent review; background
Merrick,J. 2000
syndrome Medicine and Health information
Ergonomic risk exposure and upper-
Meservy,D.; Suruda,A.J.; extremity cumulative trauma disorders
1997 J.Occup.Environ.Med. Not relevant
Bloswick,D.; Lee,J.; Dumas,M. in a maquiladora medical devices
manufacturing plant
Mesgarzadeh,M.; Schneck,C.D.;
Carpal tunnel: MR imaging. Part II. summary review; very
Bonakdarpour,A.; Mitra,A.; 1989
Carpal tunnel syndrome low study design
Conaway,D.
905
Reason for
Exclusion
Upper extremity disorders commonly
Meyerdierks,E.M. 1991 N.C Med J Background Information
seen in women
Liquid crystal thermography:
Meyers,S.; Cros,D.; Sherry,B.; insufficient data; very
1989 quantitative studies of abnormalities in
Vermeire,P. low study design
Prognostic factors in carpal tunnel
Meys,V.; Thissen,S.;
2011 syndrome treated with a corticosteroid Muscle Nerve Very Low Quality
Rozeman,S.; Beekman,R.
injection
Median nerve ultrasound as a screening
tool in carpal tunnel syndrome: confounded comparisons;
Mhoon,J.T.; Juel,V.C.;
2012 correlation of cross-sectional area Muscle Nerve not best available
Hobson-Webb,L.D.
measures with electrodiagnostic evidence
abnormality
Michalsen,A.; Bock,S.;
Ludtke,R.; Rampp,T.; Effects of traditional cupping therapy in Does not meet inclusion
Baecker,M.; Bachmann,J.; 2009 patients with carpal tunnel syndrome: a J Pain criteria (follow-up <1
Langhorst,J.; Musial,F.; randomized controlled trial month)
Dobos,G.J.
Prospective, randomized evaluation of
Michelotti,B.; Romanowsky,D.; endoscopic versus open carpal tunnel Does not address
2014 Ann Plast Surg
Hauck,R.M. release in bilateral carpal tunnel question of interest
syndrome: an interim analysis
Micheo,W.F.; Rodriguez,R.A.; Joint and soft-tissue injections of the
1995 Phys.Med.Rehabil.Clin.N.Am. Background information
Amy,E. upper extremity
Michlovitz,S.; Hun,L.; Does not meet inclusion
Continuous low-level heat wrap therapy
Erasala,G.N.; Hengehold,D.A.; 2004 Arch Phys Med Rehabil. criteria (follow-up <1
is effective for treating wrist pain
Weingand,K.W. month)
Topical pain management with the 5%
Mick,G.; Correa-Illanes,G. 2012 Curr.Med Res.Opin. systematic review
lidocaine medicated plaster--a review
Mihalsky,S. 1998 Carpal tunnel syndrome: an overview J Okla.Dent.Assoc background
Millender,L.H.; A team approach to reduce disability in
1996 Orthop.Clin.North Am. Background Information
Tromanhauser,S.G.; Gaynor,S. work-related disorders
How to spot - and treat - carpal tunnel
Miller,B.K. 1980 Nursing (Lond). background
syndrome - early
Miller,B.K.; Gregory,M. 1983 Carpal tunnel syndrome AORN J background
906
Reason for
Exclusion
Miller,R.S.; Iverson,D.C.; Carpal tunnel syndrome in primary
Fried,R.A.; Green,L.A.; 1994 care: a report from ASPN. Ambulatory J Fam Pract.
study
Nutting,P.A. Sentinel Practice Network
Miller,R.S.; Iverson,D.C.;
Carpal tunnel syndrome in primary
Fried,R.A.; Green,L.A.; 1994 J.Fam.Pract. duplicate
care: A report from ASPN
Nutting,P.A.
prediction model; does
A stress-strength interference model for International Journal of Industrial
Miller,S.A.; Freivalds,A. 1995 not answer a question of
predicting CTD probabilities Ergonomics
interest
Nerve entrapment syndromes of the
Miller,T.T.; Reinus,W.R. 2010 Am.J.Roentgenol. background
elbow, forearm, and wrist
Millesi,H. 1981 Reappraisal of nerve repair Surg Clin North Am Background article
Orthodromic sensory action potentials
Mills,K.R. 1985 from palmar stimulation in the J Neurol Neurosurg.Psychiatry
low study design
Local corticosteroid treatment for carpal
Milo,R.; Kalichman,L.; tunnel syndrome: a 6-month clinical
2009 J Back Musculoskelet.Rehabil. Very Low Quality
Volchek,L.; Reitblat,T. and electrophysiological follow-up
study
Computer use related upper limb
Ming,Z.; Zaproudina,N. 2003 Pathophysiology background
musculoskeletal (ComRULM) disorders
Misdiagnosis of carpal tunnel
Mireles,M.C.; Miller,J.A.; literature review;
2009 syndrome: A systematic J.Clin.Eng.
Paske,W.C. background information
misclassification or error of omission
Mitz,M.; Gokulananda,T.; Median nerve determinations: Analysis only healthy study
1984 Arch.Phys.Med.Rehabil.
Di,Benedetto M.; Klingbeil,G.E. of two techniques subjects
Ultrasonography of carpal tunnel
Miwa,T.; Miwa,H. 2011 syndrome: clinical significance and Intern.Med
low study design
limitations in elderly patients
Miyamoto,H.; Halpern,E.J.;
Carpal Tunnel Syndrome: Diagnosis by
Kastlunger,M.; Gabl,M.;
Means of Median Nerve Elasticity- insufficient data; very
Arora,R.; Bellmann-Weiler,R.; 2014
Improved Diagnostic Accuracy of US low study design
Feuchtner,G.M.; Jaschke,W.R.;
with Sonoelastography
Klauser,A.S.
907
Reason for
Exclusion
Miyamoto,H.; Siedentopf,C.;
Intracarpal tunnel contents: evaluation
Kastlunger,M.; Martinoli,C.;
2014 of the effects of corticosteroid injection Very Low Quality
Gabl,M.; Jaschke,W.R.;
with sonoelastography
Klauser,A.S.
Mizrak,A.; Bozgeyik,S.; The addition of low-dose mivacurium
Deemed clinically
Karakurum,G.; Kocamer,B.; 2010 to lidocaine for intravenous regional Journal of Musculoskeletal Pain
irrelevant
Oner,U. anesthesia
Premedication with dexmedetomidine
Mizrak,A.; Gul,R.; Erkutlu,I.; Deemed clinically
2010 alone or together with 0.5% lidocaine J Surg Res.
Alptekin,M.; Oner,U. irrelevant
for IVRA
Mizrak,A.; Gul,R.;
Dexmedetomidine premedication of Deemed clinically
Ganidagli,S.; Karakurum,G.; 2011 Middle East J Anesthesiol.
outpatients under IVRA irrelevant
Keskinkilic,G.; Oner,U.
Effect of custom-made and
Mlakar,M.; Ramstrand,N.;
2013 prefabricated orthoses on grip strength Prosthet.Orthot.Int. Very Low Quality
Burger,H.; Vidmar,G.
in persons with carpal tunnel syndrome
Myofascial release treatment of specific
Mock,L.E. 1997 muscles of the upper extremity (Levels Clinical Bulletin of Myofascial Therapy Background article
3 and 4): Part 3
Mody,G.N.; Anderson,G.A.; Carpal tunnel syndrome in Indian
+Does not answer a
Thomas,B.P.; Pallapati,S.C.; 2009 patients: use of modified questionnaires J Hand Surg Eur.Vol.
Santoshi,J.A.; Antonisamy,B. for assessment
confounding
Moghtaderi,A.; Dahmardeh,M.; Subclinical carpal tunnel syndrome in
2012 Iran J Neurol comorbidities without
Dabiri,S. patients with acute stroke
statistical control
Evaluating the effectiveness of local
Moghtaderi,A.R.;
2011 dexamethasone injection in pregnant J Res.Med Sci Very low quality
Moghtaderi,N.; Loghmani,A.
women with carpal tunnel syndrome
Contribution of power Doppler and
Mohamed,R.E.; Amin,M.A.; gray-scale ultrasound of the median Egyptian Journal of Radiology and insufficient data; very
2014
Aboelsafa,A.A.; Elsayed,S.E. nerve in evaluation of carpal tunnel Nuclear Medicine low study design
syndrome
Mohammadi,A.; Afshar,A.; Diagnostic value of cross-sectional area
Etemadi,A.; Masoudi,S.; 2010 of median nerve in grading severity of Arch Iran Med very low study design
Baghizadeh,A. carpal tunnel syndrome
908
Reason for
Exclusion
Comparison of high resolution
ultrasonography and nerve conduction
Mohammadi,A.; Afshar,A.R.; insufficient data; very
2009 study in the diagnosis of carpal tunnel Iranian Journal of Radiology
Masudi,S.; Etemadi,A. low study design
syndrome: Diagnostic value of median
nerve cross-sectional area
Mohammadi,A.; Ghasemi- Correlation between the severity of
Rad,M.; Mladkova-Suchy,N.; 2012 carpal tunnel syndrome and color AJR Am J Roentgenol.
low study design
Ansari,S. Doppler sonography findings
Retractor-assisted endoscopic nerve
Mohanty,C.B.; Midha,R. 2014 decompression in entrapment World Neurosurgery Narrative review
neuropathy
Mojaddidi,M.A.; Ahmed,M.S.; Molecular and pathological studies in
Ali,R.; Jeziorska,M.; Al- the posterior interosseous nerve of Does not address
2014
Sunni,A.; Thomsen,N.O.; diabetic and non-diabetic patients with question of interest
Dahlin,L.B.; Malik,R.A. carpal tunnel syndrome
Clinical revision series. 5. Carpal tunnel
Molitor,P. 1985 Nurs.Mirror background
syndrome
A diagnostic test for carpal tunnel insufficient data; very
Molitor,P.J. 1988 J Hand Surg Br
syndrome using ultrasound low study design
The pillar pain in the carpal tunnel's
Monacelli,G.; Rizzo,M.I.;
surgery. Neurogenic inflammation? A
Spagnoli,A.M.; Pardi,M.; 2008 J Neurosurg.Sci Insufficient data
new therapeutic approach with local
Irace,S.
anaesthetic
Monagle,K.; Dai,G.; Chu,A.; Quantitative MR imaging of carpal <10 patients per group;
1999 AJR Am J Roentgenol.
Burnham,R.S.; Snyder,R.E. tunnel syndrome very low study design
Mondelli,M.; Aprile,I.;
Sex differences in carpal tunnel
Ballerini,M.; Ginanneschi,F.; +not best available
2005 syndrome: comparison of surgical and Eur.J Neurol
Reale,F.; Romano,C.; Rossi,S.; evidence
non-surgical populations
Padua,L.
Low sensitivity of F-wave in the
insufficient data; unclear
Mondelli,M.; Aretini,A. 2015 electrodiagnosis of carpal tunnel J.Electromyogr.Kinesiol.
reference standard
syndrome
Mondelli,M.; Baldasseroni,A.; Prevalent involvement of thenar motor Does not answer a
Aretini,A.; Ginanneschi,F.; 2010 fibres in vineyard workers with carpal Clin Neurophysiol. question of interest;
Padua,L. tunnel syndrome insufficient data
909
Reason for
Exclusion
Diagnostic utility of ultrasonography
Mondelli,M.; Filippou,G.; insufficient data; very
2008 versus nerve conduction studies in mild Arthritis Rheum.
Gallo,A.; Frediani,B. low study design
Mondelli,M.; Giannini,F.; Carpal tunnel syndrome incidence in a all CTS cases; no
2002
Giacchi,M. general population comparison group
Mondelli,M.; Padua,L.;
A self-administered questionnaire of
Giannini,F.; Bibbo,G.; 2006 Neurol Sci Not relevant to CTS
ulnar neuropathy at the elbow
Aprile,I.; Rossi,S.
Carpal tunnel syndrome in elderly
2004 patients: results of surgical J Peripher.Nerv.Syst. very low quality
Reale,F.
decompression
Outcome of surgical release among Does not address
Reale,F.; Signorini,A.M.; 2004 Arch Phys Med Rehabil.
diabetics with carpal tunnel syndrome question of interest
Romano,C.
Mondelli,M.; Passero,S.; Provocative tests in different stages of insufficient data; very
2001 Clin Neurol Neurosurg.
Giannini,F. carpal tunnel syndrome low study design
Mondelli,M.; Rossi,S.; Factors influencing the diagnostic insufficient data; very
2013 Neurol Sci
Ballerini,M.; Mattioli,S. process of carpal tunnel syndrome low study design
Mondelli,M.; Rossi,S.;
Long term follow-up of carpal tunnel
Monti,E.; Aprile,I.;
2007 syndrome during pregnancy: a cohort Electromyogr.Clin Neurophysiol. Very low quality
Caliandro,P.; Pazzaglia,C.;
study and review of the literature
Romano,C.; Padua,L.
Mondelli,M.; Rossi,S.;
Prospective study of positive factors for
Monti,E.; Aprile,I.;
2007 improvement of carpal tunnel syndrome Muscle Nerve Very low quality
Caliandro,P.; Pazzaglia,C.;
in pregnant women
Romano,C.; Padua,L.
Carpal tunnel syndrome. Measurement
Monga,T.N.; Laidlow,D.M. 1982 of sensory potentials using ring and Am J Phys Med
low study design
index fingers
Monga,T.N.; Shanks,G.L.; Sensory palmar stimulation in the insufficient data; very
Poole,B.J. diagnosis of carpal tunnel syndrome low study design
Monsivais,J.J.; Bucher,P.A.; Nonsurgically treated carpal tunnel
1994 Plast.Reconstr.Surg Very Low Quality
Monsivais,D.B. syndrome in the manual worker
The motor tinel sign: a useful sign in
Montagna,P.; Liguori,R. 2000 Muscle Nerve not exclusive to CTS
entrapment neuropathy?
910
Reason for
Exclusion
Ultrasonography of palm to elbow
Moon,H.I.; Kwon,H.K.; insufficient data; very
2013 segment of median nerve in different Clin Neurophysiol.
Kim,L.; Lee,H.J.; Lee,H.J. low study design
degrees of diabetic polyneuropathy
Ultrasonography of palm to elbow not CTS specific;
Moon,H.I.; Kwon,H.K.;
2014 segment of median nerve in different Clin.Neurophysiol. insufficient data for
Kim,L.; Lee,H.J.; Lee,H.J.
degrees of diabetic polyneuropathy diagnostic conclusions
Quantifying exposure in occupational
review; background
Moore,A.; Wells,R.; Ranney,D. 1991 manual tasks with cumulative trauma
information
disorder potential
Moore,J.S. 1992 Carpal tunnel syndrome Occup.Med Background Information
Clinical determination of work- insufficient data; very
Moore,J.S. 1991 J Occup.Rehabil.
relatedness in carpal tunnel syndrome low study design
The strain index: A proposed method to
Moore,J.S.; Garg,A. 1995 analyze jobs for risk of distal upper Am.Ind.Hyg.Assoc.J. Background Information
extremity disorders
Moran,E.; Naff,N.J. 2001 Endoscopic carpal tunnel release Seminars in Neurosurgery Background article
Clinical and electrophysiological
Morgan,M.H.; Read,A.E.; not exclusive to CTS;
1979 studies of peripheral nerve function in Clin.Sci.
Campbell,M.J. very low study design
patients with chronic liver disease
Morgan,R.F.; Stuart,J.D.; Peripheral nerve compression in the
1989 Compr.Ther. background
Persing,J.A.; Edlich,R.F. upper extremity
Most factors contributing to CTS can be
Morgan,S. 1991 Occup.Health Saf Background article
minimized, if not eliminated
Surgical treatment of carpal tunnel
Morgenlander,J.C.; Lynch,J.R.;
1997 syndrome in patients with peripheral Retrospective case series
Sanders,D.B.
neuropathy
Comparison of the distal motor latency
Mortier,G.; Deckers,K.; insufficient data; very
1988 of the ulnar nerve in carpal tunnel Electromyogr.Clin Neurophysiol.
Dijs,H.; Vander Auwera,J.C. low study design
syndrome with a control group
Journal of the American Society for
Mosher,Jr 2001 Mini open carpal tunnel release Background article
Surgery of the Hand
Tinel's sign and the carpal tunnel +not best available
Mossman,S.S.; Blau,J.N. 1987 Br Med J (Clin Res.Ed)
syndrome evidence
911
Reason for
Exclusion
Mouzakis,D.E.; Rachiotis,G.; Finite element simulation of the
bio-study; CT image
Zaoutsos,S.; Eleftheriou,A.; 2014 mechanical impact of computer work J Biomech.
review
Malizos,K.N. on the carpal tunnel syndrome
Proposed screening tool for the
Muffly-Elsey,D.; Flinn-
1987 detection of cumulative trauma J Hand Surg Am Not relevant to CTS
Wagner,S.
disorders of the upper extremity
Carpal tunnel syndrome--course and Not relevant to PICO
Muhlau,G.; Both,R.; Kunath,H. 1984 J Neurol
prognosis question.
Lead exposure during demolition of a
steel structure coated with lead-based
Muijser,H.; Hoogendijk,E.M.G.;
1987 paints. II. Reversible changes in the Scand.J.Work.Environ.Health Not relevant to CTS
Hooisma,J.; Twisk,D.A.M.
conduction velocity of the motor nerves
in transiently exposed workers
Effectiveness of hand therapy
Muller,M.; Tsui,D.; Schnurr,R.;
interventions in primary management of
Biddulph-Deisroth,L.; Hard,J.; 2004 J Hand Ther Systematic review
carpal tunnel syndrome: a systematic
MacDermid,J.C.
review
Muller-Felber,W.; Landgraf,R.;
High incidence of carpal tunnel
Reimers,C.D.; Scheuer,R.;
syndrome in diabetic patients after no comparison group;
Wagner,S.; Nusser,J.; 1993 Acta Diabetol.
combined pancreas and kidney uncontrolled confounders
Abendroth,A.; Illner,W.D.;
transplantation
Land,W.
Munirah,M.A.; Prevalence of probable carpal tunnel International Journal of Collaborative
no comparison group;
Normastura,A.R.; Azizah,Y.; 2014 syndrome and its associated factors Research on Internal Medicine and
prevalence study
Aziah,D. among dentists in Kelantan Public Health
Effects of lead, zinc and copper Does not answer a
Murata,K.; Araki,S.; Aono,H. 1987 absorption on peripheral nerve Int.Arch.Occup.Environ.Health question of interest; no
conduction in metal workers diagnosis of CTS
Subclinical impairment in the median
Murata,K.; Araki,S.; insufficient data; no
1996 nerve across the carpal tunnel among Int.Arch Occup.Environ.Health
Okajima,F.; Saito,Y. diagnosis of CTS
female VDT operators
Original Article: Subclinical
Does not answer a
Murata,K.; Araki,S.; impairment in the median nerve across
1996 Int.Arch.Occup.Environ.Health question of interest; no
Okajima,F.; Saito,Y. the carnal tunnel among female VDT
diagnosis of CTS
operators
912
Reason for
Exclusion
The carpal tunnel syndrome.
Murga,L.; Moreno,J.M.; Relationship between median distal not best evidence; no true
Menendez,C.; Castilla,J.M. motor latency and graded results of reference standard
needle electromyography
The Carpal Tunnel Syndrome.
Murga,Oporto L.; Moreno,J.M.; Relationship between median distal Duplicate of AAOD ID
1994 Electromyogr.Clin.Neurophysiol.
Menendez,C.; Castilla,J.M. motor latency and graded results of 4675
needle electromyography
Murphy,F.; Beetham,Jr;
1974 tophaceous gout: Report of two cases Lahey Clin.Found.Bull. n<10
Torgerson Jr,W.R.
with review of the literature
review; background
Murtagh,J. 1990 The painful arm Aust.Fam Physician
information
Murtagh,J. 1990 Simple tests for carpal tunnel syndrome Aust.Fam Physician Background Information
not best available
Carpal tunnel syndrome - How common
Murthy,J.M.K.; Meena,A.K. 1995 Neurol.India evidence; very low study
is the problem in South India
design
Murthy,P.G.; Abzug,J.M.; The tenosynovial flap for recalcitrant Does not address
2013 Tech.Hand Up Extrem.Surg
Jacoby,S.M.; Culp,R.W. carpal tunnel syndrome question of interest
Clinical, electrophysiological and not best available
Musluoglu,L.; Celik,M.;
2004 magnetic resonance imaging findings in Electromyogr.Clin Neurophysiol. evidence for any MRI
Tabak,H.; Forta,H.
carpal tunnel syndrome abnormality
Utility of the clinical examination for
Myers,K.A. 2000 literature review
Management of the carpal tunnel
Myles,A.B.; Casemore,V.A.;
1973 syndrome with local corticosteroid Rheumatol.Rehabil. Very Low Quality
Coulthard,M.
injections
Endoscopic Carpal Tunnel Release
Nabhan,A.; Ishak,B.; Al- using a modified application technique
2008 J Brachial.Plex.Peripher.Nerve Inj. Very low quality
Khayat,J.; Steudel,W.I. of local anesthesia: safety and
effectiveness
Assessment of mixed forearm
Nada,M.A.; Nawito,A.M.; Egyptian Journal of Neurology, insufficient data; very
2012 conduction velocity in carpal tunnel
Abd-Elhamid,Y.Z.; Fayed,E.N. Psychiatry and Neurosurgery low study design
syndrome
913
Reason for
Exclusion
Carpal tunnel syndrome pain treated
Incorrect patient
Naeser,M.A.; Hahn,K.A.; with low-level laser and microamperes
2002 Arch Phys Med Rehabil. population (<10
Lieberman,B.E.; Branco,K.F. transcutaneous electric nerve
patients/group)
stimulation: A controlled study
Endoscopic carpal tunnel release: Chow
Nagle,D.J. 1995 Instr.Course Lect. Narrative review
dual-portal technique
Nagle,D.J.; Fischer,T.J.;
A multicenter prospective review of
Harris,G.D.; Hastings,H.;
640 endoscopic carpal tunnel releases
Osterman,A.L.; Palmer,A.K.; 1996 very low quality
using the transbursal and extrabursal
Viegas,S.F.; Whipple,T.L.;
chow techniques
Foley,M.
The impact of tourniquet on patient
Nagpal,K.; Gossiel,M.;
2007 satisfaction in carpal tunnel Central European Journal of Medicine Retrospective case series
Kumar,H.
decompression
Carpal tunnel syndrome in the
Nahra,M.E. 1999 Current Opinion in Orthopaedics Background Information
workplace
Naito,K.; Lequint,T.; Should we stop oral anticoagulants in
Zemirline,A.; Gouzou,S.; 2012 the surgical treatment of carpal tunnel Hand (N.Y) Very low strength
Facca,S.; Liverneaux,P. syndrome?
Insufficient data (missing
Ultrasonographically assisted carpal
Nakamichi,K.; Tachibana,S. 1997 J Hand Surg Am N at each follow-up time
tunnel release
point)
Restricted motion of the median nerve insufficient data; very
Nakamichi,K.; Tachibana,S. 1995 J Hand Surg Br
in carpal tunnel syndrome low study design
Small hand as a risk factor for
Nakamichi,K.; Tachibana,S. 1995 Muscle Nerve Short report
Unilateral carpal tunnel syndrome and +Does not answer a
Nakamichi,K.; Tachibana,S. 1993 J Hand Surg Br
space-occupying lesions question of interest
Percutaneous carpal tunnel release
Nakamichi,K.; Tachibana,S.; compared with mini-open release using
Yamamoto,S.; Ida,M. ultrasonographic guidance for both
techniques
Enlarged median nerve in idiopathic insufficient data; very
Nakamichi,K.I.; Tachibana,S. 2000 Muscle Nerve
914
Reason for
Exclusion
Nakamura,Y.; Uchiyama,S.; Longitudinal Median Nerve Conduction
does not address question
Toriumi,H.; Nakagawa,H.; 1999 Studies After Endoscopic Carpal Hand Surg
of interest
Miyasaka,Ta Tunnel Release
Peripheral nerve entrapments, repetitive
Nakano,K.K. 1991 strain disorder, occupation-related Curr.Opin.Rheumatol. Background Information
syndromes, bursitis, and tendonitis
Nakano,K.K. 1978 The entrapment neuropathies Muscle Nerve background
Liquid crystal contact thermography
Journal of Neurological and no comparison group; not
Nakano,K.K. 1984 (LCT) in the evaluation of patients with
Orthopaedic Surgery CTS exclusive
upper limb entrapment neuropathies
Electrophysiological studies and
physical examinations in entrapment
neuropathy: sensory and motor insufficient data; very
Nakazumi,Y.; Hamasaki,M. 2001 Electromyogr.Clin Neurophysiol.
functions compensation for the central low study design
nervous system in cases with peripheral
nerve damage
State of health in dental technicians
Nakladalova,M.; Fialova,J.; Not relevant, prevalence
1995 with regard to vibration exposure and Cent.Eur.J Public Health
Korycanova,H.; Nakladal,Z. study
overload of upper extremities
An Open-Label Pilot Study Evaluating
the Effectiveness of the Heated
Nalamachu,S.; Nalamasu,R.;
2013 Lidocaine/Tetracaine Patch for the Pain Pract. Very Low Quality
Jenkins,J.; Marriott,T.
Treatment of Pain Associated with
Carpal Tunnel Syndrome
An open-label pilot study evaluating the
effectiveness of the heated Does not meet inclusion
Nalamachu,S.; Nalamasu,R.;
2014 lidocaine/tetracaine patch for the Pain Practice criteria (follow-up<1
Jenkins,J.; Marriott,T.
treatment of pain associated with carpal month)
tunnel syndrome
The effect of patient involvement in
Nam,K.P.; Gong,H.S.;
surgical decision making for carpal Does not address
Bae,K.J.; Rhee,S.H.; Lee,H.J.; 2014 J Hand Surg Am
tunnel release on patient-reported question of interest
Baek,G.H.
outcome
Carpal tunnel syndrome in patients who
Not relevant,
Namazi,H.; Majd,Z. 2007 are receiving long-term renal Arch Orthop Trauma Surg
hemodialysis patient
hemodialysis
915
Reason for
Exclusion
The perioperative use of oral
Nandoe Tewarie,R.D.; anticoagulants during surgical
2010 Acta Neurochir.(Wien.) Very low quality
Bartels,R.H. procedures for carpal tunnel syndrome.
A preliminary study
Body height-workstation settings
International Journal of Industrial
Nanthavanij,S. 1996 matrix: A practical tool for ergonomic review
Ergonomics
VDT workstation adjustment
Napadow,V.; Kettner,N.;
Hypothalamus and amygdala response
Liu,J.; Li,M.; Kwong,K.K.;
2007 to acupuncture stimuli in Carpal Tunnel Very Low Quality
Vangel,M.; Makris,N.;
Syndrome
Audette,J.; Hui,K.K.
Napadow,V.; Liu,J.; Li,M.;
Somatosensory cortical plasticity in
Kettner,N.; Ryan,A.;
2007 carpal tunnel syndrome treated by Hum.Brain Mapp. Very Low Quality
Kwong,K.K.; Hui,K.K.;
acupuncture
Audette,J.F.
Naranjo,A.; Ojeda,S.;
Usefulness of clinical findings, nerve
Arana,V.; Baeta,P.; Fernandez-
conduction studies and ultrasonography Does not address
Palacios,J.; Garcia-Duque,O.; 2009 Clin Exp.Rheumatol.
to predict response to surgical release in question of interest
Rodriguez-Lozano,C.;
Carmona,L.
Naranjo,A.; Ojeda,S.; Rua-
Limited value of ultrasound assessment
Figueroa,I.; Garcia-Duque,O.;
2010 in patients with poor outcome after Scand.J Rheumatol. very low quality
Fernandez-Palacios,J.;
carpal tunnel release surgery
Carmona,L.
Narasimha,P.D.; Rajeev,D.; Rheumatological manifestations in
2001 JK Science Background Information
Dharmanand,B.G. hypothyroidism
inadequate presentation
of data. data for risk
factors presented as
percent of variance
Carpal tunnel syndrome and its relation
Nathan,P.A.; Keniston,R.C. 1993 Hand Clin explained by variable,
to general physical condition
without reporting if all of
the variables were
statistically significant
predictors
Nathan,P.A.; Keniston,R.C.; Predictive value of nerve conduction
1993 Muscle Nerve Not relevant
Meadows,K.D.; Lockwood,R.S. measurements at the carpal tunnel
916
Reason for
Exclusion
Obesity as a risk factor for slowing of
sensory conduction of the median nerve
Nathan,P.A.; Keniston,R.C.; insufficient data; no
1992 in industry. A cross-sectional and J Occup.Med
Myers,L.D.; Meadows,K.D. diagnosis of CTS
longitudinal study involving 429
workers
Sensory segmental latency values of the
Nathan,P.A.; Meadows,K.D.; insufficient data; very
1988 median nerve for a population of Arch Phys Med Rehabil.
Doyle,L.S. low study design
normal individuals
Occupation as a risk factor for impaired
Nathan,P.A.; Meadows,K.D.; insufficient data; no
1988 sensory conduction of the median nerve J Hand Surg Br
Doyle,L.S. diagnosis of CTS
at the carpal tunnel
Rehabilitation of carpal tunnel surgery
Nathan,P.A.; Meadows,K.D.; patients using a short surgical incision
1993 J Hand Surg Am Very low strength
Keniston,R.C. and an early program of physical
therapy
Location of impaired sensory
Nathan,P.A.; Srinivasan,H.; +Does not answer a
1990 conduction of the median nerve in J Hand Surg Br
Doyle,L.S.; Meadows,K.D. question of interest
Effects of an aerobic exercise program
Nathan,P.A.; Wilcox,A.;
on median nerve conduction and
Emerick,P.S.; Meadows,K.D.; 2001 J Occup.Environ.Med Very Low Quality
symptoms associated with carpal tunnel
McCormack,A.L.
syndrome
Prediction of outcome of
Nau,H.E.; Lange,B.; Lange,S. 1988 decompression for carpal tunnel J Hand Surg Br Retrospective case series
syndrome
+Does not answer a
Neal,N.C.; McManners,J.; Pathology of the flexor tendon sheath in
1987 J Hand Surg Br question of interest; bio-
Stirling,G.A. the spontaneous carpal tunnel syndrome
study
Neary,D. 1980 Entrapment neuropathy Br.J.Hosp.Med. background
Nelson,K.H.; Briner,Jr; Corticosteroid injection therapy for
1995 Am.Fam.Physician Background article
Cummins,J. overuse injuries
The benefit of transverse carpal
Netscher,D.T. 2003 ligament reconstruction following open Plast.Reconstr.Surg. Commentary
917
Reason for
Exclusion
Nerve entrapment syndromes: Non-
Neundorfer,B.; Jaspert,A.; European Journal of Physical Medicine
1993 surgical treatment and postoperative Background article
Grehl,H. and Rehabilitation
care
Complications of local corticosteroid Journal of the American Medical
Neustadt,D.H. 1981 Letter
injections Association
Nicholas,G.G.; Noone,R.B.; Does not address
1971 Carpal tunnel syndrome in pregnancy
Graham,W.P. question of interest
Nicholas,J.J.; Reidy,M.; An epidemiologic survey of injury in not exclusive to CTS;
1998 Journal of Sport Rehabilitation
Oleske,D.M. golfers insufficient data
Niekel,M.C.;
Lindenhovius,A.L.; Correlation of DASH and QuickDASH insufficient data; very
2009 J Hand Surg Am
Watson,J.B.; Vranceanu,A.M.; with measures of psychological distress low study design
Ring,D.
Niemer,G.W.; Bolster,M.B.; Not relevant, prevalence
2001 Carpal tunnel syndrome in sarcoidosis Sarcoidosis Vasc.Diffuse Lung Dis
Buxbaum,L.; Judson,M.A. study
Comparison of ropivacaine 2 mg ml(-1)
Niemi,T.T.; Neuvonen,P.J.; and prilocaine 5 mg ml(-1) for i.v. Not exclusive to CTS
2006 Br J Anaesth.
Rosenberg,P.H. regional anaesthesia in outpatient patients
surgery
Local injection of dexamethasone for
Niempoog,S.; Sanguanjit,P.;
2007 the treatment of carpal tunnel syndrome J Med Assoc Thai. Very low quality
Waitayawinyu,T.; Angthong,C.
in pregnancy
Nijsse,B.; Roks,G. 2012 remitting seronegative symmetrical BMJ Case Rep. case report
synovitis with pitting oedema
Pain and efficacy rating of a
microprocessor-controlled metered Deemed clinically
Nimigan,A.S.; Gan,B.S. 2011 Pain Res.Treat.
injection system for local anaesthesia in irrelevant
minor hand surgery
Nishimura,A.; Ogura,T.; Objective evaluation of sensory
Hase,H.; Makinodan,A.; function in patients with carpal tunnel insufficient data; very
2003 J Orthop Sci
Hojo,T.; Katsumi,Y.; Yagi,K.; syndrome using the current perception low study design
Mikami,Y.; Kubo,T. threshold
Treatment considerations in carpal Does not answer a
Nissenbaum,M.; Kleinert,H.E. 1980 tunnel syndrome with coexistent J Hand Surg Am question of interest; not
Dupuytren's disease best available evidence
918
Reason for
Exclusion
Upper extremity tourniquet effects in Does not address
Nitz,A.J.; Dobner,J.J. 1989 J Hand Surg Am
carpal tunnel release question of interest
Carpal tunnel syndrome following
Noble,D.; Richards,T.;
2005 simultaneous kidney-pancreas Nephrol.Dial.Transplant case report
Mitchell,D.; Vaidya,A.C.
transplant
Effects of wrist splinting for Carpal
Nobuta,S.; Sato,K.;
2008 Tunnel syndrome and motor nerve Ups.J Med Sci Very Low Quality
Nakagawa,T.; Hatori,M.; Itoi,E.
conduction measurements
A Bayesian argument against rigid cut-
Nodera,H.; Herrmann,D.N.; insufficient data; very
2003 offs in electrodiagnosis of median
Holloway,R.G.; Logigian,E.L. low study design
neuropathy at the wrist
Nolan III,W.B.; Alkaitis,D.; Results of treatment of severe carpal
1992 Journal of Hand Surgery Retrospective case series
Glickel,S.Z.; Snow,S. tunnel syndrome
Obstetrics, Gynaecology and
Noori,M.; Dhanjal,M.K. 2011 Neurological disease in pregnancy Background article
Reproductive Medicine
Clinical features of 1039 patients with
Nora,D.B.; Becker,J.; Confounding
2004 neurophysiological diagnosis of carpal Clin Neurol Neurosurg.
Ehlers,J.A.; Gomes,I. comorbidities
tunnel syndrome
Nord,K.M.; Kapoor,P.;
Fisher,J.; Thomas,G.; False positive rate of thoracic outlet insufficient data; very
Sundaram,A.; Scott,K.; syndrome diagnostic maneuvers low study design
Kothari,M.J.
Norgan,G.H.; Ettipio,A.M.; A program plan addressing carpal
1995 AAOHN J. Background Information
Lasome,C.E.M. tunnel syndrome
Obstetric issues in women with Current Problems in Obstetrics,
Norwitz,E.R.; Repke,J.T. 1997 Background article
neurologic diseases Gynecology and Fertility
Novak,C.B.; Mackinnon,S.E.; Provocative sensory testing in carpal not best available
1992 J Hand Surg Br
Brownlee,R.; Kelly,L. tunnel syndrome evidence
Novak,L.M. 2000 Carpal tunnel syndrome Lippincotts.Prim.Care Pract. background
Simple clinical tests in severe carpal no comparison group; not
Nowak,M.; Noszczyk,B. 2012 Pol.Przegl.Chir
tunnel syndrome best evidence
Diagnostic significance of
Nur,Saracgil S.; Karatas,M.; ultrasonography in carpal tunnel Turkiye Fiziksel Tip ve Rehabilitasyon insufficient data; very
2009
Yerli,H.; Isiklar,I.; Karadeli,E. syndrome and comparison with Dergisi low study design
electrodiagnostic tests
919
Reason for
Exclusion
Nygaard,I.E.; Saltzman,C.L.;
1989 Hand problems in pregnancy Am Fam Physician Background Information
Whitehouse,M.B.; Hankin,F.M.
Mononeuropathy in diabetes mellitus: a
O'Brian,J.T.; Massey,E.W. 1979 Postgrad.Med Background Information
phenomenon easily overlooked
Acute fractures and dislocations of the
O'Brien,E.T. 1984 Orthop.Clin.North Am. Background Information
carpus
The impact of a hand therapy screening
O'Brien,L.; Hardman,A.; and management clinic for patients
2013 J Hand Ther Very low quality
Goldby,S. referred for surgical opinion in an
Australian public hospital
Non-surgical treatment (other than
O'Connor,D.; Marshall,S.;
2003 steroid injection) for carpal tunnel Cochrane Database Syst.Rev. Systematic review
Massy-Westropp,N.
syndrome
O'Connor,D.; Page,M.J.;
Ergonomic positioning or equipment for
Marshall,S.C.; Massy- 2012 Cochrane Database Syst.Rev. systematic review
treating carpal tunnel syndrome
Westropp,N.
Electrophysciological analysis of
Odabas,F.O.; Sayin,R.; entrapment neuropathies developed in
<10 patients in CTS
Milanlioglu,A.; Tombul,T.; 2012 acute and subacute period in paretic and J Pak.Med Assoc
Cogen,E.E.; Yildirim,G. non-paretic extremities in patients with
stroke
Carpal tunnel syndrome: coping during
O'Donnell,M.; Elio,R.; Day,D. 2010 Nurs.Womens Health Background article
pregnancy and breastfeeding
Median neuropathy (carpal-tunnel
O'Duffy,J.D.; Randall,R.V.; insufficient outcome data;
1973 syndrome) in acromegaly. A sign of Ann.Intern.Med
MacCarty,C.S. case report included
endocrine overactivity
Inflammation as the possible cause of
Does not answer a
Ogawa,H.; Saito,A.; Ono,M. 1989 cystic radiolucencies in carpal bones of ASAIO Trans
patients on hemodialysis
Oge,H.K.; Acu,B.; Gucer,T.;
Quantitative MRI analysis of idiopathic insufficient data; very
Yanik,T.; Savlarli,S.; 2012 Turk Neurosurg.
Firat,M.M.
A diagnostic algorithm for carpal tunnel
O'Gradaigh,D.; Merry,P. 2000 Rheumatology (Oxford) insufficient data
syndrome based on Bayes's theorem
920
Reason for
Exclusion
Ogura,T.; Kubo,T.; Okuda,Y.; Power spectrum analysis of compound
Lee,K.; Kira,Y.; Aramaki,S.; 2002 muscle action potential in carpal tunnel J Orthop Surg (Hong Kong)
low study design
Nakanishi,F. syndrome patients
Ogura,T.; Mori,M.; Mikami,Y.; Diagnostic utility of waveform analysis
Hase,H.; Hayashida,T.; 2004 of compound muscle action potentials J Orthop Surg (Hong Kong)
low study design
Kubo,T.; Kira,Y.; Aramaki,S. for carpal tunnel syndrome
Oguz,Akarsu E.; Acar,H.;
Ozer,F.; Gunaydin,S.;
Electromyographic findings in overt
Akarsu,O.; Aydemir,Ozcan T.; Not rekevant, does not
2013 hypothyroidism and subclinical Turk Noroloji Dergisi
Ozben,S.; Mutlu,A.; Bedir,M.; answer pico question
hypothyroidism
Cinarli,Gul G.; Cokar,O.;
Burak,Aktuglu M.
Oh,S.; Kim,H.K.; Kwak,J.;
Causes of hand tingling in visual <10 patients per group;
Kim,T.; Jang,S.H.; Lee,K.H.; 2013 Ann.Rehabil.Med
display terminal workers not exclusive to CTS
Kim,M.J.; Park,S.B.; Han,S.H.
The carpal tunnel syndrome and
Oldberg,S. 1971 Acta Soc.Med Ups. Background Information
acromegaly
Off-road machine controls: Does not answer a
Oliver,M.; Rickards,J.;
2000 investigating the risk of carpal tunnel question of interest; very
Biden,E.
Ollivere,B.J.; Logan,K.; Severity scoring in carpal tunnel
Ellahee,N.; Miller-Jones,J.C.; 2009 syndrome helps predict the value of J Hand Surg Eur.Vol. Very Low Quality
Wood,M.; Nairn,D.S. conservative therapy
O'Malley,M.J.; Evanoff,M.; Factors that determine reexploration +not best available
1992 J Hand Surg Am
Terrono,A.L.; Millender,L.H. treatment of carpal tunnel syndrome evidence
Clinical neuropsychiatric and
Omdal,R.; Mellgren,S.I.; <10 patients per group;
1988 neuromuscular manifestations in Scand.J Rheumatol.
Husby,G. not exclusive to CTS
systemic lupus erythematosus
Musculoskeletal system disorders in Incorrect patient
Omer,S.R.; Ozcan,E.; Journal of Back and Musculoskeletal
2003 computer users: Effectiveness of population (not exclusive
Karan,A.; Ketenci,A. Rehabilitation
training and exercise programs to CTS patients)
Omori,K.; Kazama,J.J.; Association of the MCP-1 gene
not best available
Song,J.; Goto,S.; Takada,T.; polymorphism A-2518G with carpal-
2002 evidence; no CTS
Saito,N.; Sakatsume,M.; tunnel syndrome in hemodialysis
outcome comparison
Narita,I.; Gejyo,F. patients
921
Reason for
Exclusion
electrodiagnostic severity and insufficient data; no
Oncel,C.; Bir,L.S.; Sanal,E. 2009 Agri.
Washington Neuropathic Pain Scale in comparison group
Ono,S.; Clapham,P.J.; Optimal management of carpal tunnel
2010 Int.J Gen.Med systematic review
Chung,K.C. syndrome
Ooi,C.C.; Png,M.A.;
Tan,B.H.A.; Chin,Y.H.A.; Diagnostic criteria of carpal tunnel
Abu,Bakar R.; Goh,S.Y.; 2013 syndrome using high resolution Skeletal Radiol.
low study design
Mohan,P.C.; Yap,T.J.R.; Ultrasonography
Wong,S.K.
Ooi,C.C.; Wong,S.K.;
Diagnostic criteria of carpal tunnel
Tan,A.B.; Chin,A.Y.;
syndrome using high-resolution insufficient data; case
Abu,Bakar R.; Goh,S.Y.; 2014 Skeletal Radiol
ultrasonography: correlation with nerve control
Mohan,P.C.; Yap,R.T.;
conduction studies
Png,M.A.
Orman,G.; Ozben,S.; Ultrasound elastographic evaluation in
Huseyinoglu,N.; Duymus,M.; 2013 the diagnosis of carpal tunnel Ultrasound Med Biol.
low study design
Orman,K.G. syndrome: initial findings
Ortiz-Corredor,F.; Calambas,N.; Factor analysis of carpal tunnel
+very low study design;
Mendoza-Pulido,C.; Galeano,J.; 2011 syndrome questionnaire in relation to Clin Neurophysiol.
not best evidence
Diaz-Ruiz,J.; Delgado,O. nerve conduction studies
Osborn,J.B.; Newell,K.J.; Carpal tunnel syndrome among Not relevant, prevalence
1990 Northwest.Dent.
Rudney,J.D.; Stoltenberg,J.L. Minnesota dental hygienists study
Simultaneous bilateral versus unilateral
Osei,D.A.; Boyer,M.I.; carpal tunnel release: A prospective
Abstract/conference
Stepan,J.; Gelberman,R.H.; 2013 comparison of early functional and Journal of Hand Surgery
poster
Goldfarb,C.A.; Calfee,R.P. economic impact in patients with
bilateral carpal tunnel syndrome
Simultaneous Bilateral or Unilateral
Osei,D.A.; Calfee,R.P.; Does not meet inclusion
Carpal Tunnel Release? A Prospective
Stepan,J.G.; Boyer,M.I.; 2014 J Bone Joint Surg Am criteria (follow-up<3
Cohort Study of Early Outcomes and
Goldfarb,C.A.; Gelberman,R.H. months)
Limitations
Osorio,A.M.; Ames,R.G.; Carpal tunnel syndrome among grocery not best evidence;
1994 Am J Ind.Med
Jones,J.; Castorina,J.; store workers confounded comparisons
922
Reason for
Exclusion
Rempel,D.; Estrin,W.;
Thompson,D.
Osterman,M.; Ilyas,A.M.;
2012 Carpal tunnel syndrome in pregnancy Orthop Clin North Am Background artcle
Matzon,J.L.
Median nerve injuries and their
Oswalt,C.E. 1977 South Med J background
management
Owen,D.S.,Jr.; Leshner,R.T.;
1987 Carpal tunnel syndrome Va.Med background
McDowell,C.L.
Owen,Jr; Leshner,R.T.;
1987 Grand rounds: Carpal tunnel syndrome Va.Med. background
McDowell,C.L.
Carpal tunnel syndrome: A products
Owen,R.D. 1994 background
liability prospective
The prevalence of hand pain in Ibadan--
Oyedele,O.O.; Shokunbi,M.T.; Does not answer a
2002 implications for the carpal tunnel West Afr.J Med
Malomo,A.O. question of interest
syndrome
Ozben,S.; Acar,H.; The second lumbrical-interosseous
Gunaydin,S.; Genc,F.; Ozer,F.; 2012 latency comparison in carpal tunnel J Clin Neurophysiol.
low study design
Ozben,H. syndrome
Ozcan,H.N.; Kara,M.;
Dynamic Doppler evaluation of the
Ozcan,F.; Bostanoglu,S.; insufficient data; very
2011 radial and ulnar arteries in patients with AJR Am J Roentgenol.
Karademir,M.A.; Erkin,G.; low study design
Ozcakar,L.
Ozdolap,S.; Emre,U.;
Upper limb tendinitis and entrapment prevalence study;
Karamercan,A.; Sarikaya,S.; 2013 Am J Ind.Med
neuropathy in coal miners insufficient data
Kokturk,F.
Alkalinisation of local anaesthetics
Ozer,H.; Solak,S.; Oguz,T.;
prescribed for pain relief after surgical
Ocguder,A.; Colakoglu,T.; 2005 J Orthop Surg (Hong Kong) Not relevant
decompression of carpal tunnel
Babacan,A.
syndrome
Minimal clinically important difference
Ozer,K.; Malay,S.; Toker,S.;
2013 of carpal tunnel release in diabetic and Plast.Reconstr.Surg very low quality
Chung,K.C.
nondiabetic patients
Subclinical peripheral neuropathy
insufficient data; not
Ozge,A.; Atis,S.; Sevim,S. 2001 associated with chronic obstructive Electromyogr.Clin Neurophysiol.
exclusive to CTS
pulmonary disease
923
Reason for
Exclusion
Ozge,A.; Comelekoglu,U.;
Subtypes of carpal tunnel syndrome: insufficient data; very
Tataroglu,C.; Yalcinkaya,D.E.; 2002 Clin Neurol Neurosurg.
median nerve F wave parameters low study design
Akyatan,M.N.
Preoperative and postoperative
Ozkal,B.; Yaldiz,C.; Asil,K.; evaluation of electromyography and Does not address
2014 Journal of Neurological Sciences
Selcuki,D.; Selcuki,M. magnetic resonance imaging findings in question of interest
Nonsteroid antiinflammatory drug
Ozoran,K.; Paker,N.;
1989 treatment in idiopathic carpal tunnel Hacettepe Medical Journal Very Low Quality
Basgoze,O.; Hascelik,Z.
syndrome
Oztas,O.; Turan,B.; Bora,I.; Ultrasound therapy effect in carpal
1998 Arch Phys Med Rehabil. Very Low Quality
Karakaya,M.K. tunnel syndrome
The minimal clinically important
Ozyurekoglu,T.; McCabe,S.J.;
2006 difference of the Carpal Tunnel J Hand Surg Am Very Low Quality
Goldsmith,L.J.; LaJoie,A.S.
Syndrome Symptom Severity Scale
Padua,L.; Di,Pasquale A.;
Systematic review of pregnancy-related
Pazzaglia,C.; Liotta,G.A.; 2010 Muscle Nerve Systematic review
Librante,A.; Mondelli,M.
Neurophysiological classification of Not relevant,does not
Padua,L.; Lo,Monaco M.;
1997 carpal tunnel syndrome: assessment of Ital.J Neurol Sci answer the PICO
Padua,R.; Gregori,B.; Tonali,P.
600 symptomatic hands question
Padua,L.; Lo,Monaco M.; A useful electrophysiologic parameter insufficient data; very
1996 Muscle Nerve
Valente,E.M.; Tonali,P.A. for diagnosis of carpal tunnel syndrome low study design
Erratum: A useful electrophysiologic
Padua,L.; Lo,Monaco M.; parameter for diagnosis of carpal tunnel abstract correction; no
1996 Muscle Nerve
Valente,E.M.; Tonali,P.A. syndrome (Muscle and Nerve (1996) 19 text
(48-53))
Padua,L.; LoMonaco,M.;
Surgical prognosis in carpal tunnel
Aulisa,L.; Tamburrelli,F.;
1996 syndrome: usefulness of a preoperative Acta Neurol Scand. Retrospective case series
Valente,E.M.; Padua,R.;
neurophysiological assessment
Gregori,B.; Tonali,P.
Padua,L.; LoMonaco,M.; Neurophysiological classification and
insufficient data; no true
Gregori,B.; Valente,E.M.; 1997 sensitivity in 500 carpal tunnel Acta Neurol Scand.
comparison group
Padua,R.; Tonali,P. syndrome hands
Boston Carpal Tunnel Questionnaire:
Padua,L.; Padua,R.; Aprile,I.; +Does not answer a
2005 the influence of diagnosis on patient- Neurol Res.
Caliandro,P.; Tonali,P. question of interest
oriented results
924
Reason for
Exclusion
Padua,L.; Padua,R.;
Multiperspective assessment of carpal Duplicate results to
Lo,Monaco M.; Aprile,I.; 1999
tunnel syndrome: A multicenter study AAOS ID 995
Tonali,P.
Clinical outcome and
Padua,L.; Padua,R.; Moretti,C.; neurophysiological results of low-
1999 Lasers in Medical Science Very Low Quality
Nazzaro,M.; Tonali,P. power laser irradiation in carpal tunnel
syndrome
Padua,L.; Pazzaglia,C.;
Carpal tunnel syndrome: ultrasound, insufficient data; <10
Caliandro,P.; Granata,G.;
2008 neurophysiology, clinical and patient- Clin Neurophysiol. patients in comparison
Foschini,M.; Briani,C.;
oriented assessment group
Martinoli,C.
Intrasurgical use of steroids on carpal
Padua,R.; Padua,L.; Bondi,R.; Does not meet inclusion
tunnel syndrome: A randomized, Journal of Orthopaedics and
Campi,A.; Ceccarelli,E.; 2003 criteria (invasive follow-
prospective, double-blind controlled Traumatology
Padua,S. up<3 month)
study
Padua,R.; Padua,L.; Italian version of the disability of the
Ceccarelli,E.; Romanini,E.; arm, shoulder and hand (DASH) +Does not answer a
2003 Journal of Hand Surgery
Zanoli,G.; Amadio,P.C.; questionnaire. Cross-cultural adaptation question of interest
Campi,A. and validation
Page,M.J.; Massy-Westropp,N.;
2012 Splinting for carpal tunnel syndrome Cochrane Database Syst.Rev. Systematic review
O'Connor,D.; Pitt,V.
Page,M.J.; O'Connor,D.; Therapeutic ultrasound for carpal tunnel
Pitt,V.; Massy-Westropp,N. syndrome
Page,M.J.; O'Connor,D.; Exercise and mobilisation interventions
2012 Cochrane Database Syst.Rev. systematic review
Pitt,V.; Massy-Westropp,N. for carpal tunnel syndrome
Carpal tunnel syndrome: surgical
Very Low Quality.
Pagnanelli,D.M.; Barrer,S.J. 1991 treatment using the Paine J Neurosurg.
Prospective case series.
retinaculatome
Carpal tunnel decompression: should
European Journal of Orthopaedic Insufficient data
Pai,I.; Guy,N.J.; Nicholl,J.E. 2005 the tourniquet be released before or
Surgery & Traumatology (irrelevant outcomes)
after closure?
Clinical usefulness of oral
Pajardi,G.; Bortot,P.; Ponti,V.; supplementation with alpha-lipoic Acid,
2014 Evid.Based Complement Alternat.Med Not relevant
Novelli,C. curcumin phytosome, and B-group
vitamins in patients with carpal tunnel
925
Reason for
Exclusion
syndrome undergoing surgical
treatment
Pajardi,G.; Pegoli,L.; Pivato,G.; Endoscopic carpal tunnel release: our

2008 Hand Surg Retrospective case series
Zerbinati,P. experience with 12,702 cases
Rheumatic disorders in diabetes with
Pal,B. 1996 special reference to orthopaedic surgery Journal of Orthopaedic Rheumatology Background article
in diabetics
Retrospectice case series.
Will be Very Low.
Palazzi,S.; Palazzi,J.L. 1980 Neurolysis in compressive neuropathies Int.Surg
Patient population is not
specific to CTS.
Median nerve compression test in
carpal tunnel syndrome diagnosis.
Paley,D.; McMurtry,R.Y. 1985 Orthop.Rev. Background Information
Reproduces signs and symptoms in
affected wrist
Paliwal,P.R.; Does measuring the median nerve at the
Therimadasamy,A.K.; 2014 carpal tunnel outlet improve ultrasound J Neurol Sci
low study design
Chan,Y.C.; Wilder-Smith,E.P. CTS diagnosis?
Refractory studies in early detection of insufficient data; very
Palliyath,S.K.; Holden,L. 1990 Electromyogr.Clin Neurophysiol.
Carpal tunnel syndrome and
Palma,G. 1983 Ann.Neurol. case report
hyperparathyroidism
Palmer,D.H.; Paulson,J.C.; Endoscopic carpal tunnel release: a
Lane-Larsen,C.L.; Peulen,V.K.; 1993 comparison of two techniques with very low quality
Olson,J.D. open release
Repeatability and validity of an upper
Palmer,K.; Smith,G.; limb and neck discomfort questionnaire:
1999 Occup.Med (Lond) not exclusive to CTS
Kellingray,S.; Cooper,C. the utility of the standardized Nordic
questionnaire
Carpal tunnel syndrome and its relation
Palmer,K.T.; Harris,E.C.;
2007 to occupation: a systematic literature Occup.Med (Lond) systematic review
Coggon,D.
review
The effects of hypothyroidism and
Palumbo,C.F.; Szabo,R.M.; <10 patients per group;
2000 thyroid replacement on the development J Hand Surg Am
Olmsted,S.L. no comparison group
926
Reason for
Exclusion
Sonographic assessment of the carpal
tunnel syndrome secondary to a
Panahi,E.; O'Connor,C.R.;
2014 tenosynovitis of the flexor digitorum J Clin Rheumatol. case report
Checa,A.
superficialis in a patient with
rheumatoid arthritis
Extracorporeal shock wave therapy and
Paoloni,M.; Tavernese,E.;
ultrasound therapy improve pain and Incorrect patient
Cacchio,A.; D',Orazi,V;
2015 function in patients with carpal tunnel Eur J Phys Rehabil Med population (<10
Ioppolo,F.; Fini,M.; Santilli,V.;
syndrome. A randomized controlled patients/group)
Mangone,M.
trial
Papaioannou,T.; Rushworth,G.; Carpal canal stenosis in men with insufficient data; very
1992 Clin Orthop Relat Res.
Atar,D.; Dekel,S. idiopathic carpal tunnel syndrome low study design
Infrared thermography based on
Papez,B.J.; Palfy,M.; Turk,Z. 2008 artificial intelligence for carpal tunnel J.Int.Med.Res.
low study design
syndrome diagnosis
Clinical versus electrodiagnostic
effectiveness of splinting in the
Papez,B.J.; Turk,Z. 2004 Wien.Klin.Wochenschr. Very Low Quality
conservative treatment of carpal-tunnel
syndrome
Pappas,G.; Markoula,S.;
Brucellosis as a cause of carpal tunnel
Seitaridis,S.; Akritidis,N.; 2005 Ann.Rheum.Dis. case report
syndrome
Tsianos,E.
Pardal-Fernandez,J.M.; Vega- A new median motor test: comparison
Gonzalez,G.; Rodriguez- 2012 with conventional motor studies in J Clin Neurophysiol.
low study design
Vazquez,M.; Iniesta-Lopez,I. carpal tunnel syndrome
The significance of work tasks for
Parenmark,G.; Alffram,P.A.; Does not address
1992 rehabilitation outcome after carpal J Occup.Rehabil.
Malmkvist,A.K. question of interest
tunnel surgery
Opponensplasty using palmaris longus
Park,I.J.; Kim,H.M.; Lee,S.U.; tendon and flexor retinaculum pulley in
2010 Arch Orthop Trauma Surg very low quality
Lee,J.Y.; Jeong,C. patients with severe carpal tunnel
syndrome
Utility of nerve conduction study in
National Journal of Physiology, insufficient data; very
Parkhad,S.; Palve,S. 2014 early diagnosis of Carpal Tunnel
Pharmacy and Pharmacology low study design
Syndrome (CTS)
JAMA patient page. Carpal tunnel
Parmet,S. 2002 background
syndrome
927
Reason for
Exclusion
Nerve conduction and
Parry,G.J.; Sumner,A.J. 1989 Curr.Opin.Neurol.Neurosurg. Background Information
electromyography
Pascual,E.; Giner,V.;
Higher incidence of carpal tunnel <10 patients per group;
Arostegui,A.; Conill,J.; 1991 Br J Rheumatol.
syndrome in oophorectomized women very low study design
Ruiz,M.T.; Pico,A.
Peripheral neuropathies in clinical
Pascuzzi,R.M. 2003 Med.Clin.North Am. case reports
practice
The rheumatologic manifestations of
Pastan,R.S.; Cohen,A.S. 1978 Med Clin North Am Background Information
diabetes mellitus
Pasternack,I.I.; Malmivaara,A.;
Magnetic resonance imaging findings in
Tervahartiala,P.; Forsberg,H.; 2003 Scand.J Work Environ.Health systematic review
respect to carpal tunnel syndrome
Vehmas,T.
A comparison of five tests for insufficient data; very
Patel,M.R.; Bassini,L. 1999 J Reconstr.Microsurg.
determining hand sensibility low study design
Patijn,J.; Vallejo,R.;
Janssen,M.; Huygen,F.;
2011 Carpal tunnel syndrome Pain Pract. background
Lataster,A.; van,Kleef M.;
Mekhail,N.
Patijn,J.; Vallejo,R.;
Janssen,M.; Huygen,F.;
2011 19. Carpal Tunnel Syndrome Pain Practice Narrative review
Lataster,A.; van,Kleef M.;
Mekhail,N.
Patil,A.; Rosecrance,J.; Prevalence of carpal tunnel syndrome Not relevant, prevalence
2012 Am J Ind.Med
Douphrate,D.; Gilkey,D. among dairy workers study
Local anaesthesia for carpal tunnel
Patil,S.; Ramakrishnan,M.;
2006 decompression: a comparison of two J Hand Surg Br
Stothard,J.
techniques
Clinical-electrophysiological
Pavesi,G.; Olivieri,M.F.; insufficient data; no
1986 correlations in the carpal tunnel Ital.J Neurol Sci
Misk,A.; Mancia,D. comparison group
syndrome
Pazzaglia,C.; Caliandro,P.; "Dropping objects": a potential index of Does not answer a
2010 Neurol Sci
Granata,G.; Tonali,P.; Padua,L. severe carpal tunnel syndrome question of interest
Pease,W.S.; Cannell,C.D.; Median to radial latency difference test insufficient data; no
1989 Muscle Nerve
Johnson,E.W. in mild carpal tunnel syndrome comparison of modalities
Pease,W.S.; Cunningham,M.L.; Determining neurapraxia in carpal Does not answer a
1988 Am J Phys Med Rehabil.
Walsh,W.E.; Johnson,E.W. tunnel syndrome question of interest
928
Reason for
Exclusion
Pease,W.S.; Lee,H.H.; Forearm median nerve conduction insufficient data; very
Johnson,E.W. velocity in carpal tunnel syndrome low study design
Sonography of carpal tunnel syndrome: review; background
Peer,S.; Gruber,H.; Loizides,A. 2012 Imaging in Medicine
Why, when and how information
Perez-Ruiz,F.; Calabozo,M.; High prevalence of undetected carpal
not best evidence; very
Alonso-Ruiz,A.; Herrero,A.; 1995 tunnel syndrome in patients with J Rheumatol.
low study design
Ruiz-Lucea,E.; Otermin,I. fibromyalgia syndrome
Sensory-motor index is useful
Peric,Z.; Sinanovic,O. 2006 parameter in electroneurographical Bosn.J Basic Med Sci
low study design
Does not answer a
Perkins,B.A.; Olaleye,D.; Carpal tunnel syndrome in patients with
2002 question of interest;
Bril,V. diabetic polyneuropathy
prevalence study
Pernia,L.R.; Ronel,D.N.; Carpal tunnel syndrome in women
2000 Plast.Reconstr.Surg Not relevant
Leeper,J.D.; Miller,H.L. undergoing reduction mammaplasty
Peters,S.; Page,M.J.;
Rehabilitation following carpal tunnel
Coppieters,M.W.; Ross,M.; 2013 Cochrane Database Syst.Rev. meta-analysis
release
Johnston,V.
Peters,Veluthamaningal C.; Randomised controlled trial of local Duplicate article
Winters,J.C.; Groenier,K.H.; 2010 corticosteroid injections for carpal BMC family practice (duplicate with AAOS ID
Meyboom-de,Jong B. tunnel syndrome in general practice 363)
Peters-Veluthamaningal,C.; Randomised controlled trial of local
Winters,J.C.; Groenier,K.H.; 2010 corticosteroid injections for carpal BMC Fam Pract. Insuff
Meyboom-de,Jong B. tunnel syndrome in general practice
Danish laser promises better treatment
Pfeiffer,N. 1993 J.Clin.Laser Med.Surg. Narrative review
The carpal-tunnel syndrome. Clinical
Phalen,G.S. 1972 Clin Orthop Relat Res. clinical review
evaluation of 598 hands
Piazzini,D.B.; Aprile,I.;
Ferrara,P.E.; Bertolini,C.; A systematic review of conservative
2007 Clin Rehabil. Systematic review
Tonali,P.; Maggi,L.; Rabini,A.; treatment of carpal tunnel syndrome
Piantelli,S.; Padua,L.
Pickett,J.B. 1984 The carpal tunnel syndrome J S.C Med Assoc background
929
Reason for
Exclusion
Surgical
A different surgical approach for carpal
Pierce,R.O. 1976 J Natl.Med Assoc technique/background
tunnel syndrome
article
Quantitative MRI and
Pierre-Jerome,C.;
electrophysiology of preoperative insufficient data; very
Bekkelund,S.I.; Mellgren,S.I.; 1997
carpal tunnel syndrome in a female low study design
Nordstrom,R.
population
Quantitative magnetic resonance
Pierre-Jerome,C.;
imaging and the electrophysiology of Does not answer a
Bekkelund,S.I.; Mellgren,S.I.; 1996 Scand.J Work Environ.Health
the carpal tunnel region in floor question of interest
Torbergsen,T.
cleaners
Pierre-Jerome,C.; MRI of the median nerve and median
Smitson,R.D.,Jr.; Shah,R.K.; artery in the carpal tunnel: prevalence +Does not answer a
2010 Surg Radiol.Anat.
Moncayo,V.; Abdelnoor,M.; of their anatomical variations and question of interest
Terk,M.R. clinical significance
Pinilla,I.; Martin-Hervas,C.; The usefulness of ultrasonography in insufficient data; very
Sordo,G.; Santiago,S. the diagnosis of carpal tunnel syndrome low study design
Carpal tunnel syndrome sufferers find
Pinkham,J. 1988 Occup.Health Saf Background article
relief with ergonomic designs
Effect of ultrasound thermotherapy in
Piravej,K.; Boonhong,J. 2004 mild to moderate carpal tunnel J Med Assoc Thai. Very Low Quality
syndrome
Carpal tunnel syndrome: occupational
Pitchford,T. 1985 Dent.Assist.(Waco.Tx.) Background Information
hazard
Carpal Tunnel Syndrome: Diagnosis European Surgery - Acta Chirurgica
Piza-Katzer,H. 2003 Background article
and Treatment Austriaca
Comparative value of the different
Plaja,J. 1971 electrodiagnostic methods in the carpal Scand.J Rehabil.Med
low study design
tunnel syndrome
Pocekay,D.; McCurdy,S.A.; A cross-sectional study of
Samuels,S.J.; Hammond,S.K.; 1995 musculoskeletal symptoms and risk Am.J.Ind.Med.
study
Schenker,M.B. factors in semiconductor workers
Podhorodecki,A.D.; Electromyographic study of overuse prevalence study;
Spielholz,N.I. syndromes in sign language interpreters insufficient data
930
Reason for
Exclusion
Critical reappraisal of referrals to
Podnar,S. 2005 electromyography and nerve conduction Eur.J Neurol
insufficient data
studies
Carpal tunnel syndrome in young
Polykandriotis,E.; Premm,W.; <10 patients per group;
2007 adults--an ultrasonographic and Minim.Invasive Neurosurg.
Horch,R.E. no comparison group
neurophysiological study
Endoscopic carpal tunnel release: its
Pomphrey,M.M.,Jr. 1998 Mo.Med Retrospective case series
time has come
Estimation and pharmacodynamic
consequences of the minimum effective
Ponrouch,M.; Bouic,N.;
anesthetic volumes for median and
Bringuier,S.; Biboulet,P.; Does not address
2010 ulnar nerve blocks: a randomized, Anesth.Analg.
Choquet,O.; Kassim,M.; question of interest
double-blind, controlled comparison
Bernard,N.; Capdevila,X.
between ultrasound and nerve
stimulation guidance
New carpal ligament traction device for
Porrata,H.; Porrata,A.;
2007 the treatment of carpal tunnel syndrome J Hand Ther Very Low Quality
Sosner,J.
unresponsive to conservative therapy
The influence of age on outcome after
Porter,P.; Venkateswaran,B.; Journal of Bone and Joint Surgery - duplicate of
2002 operation for the carpal tunnel
Stephenson,H.; Wray,C.C. Series B PM:12188486
syndrome
Pourmand,R. 1997 Diabetic neuropathy Neurol.Clin.
Pourmemari,M.H.; Viikari- Smoking and carpal tunnel syndrome:
2014 Muscle Nerve meta-analysis
Juntura,E.; Shiri,R. A meta-analysis
High incidence of absent nerve
does not address question
Povlsen,B. 2010 conduction in older patients with Ann.R Coll Surg Engl.
of interest
bilateral carpal tunnel syndrome
Long-term result and patient reported
Povlsen,B.; Bashir,M.;
2013 outcome of wrist splint treatment for J Plast.Surg Hand Surg Very Low Quality
Wong,F.
Prakash,K.M.; Fook-Chong,S.;
Sensitivities of sensory nerve
Leoh,T.H.; Dan,Y.F.; insufficient data; very
2006 conduction study parameters in carpal J Clin Neurophysiol.
Nurjannah,S.; Tan,Y.E.; low study design
tunnel syndrome
Lo,Y.L.
Conservative treatment of carpal tunnel
Pratelli,E.; Pintucci,M.; deemed clinically
2015 syndrome: Comparison between laser J Bodyw.Mov Ther
Cultrera,P.; Baldini,E.; irrelevant
therapy and fascial manipulation((R))
931
Reason for
Exclusion
Stecco,A.; Petrocelli,A.;
Pasquetti,P.
A double-blind randomized controlled
trial showing the analgesic and
Pressman,A.; Doumit,G.; anesthetic properties of lidocaine E to
2005 Can J Plast.Surg Insufficient data
Rosaeg,O.; Bell,M. be equivalent to those of ropivicaine
and bupivacaine in carpal tunnel release
surgery
The relationship among five common
Priganc,V.W.; Henry,S.M. 2003 carpal tunnel syndrome tests and the J Hand Ther
low study design
severity of carpal tunnel syndrome
Pronicka,E.; Tylki- Carpal tunnel syndrome in children
Incorrect patient
Szymanska,A.; Kwast,O.; with mucopolysaccharidoses: needs for
1988 J Ment.Defic.Res. population (non-CTS
Chmielik,J.; Maciejko,D.; surgical tendons and median nerve
patients included)
Cedro,A. release
Validation of a diagnostic sign in carpal +not best available
Pryse-Phillips,W.E. 1984 J Neurol Neurosurg.Psychiatry
tunnel syndrome evidence
Pujol,J.; Pascual-Leone,A.; The effect of repetitive magnetic Incorrect patient
Dolz,C.; Delgado,E.; Dolz,J.L.; 1998 stimulation on localized population (not exclusive
Aldoma,J. musculoskeletal pain to CTS)
Pullopdissakul,S.; Upper extremities musculoskeletal
Ekpanyaskul,C.; disorders: Prevalence and associated Not relevant, prevalence
2013 Int.J Occup.Med Environ.Health
Taptagaporn,S.; Bundhukul,A.; ergonomic factors in an electronic study
Thepchatri,A. assembly factory
Punnett,L.; Robins,J.M.;
Soft tissue disorders in the upper limbs not exclusive to CTS;
Wegman,D.H.; 1985 Scand.J Work Environ.Health
of female garment workers <10 non-cases
Keyserling,W.M.
Pyle,K.L.; Maholic,C.; Carpal tunnel syndrome: case data and
1984 J Neurosurg.Nurs. background
Gainer,J.V.,Jr. nursing implications
Pyun,S.B.; Kang,C.H.;
Application of 3-dimensional
Yoon,J.S.; Kwon,H.K.; insufficient data; very
2011 ultrasonography in assessing carpal J Ultrasound Med
Kim,J.H.; Chung,K.B.; low study design
tunnel syndrome
Oh,Y.W.
Occurrence of myofascial pain in
Qerama,E.; Kasch,H.; Not relevant, not a CTS
2009 patients with possible carpal tunnel Eur.J Pain
Fuglsang-Frederiksen,A. correlational study
syndrome - a single-blinded study
932
Reason for
Exclusion
Rab,M.; Grunbeck,M.;
Intra-individual comparison between
Beck,H.; Haslik,W.;
open and 2-portal endoscopic release in
Schrogendorfer,K.F.; 2006 J Plast.Reconstr.Aesthet.Surg Very low quality
clinically matched bilateral carpal
Schiefer,H.P.; Mittlbock,M.;
syndrome
Frey,M.
reference standard not
The familial occurrence of carpal tunnel
Radecki,P. 1994 Muscle Nerve consistent; confounded
syndrome
results
Carpal tunnel syndrome: Effects of
Radecki,P. 1997 personal factors and associated medical Phys.Med.Rehabil.Clin.N.Am. Background Information
conditions
Radhakrishnan,K.; Electrophysiologic evaluation for carpal
insufficient outcome data;
Thacker,A.K.; Maloo,J.C.; 1989 tunnel syndrome in patients with Int.Urol.Nephrol.
no comparison group
Ben,Dardef A.; Bubtana,A.G. angioaccess for haemodialysis
Radwin,R.G.; Wertsch,J.J.; Ridge detection tactility deficits <10 patients in CTS
1991 J Occup.Med
Jeng,O.J.; Casanova,J. associated with carpal tunnel syndrome group
The 'yellow fat sign' - a reliable
Ragbir,M.; Devaraj,V.S.;
1997 indicator of the completeness of carpal European Journal of Plastic Surgery Background article
Evans,D.
tunnel release
Carpal tunnel syndrome: a statistical
Ragi,E.F. 1981 Electromyogr.Clin Neurophysiol. records review
review
Rahmani,M.; Ghasemi
The ultrasonographic correlates of
Esfe,A.R.; Vaziri-Bozorg,S.M.; insufficient data; very
2011 carpal tunnel syndrome in patients with Radiol.Med
Mazloumi,M.; Khalilzadeh,O.; low study design
normal electrodiagnostic tests
Kahnouji,H.
Ralte,P.; Selvan,D.; Haemostasis in Open Carpal Tunnel
Does not address
Morapudi,S.; Kumar,G.; 2010 Release: Tourniquet vs Local Open Orthop J
Waseem,M. Anaesthetic and Adrenaline
Carpal tunnel syndrome. Testing the +Does not answer a
Randolph,J.A. 2000 sensitivity and validity of four AAOHN J question of interest; very
"localized discomfort" instruments low study design
Carpal tunnel syndrome: issues and
Rankin,E.A. 1995 J Natl.Med Assoc background
answers
Rashid,M.; Sarwar,S.U.; Tuberculous tenosynovitis: a cause of all CTS cases; no
2006 J Pak.Med Assoc
Haq,E.U.; Islam,M.Z.; Carpal Tunnel Syndrome comparison group
933
Reason for
Exclusion
Rizvi,T.A.; Ahmad,M.;
Shah,K.
Rathakrishnan,R.;
The median palmar cutaneous nerve in insufficient data; very
Therimadasamy,A.K.; 2007 Clin Neurophysiol.
normal subjects and CTS low study design
Chan,Y.H.; Wilder-Smith,E.P.
Time to return to work and surgeons'
Ratzon,N.; Schejter-Margalit,T.;
2006 recommendations after carpal tunnel Occup.Med (Lond) very low quality
Froom,P.
release
Read,R.L. 1991 Stress testing in nerve compression Hand Clin Background Information
Reddeppa,S.; Bulusu,K.;
The sympathetic skin response in carpal insufficient data; very
Chand,P.R.; Jacob,P.C.; 2000 Auton.Neurosci.
Kalappurakkal,J.; Tharakan,J.
Reddy,M.P. 1983 Peripheral nerve entrapment syndromes Am Fam Physician background
False positive electrodiagnostic tests in only healthy study
Redmond,M.D.; Rivner,M.H. 1988 Muscle Nerve
carpal tunnel syndrome subjects
Hand dominance in carpal tunnel all CTS cases; no
Reinstein,L. 1981 Arch Phys Med Rehabil.
Preventing Rsi/Wruld: use of
Does not answer a
Reis,P.; Moro,A. 2012 esthesiometry to assess hand tactile Work
sensitivity of slaughterhouse workers
Remerand,F.; Laulan,J.; Is the musculocutaneous nerve really in
Incorrect patient
Couvret,C.; Palud,M.; Baud,A.; the coracobrachialis muscle when
2010 Anesth.Analg. population (not exclusive
Velut,S.; Laffon,M.; performing an axillary block? An
to CTS)
Fusciardi,J. ultrasound study
Rempel,D.; Tittiranonda,P.; Effect of keyboard keyswitch design on insufficient data; no
Burastero,S.; Hudes,M.; So,Y. hand pain diagnosis of CTS
Resende,L.A.; Adamo,A.S.;
Bononi,A.P.; Castro,H.A.; Test of a new technique for the insufficient data; very
2000 J Electromyogr.Kinesiol.
Kimaid,P.A.; Fortinguerra,C.H.; diagnosis of carpal tunnel syndrome low study design
Schelp,A.O.
Resende,L.A.; Alves,R.P.;
+Does not answer a
Castro,H.A.; Kimaid,P.A.; 2000 Silent period in carpal tunnel syndrome Electromyogr.Clin Neurophysiol.
Fortinguerra,C.R.; Schelp,A.O.
Rettig,A.C. 1994 Wrist problems in the tennis player Med.Sci.Sports Exerc. Background Information
934
Reason for
Exclusion
Ambidextrous gloves--can they
Rhode,J. 1990 Dent.Today letter
contribute to carpal tunnel syndrome?
Prescription of diuretic drugs and
Rhodes,K.E. 1992 monitoring of long-term use in one Br.J.Gen.Pract. Cross-sectional study
general practice
Flexor superficialis abductor transfer
Richer,R.J.; Peimer,C.A. 2005 with carpal tunnel release for thenar J Hand Surg Am Retrospective case series
palsy
Orthopedic considerations during
Ritchie,J.R. 2003 Clin Obstet.Gynecol. Background article
pregnancy
Duration of postoperative dressing after
Ritting,A.W.; Leger,R.R.;
mini-open carpal tunnel release: A
Tucker,R.; Mogielnicki,L.H.; 2011 Journal of Hand Surgery Conference poster
randomized clinical control trial level 2
Rodner,C.M.
evidence
Rob,C.; May,A.G. 1975 Neurovascular compression syndromes Adv.Surg background
Robaux,S.; Blunt,C.; Viel,E.; Tramadol added to 1.5% mepivacaine
Cuvillon,P.; Nouguier,P.; for axillary brachial plexus block Deemed clinically
2004 Anesth.Analg.
Dautel,G.; Boileau,S.; improves postoperative analgesia dose- irrelevant
Girard,F.; Bouaziz,H. dependently
A review of therapeutic ultrasound:
Robertson,V.J. 2010 Systematic review
effectiveness studies
Letter: Carpal tunnel syndrome and
Robins,R.H. 1976 Br Med J letter
tennis elbow
Strategies for analyzing nerve
Robinson,L.R.; Micklesen,P.J.; insufficient data; very
1998 conduction data: superiority of a Muscle Nerve
Wang,L. low study design
summary index over single tests
Is the combined sensory (Robinson)
index routinely indicated for all cases of
Robinson,L.R.; Strakowski,J.;
2013 suspected carpal tunnel syndrome PM R case report; commentary
Kennedy,D.J.
undergoing electrodiagnostic
evaluation?
Median nerve electrophysiologic
Rodriquez,A.A.; Radwin,R.G.; +Does not answer a
1993 parameters and psychomotor Electromyogr.Clin Neurophysiol.
Jeng,O.J. question of interest
performance in carpal tunnel syndrome
935
Reason for
Exclusion
Rojviroj,S.; Sirichativapee,W.;
Pressures in the carpal tunnel. A
Kowsuwon,W.;
comparison between patients with insufficient data; very
Wongwiwattananon,J.; 1990 J Bone Joint Surg Br
carpal tunnel syndrome and normal low study design
Tamnanthong,N.;
subjects
Jeeravipoolvarn,P.
Diagnostic accuracy of ultrasonography
Roll,S.C.; Case-Smith,J.; vs. electromyography in carpal tunnel
2011 Ultrasound Med Biol. systematic review
Evans,K.D. syndrome: a systematic review of
literature
Roll,S.C.; Evans,K.D.; Li,X.; Screening for carpal tunnel syndrome insufficient data; very
Freimer,M.; Sommerich,C.M. using sonography low study design
Extracorporeal shock wave therapy in
Romeo,P.; d'Agostino,M.C.;
2011 pillar pain after carpal tunnel release: a Ultrasound Med Biol. Very low quality
Lazzerini,A.; Sansone,V.C.
preliminary study
Roquelaure,Y.; Ha,C.;
Rouillon,C.; Fouquet,N.; Risk factors for upper-extremity
Leclerc,A.; Descatha,A.; 2009 musculoskeletal disorders in the Arthritis Care Res. not exclusive to CTS
Touranchet,A.; Goldberg,M.; working population
Imbernon,E.
The relative responsiveness and
Rosales,R.S.; Diez,de la
construct validity of the Spanish version +Does not answer a
Lastra,I; McCabe,S.; Ortega 2009 J Hand Surg Eur.Vol.
of the DASH instrument for outcomes question of interest
Martinez,J.I.; Hidalgo,Y.M.
assessment in open carpal tunnel release
Palmaris brevis turnover flap as an
Rose,E.H.; Norris,M.S.;
adjunct to internal neurolysis of the Very Low Quality.
Kowalski,T.A.; Lucas,A.; 1991 J Hand Surg Am
chronically scarred median nerve in Prospective case series.
Flegler,E.J.
recurrent carpal tunnel syndrome
Rosecrance,J.C.; Cook,T.M.; Carpal tunnel syndrome among Not relevant, prevalence
2002 Am J Ind.Med
Anton,D.C.; Merlino,L.A. apprentice construction workers study
Neurophysiological diagnosis of the
Rosen,I. 1993 carpal tunnel syndrome: evaluation of Scand.J Plast.Reconstr.Surg Hand Surg
low study design
neurographic techniques
Neurophysiological investigation of
insufficient data;
Rosen,I.; Stromberg,T.; hands damaged by vibration:
1993 Scand.J Plast.Reconstr.Surg Hand Surg confounded comparison
Lundborg,G. comparison with idiopathic carpal
group
tunnel syndrome
936
Reason for
Exclusion
Rosenbaum,R.B.; Peripheral nerve and neuromuscular
1994 Neurol.Clin. Narrative review
Donaldson,J.O. disorders
Thenar eminence quantitative sensory
Rosenberg,D.; Conolley,J.; Not exclusive to CTS;
2001 testing in the diagnosis of proximal J Hand Ther
Dellon,A.L. <10 patients per group
median nerve compression
Limitation of finger joint mobility in review; background
Rosenbloom,A.L. 1989 J Diabet.Complications
diabetes mellitus information
Two simple, very useful nerve
Rosenblum,A. 1995 conduction tests for carpal tunnel Am.J.EEG Technol. Commentary/review
syndrome
Tenosynovitis: tendon and nerve
Rosenthal,E.A. 1987 Hand Clin background
entrapment
Ergonomic hazards in the workplace:
Ross,P. 1994 AAOHN J. background
Assessment and prevention
Rossi,E.; Sighinolfi,E.;
Bortolotti,P.; De,Santis G.; Nocturnal prolactin secretion in carpal all CTS cases; no
1984 Ital.J Neurol Sci
Schoenhuber,R.; Grandi,M.; tunnel syndrome comparison group
Landi,A.
Rossi,S.; Giannini,F.; Sensory neural conduction of median
Passero,S.; Paradiso,C.; 1994 nerve from digits and palm stimulation Electroencephalogr.Clin Neurophysiol.
low study design
Battistini,N.; Cioni,R. in carpal tunnel syndrome
Carpal tunnel syndrome: what is Not relevant, incidence
Rossignol,M.; Stock,S.;
1997 attributable to work? The Montreal Occup.Environ.Med study of montreal
Patry,L.; Armstrong,B.
study population metal workers
Roth,J.H.; Richards,R.S.;
1994 Endoscopic carpal tunnel release Can J Surg very low quality
MacLeod,M.D.
Rottgers,S.A.; Lewis,D.; Concomitant presentation of carpal +Does not answer a
2009 J Brachial.Plex.Peripher.Nerve Inj.
Wollstein,R.A. tunnel syndrome and trigger finger question of interest
Rozali,Z.I.; Noorman,F.M.; De
Cruz,P.K.; Feng,Y.K.; Impact of carpal tunnel syndrome on
2012 Asia Pac.Fam Med very low quality
Razab,H.W.; Sapuan,J.; the expectant woman's life
Singh,R.; Sikkandar,F.M.
Rozanski,M.; Neuhaus,V.; An open-label comparison of local Incorrect patient
Reddy,R.; Jupiter,J.B.; 2014 anesthesia with or without sedation for Hand (N Y) population (not exclusive
Rathmell,J.P.; Ring,D.C. minor hand surgery to CTS)
937
Reason for
Exclusion
Carpal tunnel syndrome: A
Rozmaryn,L.M. 1997 Current Opinion in Orthopaedics background
comprehensive review
Rozmaryn,L.M.; Dovelle,S.; Nerve and tendon gliding exercises and
Rothman,E.R.; Gorman,K.; 1998 the conservative management of carpal J Hand Ther Very Low Quality
Olvey,K.M.; Bartko,J.J. tunnel syndrome
Ruby,L.K. 1980 Common hand injuries in the athlete Orthop Clin North Am Background Information
Carpal tunnel release: efficacy and
Ruch,D.S.; Seal,C.N.;
2002 recurrence rate after a limited incision J South Orthop Assoc Retrospective case series
Bliss,M.S.; Smith,B.P.
release
Rudman,D.; Feller,A.G.;
Effects of human growth hormone on not relevant to CTS;
Cohn,L.; Shetty,K.R.; 1991 Horm.Res.
body composition in elderly men background information
Rudman,I.W.; Draper,M.W.
CTSS: an interactive microcomputer
program for the clinical screening of database records review;
Rudolfer,S.M. 1992 Electromyogr.Clin Neurophysiol.
carpal tunnel syndrome. II. Statistical statistical review
and computational aspects
CTSS: an interactive microcomputer
program for the clinical screening of
Rudolfer,S.M. 1988 Electromyogr.Clin Neurophysiol. review
carpal tunnel syndrome. I. Clinical
aspects
Painless fibro fatty hamartoma of the
Rudolph,R.; Jaffe,S. 1975 Br.J.Plast.Surg. case report
median nerve
Sabeti-Aschraf,M.; Serek,M.; The Enduro motorcyclist's wrist and
Pachtner,T.; Auner,K.; other overuse injuries in competitive Not relevant, prevalence
2008 Scand.J Med Sci Sports
Machinek,M.; Geisler,M.; Enduro motorcyclists: a prospective study
Goll,A. study
Sable,A.W. 1998 Median and ulnar nerves in the hand Phys.Med.Rehabil.Clin.N.Am. Background Information
The role of splinting and rehabilitation
Sailer,S.M. 1996 in the treatment of carpal and cubital Hand Clin Background article
tunnel syndromes
Digital nerve conduction velocity as a
Sakakibara,H.; Kondo,T.; +Does not answer a
1994 sensitive indication of peripheral Am J Ind.Med
Miyao,M.; Yamada,S. question of interest
neuropathy in vibration syndrome
The management of carpal tunnel +not best available
Sakellarides,H.T. 1983 compression syndrome. Follow-up of Orthop.Rev. evidence; summary
500 cases over a 25-year period document
938
Reason for
Exclusion
Efficacy of a new provocative test for
Sakthivel,K.; Madan,S.; European Journal of Orthopaedic insufficient data; very
2006 carpal tunnel syndrome: The straight
O'Connor,D.; Samuel,A.W. Surgery and Traumatology low study design
arm raise (SAR) test
Salerno,D.F.; Franzblau,A.; Median and ulnar nerve conduction Does not answer a
Werner,R.A.; Bromberg,M.B.; 1998 studies among workers: normative Muscle Nerve question of interest;
Armstrong,T.J.; Albers,J.W. values assessment of thresholds
Salinas,M.; Blas,G.; Regidor,I.;
An electro-clinical comparison of carpal Abstract/conference
LyPen,D.; Andreu,J.; 2003 Muscle Nerve
tunnel syndrome therapy poster
Sanchez,Olaso A.
Critical analysis of outcome measures
Sambandam,S.N.; Priyanka,P.;
2008 used in the assessment of carpal tunnel Int.Orthop systematic review
Gul,A.; Ilango,B.
syndrome
Sanati,K.A.; Mansouri,M.; Surgical techniques and return to work
Macdonald,D.; Ghafghazi,S.; 2011 following carpal tunnel release: a J Occup.Rehabil. systematic review
Macdonald,E.; Yadegarfar,G. systematic review and meta-analysis
Sensitive median-ulnar motor
Sander,H.W.; Quinto,C.; insufficient data; very
1999 comparative techniques in carpal tunnel Muscle Nerve
Saadeh,P.B.; Chokroverty,S. low study design
syndrome
Sansone,J.M.; Gatzke,A.M.;
Jules Tinel (1879-1952) and Paul historical review;
Aslinia,F.; Rolak,L.A.; 2006 Clinical Medicine and Research
Hoffmann (1884-1962) background information
Yale,S.H.
Sarkar,S.D. 1968 Carpal tunnel syndrome Br J Clin Pract. background
Sarria,L.; Cabada,T.;
Carpal tunnel syndrome: usefulness of insufficient data; very
Cozcolluela,R.; Martinez- 2000 Eur.Radiol.
sonography low study design
Berganza,T.; Garcia,S.
Vein wrapping for recurrent median Journal of the American Society for
Sarris,I.K.; Sotereanos,D.G. 2004 Background article
nerve compression Surgery of the Hand
Amelioration by mecobalamin of
Sato,Y.; Honda,Y.; Iwamoto,J.; subclinical carpal tunnel syndrome Does not address
2005 J Neurol Sci
Kanoko,T.; Satoh,K. involving unaffected limbs in stroke question of interest
patients
Sub-clinical carpal Tunnel syndrome: not best available
Satoh,K.; Nemoto,J. 1984 Electrophysiological study and natural Nihon University Journal of Medicine evidence; no comparison
course of modalities
939
Reason for
Exclusion
Sauni,R.; Paakkonen,R.;
Vibration-induced white finger
Virtema,P.; Jantti,V.;
2009 syndrome and carpal tunnel syndrome Int.Arch Occup.Environ.Health Not relevant
Kahonen,M.; Toppila,E.;
among Finnish metal workers
Pyykko,I.; Uitti,J.
Sauzet,O.; Carvajal,A.; Illustration of the weibull shape
Not relevant to CTS/ very
Escudero,A.; Molokhia,M.; 2013 parameter signal detection tool using Drug Saf
low study design
Cornelius,V.R. electronic healthcare record data
confounded comparisons;
When is the Phalen's test of diagnostic
Sawaya,R.A.; Sakr,C. 2009 J Clin Neurophysiol. not best available
value: an electrophysiologic analysis?
evidence
Journal of Neurology Neurosurgery and
Sawle,G.V.; Ramsay,M.M. 1998 The neurology of pregnancy Background article
Psychiatry
Open versus Endoscopic Carpal Tunnel
Sayegh,E.T.; Strauch,R.J. 2014 Release: A Meta-analysis of Clin.Orthop. meta-analysis
Randomized Controlled Trials
Open versus Endoscopic Carpal Tunnel
Sayegh,E.T.; Strauch,R.J. 2015 Release: A Meta-analysis of Clin Orthop Relat Res Meta-analysis
Randomized Controlled Trials
Scalco,R.S.; Pietroski,F.; Seasonal variation in prevalence of Not relevant, prevalence
2013 Muscle Nerve
Celli,L.F.; Gomes,I.; Becker,J. carpal tunnel syndrome study
Scanlon,A.; Maffei,J. 2009 Carpal tunnel syndrome J Neurosci.Nurs. background
Median mixed and sensory nerve
Scelsa,S.N.; Herskovitz,S.; insufficient data; very
1998 conduction studies in carpal tunnel Electroencephalogr.Clin Neurophysiol.
Bieri,P.; Berger,A.R. low study design
syndrome
Carpal tunnel syndrome. Anatomical
Scelsi,R.; Zanlungo,M.; and clinical correlations and
1989 Ital.J Orthop Traumatol. biomechanical study
Tenti,P. morphological and ultrastructural
aspects of the tenosynovial sheath
Schadel-Hopfner,M.;
Evidence-based hand surgery: the role
Windolf,J.; Antes,G.; 2008 J Hand Surg Eur.Vol. Narrative review
of Cochrane reviews
Sauerland,S.; Diener,M.K.
Carpal tunnel syndrome: the new
Schenck,R.R. 1989 AAOHN J Background Information
'industrial epidemic'
The role of endoscopic surgery in the Does not address
Schenck,R.R. 1995
treatment of carpal tunnel syndrome question of interest
940
Reason for
Exclusion
Is self-reported pain an appropriate
outcome measure in ergonomic-
Schierhout,G.H.; Myers,J.E. 1996 Am.J.Ind.Med. Background Information
epidemiologic studies of work-related
musculoskeletal disorders?
Carpal tunnel syndrome--a disabling yet
Schlachter,L.B.; Tindall,G.T. 1981 J Med Assoc Ga background
treatable condition
The risk of carpal tunnel syndrome with
Schmaus,D.C. 1990 AORN J Commentary; letter
computer use
Effect of splinting and exercise on
Schmid,A.B.; Elliott,J.M.; Does not meet inclusion
intraneural edema of the median nerve
Strudwick,M.W.; Little,M.; 2012 J Orthop Res. criteria (follow-up<1
in carpal tunnel syndrome--an MRI
Coppieters,M.W. month)
study to reveal therapeutic mechanisms
A vertical mouse and ergonomic mouse
Schmid,A.B.; Kubler,P.A.; pads alter wrist position but do not all CTS patients; no
2015 Appl Ergon.
Johnston,V.; Coppieters,M.W. reduce carpal tunnel pressure in patients regression analysis
Schnetzler,K.A. 2008 Acute carpal tunnel syndrome J Am Acad Orthop Surg background
Scholten,R.J.; Mink,van der
Surgical treatment options for carpal
Molen; Uitdehaag,B.M.; 2007 Cochrane Database Syst.Rev. systematic review
tunnel syndrome
Bouter,L.M.; de Vet,H.C.
Schorn,D.; Hoskinson,J.; Bone density and the carpal tunnel Does not address
1978
Dickson,R.A. syndrome question of interet
Median nerve latencies in poultry
Schottland,J.R.; processing workers: an approach to
Kirschberg,G.J.; Fillingim,R.; 1991 resolving the role of industrial J Occup.Med
diagnosis of CTS
Davis,V.P.; Hogg,F. "cumulative trauma" in the
development of carpal tunnel syndrome
Schuchmann,J.A.; Melvin,J.L.; Evaluation of local steroid injection for
1971 Arch Phys Med Rehabil. Very Low Quality
Duran,R.J.; Coleman,C.R. carpal tunnel syndrome
Schulman,R.A.; Liem,B. 2008 Medical Acupuncture Very low quality
with medical acupuncture
Schulman,R.A.; Liem,B.; Not a study (correction of
2008 with medical acupuncture (Medical Medical Acupuncture
Moroz,A. a study)
Acupuncture 20, 3, (163-167))
Schwartz,M.S.; Gordon,J.A.; Slowed nerve conduction with wrist +Does not answer a
1980 Ann.Neurol
Swash,M. flexion in carpal tunnel syndrome question of interest
941
Reason for
Exclusion
Schwarz,A.; Keller,F.; Carpal tunnel syndrome: a major
Seyfert,S.; Poll,W.; 1984 complication in long-term hemodialysis Clin Nephrol.
comparison groups
Molzahn,M.; Distler,A. patients
Carpal tunnel syndrome due to median
Schweitzer,G.; Miller,R.D. 1973 S.Afr.Med J case report
nerve enlargement
Impact of carpal tunnel education on
changing dental hygienists knowledge, Does not answer a
Scoggins,K.M.; Campbell,R.M. 1995 Work
risk behaviors, symptoms and question of interest
functional performance
Gloves, behavior changes can reduce
Sebright,J.A. 1986 Occup.Health Saf Background article
Sedal,L.; McLeod,J.G.; Ulnar nerve lesions associated with the +Does not answer a
1973 J Neurol Neurosurg.Psychiatry
Walsh,J.C. carpal tunnel syndrome question of interest
Electromyography: when to consider it Background Information;
See,D.H. 1980 Med Times
and what to expect from it case reports
Sefcovic,A.D.; Tuason,E.J.; Symptom severity, functional status,
Asaad,T.J.; Dawson,A.M.; and preventive or palliative measures Not relevant, prevalence
2000 Work
Lundberg,T.M.; Moreau,J.E.; employed by hand therapists study
Dale,L.M. experiencing carpal tunnel syndrome
Carpal tunnel syndrome: Update on
Seiler III,J.G. 1997 background
diagnostic testing and treatment options
Open carpal tunnel release with median
Seitz,Jr; Lall,A. 2013 neurolysis and Z-plasty reconstruction Current Orthopaedic Practice very low quality
of the transverse carpal ligament
Seletz,E. 1968 Peripheral nerve surgery Prog.Neurol Psychiatry Narrative review
Semple,J.C.; Cargill,A.O. 1969 Carpal-tunnel syndrome letter
Carpal-tunnel syndrome. Results of
Semple,J.C.; Cargill,A.O. 1969 Retrospective case series
surgical decompression
Sener,H.O.; Tascilar,N.F.; Sympathetic skin response in carpal insufficient data; very
Balaban,H.; Selcuki,D. tunnel syndrome low study design
An electro-physiological study of 100
Seneviratne,K.N. 1968 patients with the carpal tunnel Ceylon Med J case series; review
syndrome
Shulman syndrome associated with
Sepp,N.; Schmutzhard,E.;
1988 Borrelia burgdorferi and complicated by J.Am.Acad.Dermatol. case report
Fritsch,P.
942
Reason for
Exclusion
Yoga in treatment of carpal-tunnel
Sequeira,W. 1999 Background article
syndrome
Seradge,H.; Jia,Y.C.; In vivo measurement of carpal tunnel Does not address
1995 J Hand Surg Am
Owens,W. pressure in the functioning hand question of interest
Conservative treatment of carpal tunnel
Seradge,H.; Parker,W.;
2002 syndrome: an outcome study of adjunct J Okla.State Med Assoc Very Low Quality
Baer,C.; Mayfield,K.; Schall,L.
exercises
Sernik,R.A.; Abicalaf,C.A.; Ultrasound features of carpal tunnel
Pimentel,B.F.; Braga-Baiak,A.; 2008 syndrome: a prospective case-control Skeletal Radiol.
low study design
Braga,L.; Cerri,G.G. study
Simplified orthodromic inching test in insufficient data; very
Seror,P. 2001 Muscle Nerve
mild carpal tunnel syndrome low study design
Frequency of neurogenic thoracic outlet
syndrome in patients with definite
+Does not answer a
Seror,P. 2005 carpal tunnel syndrome: an Clin Neurophysiol.
electrophysiological evaluation in 100
women
Comparative diagnostic sensitivities of
orthodromic or antidromic sensory insufficient data; very
Seror,P. 2000 Arch Phys Med Rehabil.
inching test in mild carpal tunnel low study design
syndrome
Orthodromic inching test in mild carpal insufficient data; very
Seror,P. 1998 Muscle Nerve
Insufficient data
Pregnancy-related carpal tunnel
Seror,P. 1998 J Hand Surg Br (included from
syndrome
unpublished data)
The value of special motor and sensory
+not best available
Seror,P. 1995 tests for the diagnosis of benign and Am J Phys Med Rehabil.
evidence
minor median nerve lesion at the wrist
Sensitivity of the various tests for the insufficient data; no
Seror,P. 1994 J Hand Surg Br
diagnosis of carpal tunnel syndrome comparison group
Carpal tunnel syndrome in the elderly. +Does not answer a
Seror,P. 1991 Ann.Chir Main Memb.Super.
"Beware of severe cases" question of interest
Phalen's test in the diagnosis of carpal insufficient data; very
943
Reason for
Exclusion
Tinel's sign in the diagnosis of carpal insufficient data; very
Hand workload, computer use and risk
+Does not answer a
Seror,P.; Seror,R. 2012 of severe median nerve lesions at the Rheumatology (Oxford)
wrist
Serra,G.; Migliore,A.; Raynaud's phenomenon and entrapment
1985 Ann.Neurol. letter
Tugnoli,V. neuropathies
Serra,L.; Panagiotopoulos,K.;
Endoscopic release in carpal tunnel
Bucciero,A.; Mehrabi,F.K.;
2003 syndrome: analysis of clinical results in Minim.Invasive Neurosurg. very low quality
Pescatore,G.; Santangelo,M.;
200 cases
Vizioli,L.
Serra-Renom,J.M.; Benito,J.; Carpal tunnel release through a short
2002 Plast.Reconstr.Surg followup note
Rubio,J.M. incision: an update
Development of a carpal tunnel
Sesek,R.; Drinkaus,P.;
syndrome screening method using insufficient data; very
Khalighi,M.; Tuckett,R.P.; 2008 Work
structured interviews and vibrotactile low study design
Bloswick,D.S.
testing
Sesek,R.F.; Khalighi,M.; Effects of prolonged wrist flexion on
Does not answer a
Bloswick,D.S.; Anderson,M.; 2007 transmission of sensory information in J Pain
Tuckett,R.P. carpal tunnel syndrome
The mini incision technique for carpal
Sever,C.; Kulahci,Y.; Oksuz,S.;
2010 tunnel decompression using nasal Turk Neurosurg. very low quality
Sahin,C.
instruments
Seyfert,S.; Boegner,F.;
The value of magnetic resonance insufficient data; no
Hamm,B.; Kleindienst,A.; 1994 J Neurol
imaging in carpal tunnel syndrome comparison group
Klatt,C.
Prevalence and severity of carpal tunnel
Shaafi S; Naimian S; Itomlou
2006 syndrome (CTS) during pregnancy Very low quality
H; Sayyah Melli M
based on electrophysiologic studies
Shafer,S.W.; Koreerat,N.R.;
Median and ulnar neuropathies in u.s. Not relevant, prevalence
Gordon,L.B.; Santillo,D.R.; 2013 Med Probl.Perform.Art.
Army medical command band members study
Moore,J.H.; Greathouse,D.G.
Clinical and electrodiagnostic
Shaffer,S.W.; Moore,R.;
abnormalities of the median nerve in
Foo,S.; Henry,N.; Moore,J.H.; 2012 US.Army Med Dep.J no CTS
US Army Dental Assistants at the onset
Greathouse,D.G.
of training
944
Reason for
Exclusion
The anterior interosseous nerve latency
in the diagnosis of severe carpal tunnel
Shafshak,T.S.; el-Hinawy,Y.M. 1995 Arch Phys Med Rehabil. low study design; not
syndrome with unobtainable median
exclusive to CTS
nerve distal conduction
Ultrasound has supplementary
diagnostic value to clinical and Egyptian Journal of Neurology, insufficient data; very
Shaheen,H.A.; Yossef,A.T. 2011
neurophysiological studies in Carpal Psychiatry and Neurosurgery low study design
tunnel syndrome
Entrapment and Compressive
Shapiro,B.E.; Preston,D.C. 2009 Med.Clin.North Am. background
Neuropathies
Entrapment and compressive
Shapiro,B.E.; Preston,D.C. 2003 Med.Clin.North Am. case report
neuropathies
Shapiro,S. 1995 Microsurgical carpal tunnel release Insufficient data
Early diagnosis of carpal tunnel +Does not answer a
Sharma,K.R.; Rotta,F.;
2001 syndrome: comparison of digit 1 with Neurol Clin Neurophysiol. question of interest; very
Romano,J.; Ayyar,D.R.
wrist and distoproximal ratio low study design
Self-administered hand symptom
Sharma,V.; Wilder-Smith,E.P. 2004 diagram for carpal tunnel syndrome J Hand Surg Br
low study design
diagnosis
When you're asked about carpal tunnel
Shellenbarger,T. 1991 background
syndrome
Repetitive strain injury 2. Diagnostic
Sheon,R.P. 1997 and treatment tips on six common Postgrad.Med. background
problems
+Does not answer a
Clinical outcomes of electrodiagnostic
Shepherd,M.M. 2010 J Am Board Fam Med question of interest; not
testing conducted in primary care
CTS exclusive
Segmental study of the median nerve
Sheu,J.J.; Yuan,R.Y.;
versus comparative tests in the insufficient data; very
Chiou,H.Y.; Hu,C.J.; 2006 Clin Neurophysiol.
diagnosis of mild carpal tunnel low study design
Chen,W.T.
syndrome
Is surgical intervention more effective
Shi,Q.; MacDermid,J.C. 2011 than non-surgical treatment for carpal J Orthop Surg Res. Systematic Review
tunnel syndrome? A systematic review
945
Reason for
Exclusion
Influences of span and wrist posture on
International Journal of Industrial only healthy study
Shih,Y.-C.; Ou,Y.-C. 2005 peak chuck pinch strength and time
Ergonomics subjects
needed to reach peak strength
Shikha,Gandhi M.; Redd,C.B.;
A Novel Device to Evaluate the Journal of Medical Devices, insufficient data; very
Tuckett,R.P.; Sesek,R.F.; 2012
Vibrotactile Threshold Transactions of the ASME low study design
Bamberg,S.J.M.
Acupuncture for carpal tunnel
Shim,H.; Shin,B.; Lee,M.; BMC Complementary and Alternative
2012 syndrome: A systematic review of Presentation
Jung,A.; Lee,H.; Ernst,E. Medicine
randomized controlled trials
Disability outcomes in a worker's
Shin,A.Y.; Perlman,M.; compensation population: surgical
2000 Am J Orthop (Belle.Mead NJ) No critical outcomes
Shin,P.A.; Garay,A.A. versus nonsurgical treatment of carpal
tunnel syndrome
Shin,C.H.; Paik,N.J.; Lim,J.Y.;
Carpal tunnel syndrome and
Kim,T.K.; Kim,K.W.; Lee,J.J.; Not relevant, prevalence
2012 radiographically evident basal joint J Bone Joint Surg Am
Park,J.H.; Baek,G.H.; study
arthritis of the thumb in elderly Koreans
Gong,H.S.
Preventing mercury poisoning in dental
Ship,I.I.; Shapiro,I.M. 1983 Anesth.Prog. Not relevant
practice
Hypothyroidism and carpal tunnel
Shiri,R. 2014 Muscle Nerve meta-analysis
syndrome: a meta-analysis
Computer use and carpal tunnel
Shiri,R.; Falah-Hassani,K. 2015 J Neurol Sci meta-analysis
syndrome: A meta-analysis
Shiri,R.; Miranda,H.; Physical work load factors and carpal
Heliovaara,M.; Viikari- 2009 tunnel syndrome: a population-based Occup.Environ.Med
study
Juntura,E. study
Shivde,A.J.; Dreizin,I.; The carpal tunnel syndrome. A clinical insufficient data; very
Fisher,M.A. - electrodiagnostic analysis low study design
The carpal tunnel syndrome as a
Shizukuishi,S.; Nishii,S.; probable primary deficiency of vitamin
1980 Biochem.Biophys.Res.Commun. does not answer a
Ellis,J.; Folkers,K. B6 rather than a deficiency of a
dependency state
Shizukuishi,S.; Nishii,S.; Distribution of vitamin B6 deficiency in
1981 J Nutr.Sci Vitaminol.(Tokyo) does not answer a
Folkers,K. university students
946
Reason for
Exclusion
Amyloidosis and the carpal tunnel biopsy study; no
Short,W.H.; Palmer,A.K. 1981 Orthop.Rev.
Numerical correlation between nerve
conduction velocity and compound
Shoushtari,M.J.; Shokri,A.; insufficient data; very
2007 nerve action potential of median nerve Electromyogr.Clin Neurophysiol.
Shahab,S. low study design
in patients with carpal tunnel syndrome
and normal group
Acute compartment syndromes and
Shuman,L.H.; Hirsh,H.L. 1995 Trauma background
entrapment neuropathies
Shuman,S.; Osterman,L.;
1987 Compression neuropathies Semin.Neurol background
Bora,F.W.
Upper extremity pain in the
Sie,I.H.; Waters,R.L.; prevalence study; not
1992 postrehabilitation spinal cord injured Arch Phys Med Rehabil.
Adkins,R.H.; Gellman,H. CTS exclusive
patient
Carpal tunnel syndrome. Priorities for
Siebenaler,M.J.; McGovern,P. 1992 AAOHN J Background article
prevention
Standard open decompression in carpal
tunnel syndrome compared with a
Siegmeth,A.W.; Hopkinson-
2006 modified open technique preserving the J Hand Surg Am Very low quality
Woolley,J.A.
superficial skin nerves: a prospective
randomized study
Sigmond,E.; Luthra,H.S. 1980 Carpal tunnel syndrome Minn.Med background
Sikka,A.; Kemmann,E.; Carpal tunnel syndrome associated with
1983 Am J Obstet.Gynecol. Case report
Vrablik,R.M.; Grossman,L. danazol therapy
Carpal tunnel syndrome: associated
Silver,M.A.; Gelberman,R.H.; abnormalities in ulnar nerve function
1985 J Hand Surg Am
Gellman,H.; Rhoades,C.E. and the effect of carpal tunnel release
on these abnormalities
Silverstein,B.; Fine,L.; Hand-wrist disorders among investment Not relevant, prevalence
1987 J Hand Surg Am
Stetson,D. casting plant workers study
Silverstein,B.A.; Fan,Z.J.;
Bonauto,D.K.; Bao,S.; The natural course of carpal tunnel very low strength of
2010 Scand.J Work Environ.Health
Smith,C.K.; Howard,N.; syndrome in a working population evidence
Viikari-Juntura,E.
Upper extremity musculoskeletal Not relevant, prevalence
Silverstein,B.A.; Hughes,R.E. 1996 Appl.Ergon.
disorders at a pulp and paper mill study
947
Reason for
Exclusion
Acupuncture for carpal tunnel
Sim,H.; Shin,B.C.; Lee,M.S.;
2011 syndrome: a systematic review of J Pain Systematic review
Jung,A.; Lee,H.; Ernst,E.
Sim,Hoseob; Choi,Gwang Ho;
Acupuncture and related interventions
Wieland,L.Susan; Cochrane Database of Systematic
2014 for the treatment of symptoms systematic review
Lee,Hyangsook; Lee,Myeong Reviews
Soo; Shin,Byung Cheul
Interfascicular transplantation in
Simesen,K.; Haase,J.; Bjerre,P. 1980 Acta Orthop.Scand.
median nerve injuries
Simmer,Beck M.; Bray,K.K.; Comparison of muscle activity Journal of dental hygiene : JDH./
+Does not answer a
Branson,B.; Glaros,A.; 2006 associated with structural differences in American Dental
Weeks,J. dental hygiene mirrors Hygienists'.Association
Simoneau,G.G.; Marklin,R.W.; Computer keyboard slope and wrist
Berman,J.E.; Monroe,J.F.; 2000 extension angle on individuals with Arch.Physiol.Biochem. <10 patients per group
Welsh,S.E. carpal tunnel syndrome
The median nerve terminal latency
Simovic,D.; Weinberg,D.H. 1999 index in carpal tunnel syndrome: a Muscle Nerve insufficient data
clinical case selection study
Simovic,D.; Weinberg,D.H. 2000 Carpal tunnel syndrome Arch.Neurol. background
Fasciculation and focal loss of nerve
Simpson,J.A.; Thomaides,T. 1988 accommodation in peripheral Acta Neurol Scand.
neuropathies
Multiple compression neuropathies and
Simpson,R.L.; Fern,S.A. 1996 Orthop.Clin.North Am. background
the double-crush syndrome
The carpal tunnel syndrome: clinical
Singh,I.; Khoo,K.M.;
1994 evaluation and results of surgical Ann.Acad Med Singapore Retrospective case series
Krishnamoorthy,S.
decompression
Sipos,D.A. 1995 Carpal tunnel syndrome Orthop Nurs. background
Skandalakis,J.E.; Colborn,G.L.;
Skandalakis,P.N.;
1992 The carpal tunnel syndrome: Part III Am Surg background
McCollam,S.M.;
Skandalakis,L.J.
Skandalakis,P.N.;
1992 The carpal tunnel syndrome: Part II Am Surg background
McCollam,S.M.;
Skandalakis,L.J.
948
Reason for
Exclusion
Skandalakis,P.N.;
1992 The carpal tunnel syndrome: Part I Am Surg background
McCollam,S.M.;
Skandalakis,L.J.
Endoscopic median nerve
Skoff,H.D.; Sklar,R. 1994 Plast.Reconstr.Surg very low quality
decompression: early experience
Diagnosis and treatment of carpal
Slater,Jr; Bynum,D.K. 1993 Orthop.Rev. background
tunnel syndrome
Endoscopic carpal tunnel release. Use
Slattery,P.G. 1994 of the modified Chow technique in 215 Med J Aust. very low quality
cases
Criteria document for evaluating the
Sluiter,J.K.; Rest,K.M.; Frings-
2001 work-relatedness of upper-extremity Scand.J.Work.Environ.Health Background Information
Dresen,M.H.W.
musculoskeletal disorders
Use of nerve conduction studies and the
Slutsky,D.J. 2009 pressure-specified sensory device in the J Hand Surg Eur.Vol.
low study design
Electrodiagnostic testing in hand
Slutsky,D.J. 2005 Atlas of Hand Clinics Background Information
surgery
Nerve conduction studies in hand Journal of the American Society for
Slutsky,D.J. 2003 Background Information
surgery Surgery of the Hand
Carpal tunnel syndrome: clinical and
Smidt,M.H.; Visser,L.H. 2008 Muscle Nerve
sonographic follow-up after surgery
Elective hand surgery in patients taking
Smit,A.; Hooper,G. 2004 J Hand Surg Br Very low quality
warfarin
Smith,C.; O'Neill,J.; Parasu,N.; The role of ultrasonography in the
2009 Can Assoc Radiol.J background
Finlay,K. assessment of carpal tunnel syndrome
Common nonarticular syndromes in the
Smith,D.L.; Wernick,R. 1994 Postgrad.Med. Background article
elbow, wrist, and hand
Smith,E.M.; Sonstegard,D.A.; Carpal tunnel syndrome: contribution of
1977 Arch Phys Med Rehabil. cadaver study
Anderson,W.H.,Jr. flexor tendons
Radial nerve conduction in patients +Does not answer a
Smith,J. 1981 Appl Neurophysiol.
with carpal tunnel syndrome question of interest
Nerve conduction studies for carpal
Smith,N.J. 2002 tunnel syndrome: essential prelude to J Hand Surg Br
surgery or unnecessary luxury?
949
Reason for
Exclusion
Snell,N.J.; Coysh,H.L.; Carpal tunnel syndrome presenting in
1980 Case reports
Snell,B.J. the puerperium
Evaluation of thermography in the
So,Y.T.; Olney,R.K.; insufficient data; very
1989 diagnosis of selected entrapment
Aminoff,M.J. low study design
neuropathies
Soccetti,A.; Raffaelli,P.;
MR imaging in the diagnosis of carpal no comparison group;
Giovagnoni,A.; Ercolani,P.; 1992 Ital.J Orthop Traumatol.
tunnel syndrome very low study design
Mercante,O.; Pelliccioni,G.
Sohn,M.K.; Jee,S.J.; Motor unit number estimation and
Hwang,S.L.; Kim,Y.J.; 2011 motor unit action potential analysis in Ann.Rehabil.Med
low study design
Shin,H.D. carpal tunnel syndrome
Changes in Dermatomal Somatosensory
Sohn,S.Y.; Seo,J.H.; Min,Y.; Evoked Potentials according to insufficient data; very
2012 J Korean Neurosurg.Soc.
Seo,M.H.; Eun,J.P.; Song,K.J. Stimulation Intensity and Severity of low study design
Revision Decompression and Collagen
Soltani,A.M.; Allan,B.J.;
Nerve Wrap for Recurrent and
Best,M.J.; Mir,H.S.; 2013 Ann.Plast.Surg systematic review
Persistent Compression Neuropathies of
Panthaki,Z.J.
the Upper Extremity
Soltani,A.M.; Allan,B.J.; A systematic review of the literature on
Best,M.J.; Mir,H.S.; 2013 the outcomes of treatment for recurrent Plast.Reconstr.Surg systematic review
Panthaki,Z.J. and persistent carpal tunnel syndrome
The pressure angle of the median nerve
Somay,G.; Somay,H.;
as a new magnetic resonance imaging Does not address
Cevik,D.; Sungur,F.; 2009 Clin Neurol Neurosurg.
parameter for the evaluation of carpal question of interest
Berkman,Z.
tunnel
Song,C.H.; Gong,H.S.; Evaluation of female hormone-related
Does not answer question
Bae,K.J.; Kim,J.H.; Nam,K.P.; 2014 symptoms in women undergoing carpal J Hand Surg Eur.Vol.
of interest
Baek,G.H. tunnel release
The relationship between neuropathic
pain, and the function of the upper
Sonohata,M.; Tsuruta,T.;
limbs based on clinical severity +Does not answer a
Mine,H.; Morimoto,T.; 2013 Open Orthop J
according to electrophysiological question of interest
Mawatari,M.
studies in patients with carpal tunnel
syndrome
950
Reason for
Exclusion
Sonoo,M.; Tsaiweichao- Spread of the radial SNAP: a pitfall in
Shozawa,Y.; Oshimi- the diagnosis of carpal tunnel syndrome insufficient data; very
Sekiguchi,M.; Hatanaka,Y.; using standard orthodromic sensory low study design
Shimizu,T. conduction study
Sorensen,A.A.; Howard,D.; Minimal clinically important Incorrect patient
Tan,W.H.; Ketchersid,J.; 2013 differences of 3 patient-rated outcomes Journal of Hand Surgery population (not exclusive
Calfee,R.P. instruments to CTS)
Nerve entrapment syndromes in the
Southwick,G. 1984 Aust.Fam Physician Background article
upper limb
Diurnal variation in clinical and
Sozay,S.; Sarfakoglu,A.B.; +Does not answer a
2011 electrophysiologic parameters Am J Phys Med Rehabil.
Ayas,S.; Cetin,N. question of interest
Spontaneous rhythmic motor unit Does not answer a
Spaans,F. 1982 J Neurol Neurosurg.Psychiatry
potentials in the carpal tunnel syndrome question of interest
Sparkes,R.S.; Spence,M.A.; Does not answer a
Gottlieb,N.L.; Gray,R.G.; Genetic linkage analysis of the carpal question of interest;
1985 Hum.Hered.
Crist,M.; Sparkes,M.C.; tunnel syndrome biostudy of genetic
Marazita,M. markers
Pre-surgery disability compensation Not relevant,does not
Spector,J.T.; Turner,J.A.;
2012 predicts long-term disability among Am J Ind.Med answer the PICO
Fulton-Kehoe,D.; Franklin,G.
workers with carpal tunnel syndrome question
Carpal tunnel syndrome: a frequent,
Spertini,F.; Wauters,J.P.; Not relevant,
1984 invalidating, long-term complication of Clin Nephrol.
Poulenas,I. hemodialysis patient
chronic hemodialysis
Spickler,L. 1979 Carpal tunnel syndrome ONA J case report
Nerve conduction studies and
Spindler,H.A.; Dellon,A.L. 1982 sensibility testing in carpal tunnel J Hand Surg Am insufficient data
syndrome
Compressive neuropathies of the upper
Spinner,R.J.; Amadio,P.C. 2003 Clin.Plast.Surg. Background Information
extremity
Deemed clinically
Spooner,G.R.; Desai,H.B.; irrelevant (general
Using pyridoxine to treat carpal tunnel
Angel,J.F.; Reeder,B.A.; 1993 Can Fam Physician nonvalidated
syndrome. Randomized control trial
Donat,J.R. subjective/symptom
questionnaire)
951
Reason for
Exclusion
How I treat anticoagulated patients
Spyropoulos,A.C.;
2012 undergoing an elective procedure or Case reports
Douketis,J.D.
surgery
Carpal tunnel syndrome in lysosomal
Sri-Ram,K.; Vellodi,A.;
2007 storage disorders: simple J Pediatr Orthop B very low quality
Pitt,M.; Eastwood,D.M.
decompression or external neurolysis?
Stack,R.E. 1973 Carpal tunnel syndrome Am Fam Physician not relevant
Stahl,S.; Ben-David,B.; The effect of local infiltration with Deemed clinically
Moscona,R.A. morphine before carpal tunnel release irrelevant
Stahl,S.; Blumenfeld,Z.; Carpal tunnel syndrome in pregnancy:
1996 J Neurol Sci Insufficient data
Yarnitsky,D. indications for early surgery
Stal,M.; Hansson,G.-A.; Upper extremity muscular load during International Journal of Industrial insufficient data for
2000
Moritz,U. machine milking Ergonomics comparable groups
Unilateral vs. bilateral carpal tunnel:
Stanek III,E.J.; Pransky,G. 1996 Am.J.Ind.Med. Background article
Challenges and approaches
retrospective review;
Stapleton,M.J. 2006 Occupation and carpal tunnel syndrome ANZ J Surg
summary document
Cochrane corner: local corticosteroid
Stark,H.; Amirfeyz,R. 2013 J Hand Surg Eur.Vol. Systematic review
injection for carpal tunnel syndrome
Carpal tunnel syndrome, failure of
Stark,W.A. 1968 J Indiana State Med Assoc background
surgery
with polarized polychromatic
Stasinopoulos,D.;
2005 noncoherent light (Bioptron light): a Photomed.Laser Surg Very Low Quality
Stasinopoulos,I.; Johnson,M.I.
preliminary, prospective, open clinical
trial
Carpal tunnel syndrome: the risk to
Stedt,J.D. 1989 Am Ann.Deaf Background Information
educational interpreters
Stein,D.; Neufeld,A.;
Diffusion tensor imaging of the median
Pasternak,O.; Graif,M.; <10 patients per group;
2009 nerve in healthy and carpal tunnel J Magn Reson.Imaging
Patish,H.; Schwimmer,E.; very low study design
syndrome subjects
Ziv,E.; Assaf,Y.
Stein,K.; Storkel,S.; Chemical heterogeneity of amyloid in Virchows Arch A
1987 bio-study/ biopsy
Linke,R.P.; Goebel,H.H. the carpal tunnel syndrome Pathol.Anat.Histopathol.
952
Reason for
Exclusion
Steinberg,D.R.; The utility of portable nerve conduction
Gelberman,R.H.; Rydevik,B.; 1992 testing for patients with carpal tunnel J Hand Surg Am
low study design
Lundborg,G. syndrome: a prospective clinical study
The dose-response relationship of
Steinberg,R.B.; Reuben,S.S.; ketorolac as a component of Deemed clinically
1998 Anesth.Analg.
Gardner,G. intravenous regional anesthesia with irrelevant
lidocaine
Effects of perineural steroid injections
Stepic,N.; Novakovic,M.; Does not address
2008 on median nerve conduction during the Vojnosanit.Pregl.
Martic,V.; Peric,D. question of interest
Sternbach,G. 1999 The carpal tunnel syndrome J.Emerg.Med. background
Median sensory distal amplitude and
Stetson,D.S.; Silverstein,B.A.;
latency: Comparisons between Not relevant, not a risk
Keyserling,W.M.; Wolfe,R.A.; 1993 Am.J.Ind.Med.
nonexposed managerial/professional study
Albers,J.W.
employees and industrial workers
AAEE minimonograph #26: The
Stevens,J.C. 1987 electrodiagnosis of carpal tunnel Muscle Nerve Background Information
syndrome
AANEM minimonograph 26: The
Stevens,J.C. 1997 electrodiagnosis of carpal tunnel Muscle Nerve Background Information
syndrome
Stevens,J.C.; Beard,C.M.; Conditions associated with carpal medical record review;
1992 Mayo Clin Proc.
O'Fallon,W.M.; Kurland,L.T. tunnel syndrome no comparison group
Stewart,H.D.; Innes,A.R.; The hand complications of Colles' no comparison group; not
1985 J Hand Surg Br
Burke,F.D. fractures CTS exclusive
Tinel's sign and the carpal tunnel insufficient data; very
Stewart,J.D.; Eisen,A. 1978 Br Med J
Steyers,C.M. 2002 Recurrent carpal tunnel syndrome Hand Clin background
Practical management of carpal tunnel pdf does not match
Steyers,C.M.; Schelkun,P.H. 1995 Physician and Sportsmedicine
syndrome abstract
Workplace ergonomic factors and the
development of musculoskeletal
Stock,S.R. 1991 Am J Ind.Med meta-analysis
disorders of the neck and upper limbs: a
meta-analysis
953
Reason for
Exclusion
Stockton,D.W.; Meade,R.A.;
Hereditary neuropathy with liability to
Netscher,D.T.; Epstein,M.J.; all CTS cases; no
2001 pressure palsies is not a major cause of Arch Neurol
Shenaq,S.M.; Shaffer,L.G.; comparison group
Lupski,J.R.
Retrograde changes of nerve fibers with
Stoehr,M.; Petruch,F.; insufficient data; no
1978 the carpal tunnel syndrome. An J Neurol
Scheglmann,K.; Schilling,K. comparison group
electroneurographic investigation
Stolp-Smith,K.A.; Pascoe,M.K.; Carpal tunnel syndrome in pregnancy:
1998 Arch Phys Med Rehabil. retrospective case series
Ogburn,P.L.,Jr. frequency, severity, and prognosis
Stransky,G.; Weis,S.;
Morphometric analysis of collagen
Neumuller,J.; Hakimzadeh,A.;
1987 fibrils in idiopathic carpal tunnel Exp.Cell Biol. bio-study/ biopsy
Firneis,F.; Ammer,K.;
syndrome
Partsch,G.; Eberl,R.
Incorrect patient
Stransky,M.; Rubin,A.; Treatment of carpal tunnel syndrome
1989 South Med J population (<10
Lava,N.S.; Lazaro,R.P. with vitamin B6: a double-blind study
patients/group)
Staged release of bilateral carpal tunnel
Street,E.R.; Eastwood,G.L.;
2013 syndrome: cancellation rates of the J Hand Surg Eur.Vol. Letter
Royle,S.G.
second side procedure
Accuracy of in-office nerve conduction
Strickland,J.W.; Gozani,S.N. 2011 studies for median neuropathy: a meta- J Hand Surg Am meta-analysis
analysis
Strickland,J.W.; Idler,R.S.;
1991 Carpal tunnel syndrome Indiana Med background
Creighton,J.C.
Incorrect patient
Strohecker,J.; Piotrowski,W.; Ultrastructural findings after the use of
1985 Lasers Surg Med population (N<10
Lametschwandtner,A. a CO2 laser in carpal tunnel surgery
patients)
not assessing RF of CTS
Stromberg,T.; Dahlin,L.B.; Hand problems in 100 vibration-
1996 J Hand Surg Br but if CTS causes other
Lundborg,G. exposed symptomatic male workers
problems
Not relevant,
Stromberg,T.; Dahlin,L.B.; Neurophysiological findings in neurophysiological
1999 J Hand Surg Br
Rosen,I.; Lundborg,G. vibration-exposed male workers findings in exposed
workers
Strong,D.R.; Lennartz,F.H. 1992 Carpal tunnel syndrome J Calif.Dent.Assoc background
954
Reason for
Exclusion
Stuart,R.M.; Koh,E.S.C.; Sonography of Peripheral Nerve
2004 Am.J.Roentgenol. Background Information
Breidahl,W.H. Pathology
Revision surgery after carpal tunnel Incorrect patient
Stutz,N.; Gohritz,A.;
2006 release--analysis of the pathology in J Hand Surg Br population (prior invasive
van,Schoonhoven J.; Lanz,U.
200 cases during a 2 year period intervention)
Su,C.Y.; Liang,W.L.; Chen- Physician practices in the diagnosis of
Sea,M.J.; Liu,C.W.; 2004 carpal tunnel syndrome at a medical Kaohsiung J Med Sci records review
Huang,M.H.; Lai,Y.C. center in southern Taiwan
Correlation between subclinical median
Su,P.H.; Chen,W.S.; insufficient data; very
2013 neuropathy and the cross-sectional area Ultrasound Med Biol.
Wang,T.G.; Liang,H.W. low study design
of the median nerve at the wrist
Palpatory diagnosis and manipulative
Sucher,B.M. 1994 J Am Osteopath.Assoc confounding previous
management of carpal tunnel syndrome
treatments
Ultrasound imaging of the carpal tunnel <10 patients per group;
Sucher,B.M. 2009 Curr.Rev.Musculoskelet.Med
during median nerve compression very low study design
Sucher,B.M.; Glassman,J.H. 1996 Upper extremity syndromes Phys.Med.Rehabil.Clin.N.Am. Background information
Erratum: Manipulative treatment of
carpal tunnel syndrome: Biomechanical
and osteopathic intervention to increase
Sucher,B.M.; Hinrichs,R.N.; the length of the transverse carpal
abstract correction; no
Welcher,R.L.; Quiroz,L.D.; 2005 ligament: Part 2. Effect of sex J.Am.Osteopath.Assoc.
text
Laurent,B.F.; Morrison,B.J. differences and manipulative "priming"
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143))
Sud,V. 2002 Nerve entrapment and gene therapy J Long Term Eff.Med Implants Background article
Carpal tunnel syndrome: evaluation of
Sugimoto,H.; Miyaji,N.;
1994 median nerve circulation with dynamic <10 patients per group
Ohsawa,T.
contrast-enhanced MR imaging
Conduction velocity distribution
Sundar,S.; Gonzalez-Cueto,J.A.; Biomedical Signal Processing and
2008 estimation using the collision Background Information
Gilbert,C.S. Control
technique-Theory and simulation study
The nerve lesion in the carpal tunnel Background Information;
Sunderland,S. 1976 J Neurol Neurosurg.Psychiatry
syndrome review
955
Reason for
Exclusion
The restoration of median nerve
Sunderland,S. 1974 function after destructive lesions which Background article
preclude end to end repair
The relationship between body mass
Sungpet,A.; Suphachatwong,C.; Not relevant, patients
1999 index and the number of sides of carpal J Med Assoc Thai.
Kawinwonggowit,V. with known CTS
tunnel syndrome
Suresh,S.S.; Raniga,S.; Carpal tunnel syndrome due to
Shanmugam,V.; George,M.; 2013 hydroxyapatite crystal deposition J Hand Microsurg. case report
Zaki,H. disease
Sutro,C.J. 1969 calcification in the deep or volar radio- Bull Hosp.Joint Dis case report
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Carpal tunnel syndrome: a five-year
Swajian,G.R. 1981 J Am Osteopath.Assoc background
study
Swinton,N.W.,Jr.; Rosen,B.J.; The carpal tunnel syndrome and
1970 Lahey.Clin Found.Bull case report
Shefer,A.L.; Leach,R.E. multiple myeloma
Perioperative antibiotics for carpal
Szabo,R.M. 2010 J Hand Surg Am Narrative review
tunnel surgery
Stress carpal tunnel pressures in
Szabo,R.M.; Chidgey,L.K. 1989 patients with carpal tunnel syndrome J Hand Surg Am
low study design
and normal patients
Szabo,R.M.; Madison,M. 1992 Carpal tunnel syndrome Orthop Clin North Am Background article
Szabo,R.M.; Slater,R.R.,Jr.;
The value of diagnostic testing in carpal insufficient data; very
Farver,T.B.; Stanton,D.B.; 1999 J Hand Surg Am
Sharman,W.K.
Restoration of hand function and ability
Szczechowicz,J.; Pieniazek,M.; to perform activities of daily living Results not completely in
2008 Ortop.Traumatol.Rehabil.
Pelczar-Pieniazek,M. following surgery for carpal tunnel English
syndrome
Szyluk,K.; Koczy,B.;
Evaluation of results of single portal
Jasinski,A.; Widuchowski,J.; 2006 Ortop.Traumatol.Rehabil. not in english
Widuchowski,W.
Szyluk,K.; Widuchowski,J.; Early results of surgical treatment for
Jasinski,A.; Koczy,B.; 2006 carpal tunnel syndrome using a single- Ortop.Traumatol.Rehabil. Not in English
Widuchowski,W. portal endoscopic method
956
Reason for
Exclusion
Comparison of orthodromic and
Tackmann,W.; Kaeser,H.E.; antidromic sensory nerve conduction insufficient data; very
1981 J Neurol
Magun,H.G. velocity measurements in the carpal low study design
tunnel syndrome
Relative refractory period of median
Tackmann,W.; Lehmann,H.J. 1974 nerve sensory fibres in the carpal tunnel Eur.Neurol <10 patients per group
syndrome
Tagliafico,A.; Rubino,M.;
Autuori,A.; Bianchi,S.; 2007 Wrist and hand ultrasound Seminars in Musculoskeletal Radiology Background Information
Martinoli,C.
Changes in electrophysiological
Tahririan,M.A.; Moghtaderi,A.;
2012 parameters after open carpal tunnel Adv.Biomed Res. very low quality
Aran,F.
release
Ultrasonography for diagnosing carpal
Tai,T.W.; Wu,C.Y.; Su,F.C.;
2012 tunnel syndrome: a meta-analysis of Ultrasound Med Biol. meta-analysis
Chern,T.C.; Jou,I.M.
diagnostic test accuracy
Carpal tunnel syndrome. The
Tait,P. 1976 Nurs.Mirror Midwives J background
physiotherapist's role
Diagnostic utility of sonography and
Tajika,T.; Kobayashi,T.;
correlation between sonographic and insufficient data; very
Yamamoto,A.; Kaneko,T.; 2013 J Ultrasound Med
clinical findings in patients with carpal low study design
Takagishi,K.
tunnel syndrome
Reliability of upper limb tension test 1
Talebi,G.A.; Oskouei,A.E.; insufficient data; very
2012 in normal subjects and patients with J Back Musculoskelet.Rehabil.
Shakori,S.K. low study design
Lesions of the intra-operative carpal
Talia,B. 1977 Acta Thermographica Background Information
tunnel
Intraoperative thermography in micro
Talia,B.; Landi,A. 1976 surgery: physiopathologic study of the Acta Thermographica Background article
Correlation of carpal tunnel size and
all healthy subjects; no
conduction velocity of the sensory
Tan,M.; Tan,U. 1998 Percept.Mot.Skills CTS diagnosis
median and ulnar nerves of male and
determined
female controls and carpet weavers
Tanaka,H.; Hashizume,H.; Accuracy of a portable +does not answer a
McCown,C.; Senda,M.; 2005 electroneurometer for measuring distal J Orthop Sci question of interest; very
Nishida,K.; Inoue,H. motor latency low study design
957
Reason for
Exclusion
Prevalence and work-relatedness of
self-reported carpal tunnel syndrome
Tanaka,S.; Wild,D.K.;
among U.S. workers: analysis of the Not relevant, prevalence
Seligman,P.J.; Halperin,W.E.; 1995 Am J Ind.Med
Occupational Health Supplement data study
Behrens,V.J.; Putz-Anderson,V.
of 1988 National Health Interview
Survey
A conceptual quantitative model for
Tanaka,Shiro; International Journal of Industrial
1993 prevention of work-related carpal tunnel Background Information
McGlothlin,James D. Ergonomics
syndrome (CTS)
Nerve injuries: Testing and treatment
Tardif,G.S. 1995 Physician and Sportsmedicine background
tactics
Low-level laser in the treatment of
Tascioglu,F.; Degirmenci,N.A.; carpal tunnel syndrome: clinical,
2012 Rheumatol.Int. criteria (follow-up <1
Ozkan,S.; Mehmetoglu,O. electrophysiological, and
month)
ultrasonographical evaluation
Tasdelen,N.; Gurses,B.;
Kilickesmez,O.; Firat,Z.; Diffusion tensor imaging in carpal insufficient data; very
2012 Diagn.Interv.Radiol.
Karlikaya,G.; Tercan,M.; tunnel syndrome low study design
Ulug,A.M.; Gurmen,A.N.
Repetitive differential finger motion
increases shear strain between the
Tat,J.; Kociolek,A.M.; Keir,P.J. 2013 J Orthop Res. Not relevant to CTS
flexor tendon and subsynovial
connective tissue
The second lumbrical-interossei latency
Tawfik,E.A.; El Zohiery,A.K.; insufficient data; very
2013 difference in carpal tunnel syndrome: Is Alexandria Journal of Medicine
Abaza,N.M. low study design
it a mandatory or a dispensable test?
Clinical profile, electrodiagnosis and
Tay,L.B.; Urkude,R.; +Does not answer a
2006 outcome in patients with carpal tunnel Singapore Med J
Verma,K.K. question of interest
syndrome: a Singapore perspective
Clinical diagnosis of the carpal tunnel
Taylor,N. 1970 Am Fam Physician GP. background
syndrome
Thermographic observations in
Tchou,S.; Costich,J.F.; insufficient data; very
1992 unilateral carpal tunnel syndrome: J Hand Surg Am
Burgess,R.C.; Wexler,C.E. low study design
report of 61 cases
A research synthesis of therapeutic
Teasell,R.W.; McClure,J.A.;
2010 interventions for whiplash-associated Pain Res.Manag. Not relevant to CTS
Walton,D.; Pretty,J.; Salter,K.;
disorder (WAD): part 5 - surgical and
958
Reason for
Exclusion
Meyer,M.; Sequeira,K.; injection-based interventions for
Death,B. chronic WAD
Teitz,C.C.; DeLisa,J.A.; Results of carpal tunnel release in renal

1985 Clin Orthop Relat Res. very low study design
Halter,S.K. hemodialysis patients
The pneumatic compression test and
Tekeoglu,I.; Dogan,A.; insufficient data; very
2007 modified pneumatic compression test in J Hand Surg Eur.Vol.
Demir,G.; Dolar,E. low study design
Carpal tunnel release under intravenous
Deemed clinically
Tekin,I.; Mirzai,H.; Ok,G. 2005 regional anaesthesia with ropivacaine or Pain Clinic
irrelevant
lidocaine
Teli,M.; Bidwell,J.; Prevalence and treatment of carpal insufficient data; very
2005 Chir Organi Mov
Kinninmonth,A.; Zoccali,C. tunnel syndrome in renal haemodialysis low study design
Carpal tunnel decompression: open vs
Tennent,T.D.; Goddard,N.J. 1997 Br J Hosp.Med Background article
endoscopic
Terrono,A.L. 2005 Atlas of Hand Clinics Background Information
or inflammatory arthritic patients
Terzis,S.; Paschalis,C.; Early diagnosis of carpal tunnel
Metallinos,I.C.; 1998 syndrome: comparison of sensory Muscle Nerve
low study design
Papapetropoulos,T. conduction studies of four fingers
A new provocative test for carpal tunnel
Tetro,A.M.; Evanoff,B.A.; insufficient data; very
1998 syndrome. Assessment of wrist flexion J Bone Joint Surg Br
Hollstien,S.B.; Gelberman,R.H. low study design
and nerve compression
Tetro,A.M.; Evanoff,B.A.; A new provocative test for carpal tunnel Journal of Bone and Joint Surgery - insufficient data; very
1998
Hollstien,S.B.; Gelberman,R.H. syndrome Series B low study design
Tezel,E.; Imer,B.; Carpal tunnel release via limited palmar
2002 Marmara Medical Journal Retrospective case series
Numanoglu,A. incision using rhinoplasty instruments
Advantages and pitfalls of endoscopic
Abstract/conference
Thal,H.U. 1998 versus open surgery of carpal ligament Zentralbl.Neurochir.
poster
in carpal tunnel syndrome
Methylprednisolone injections reduced
Duplicate study (AAOS
Thoma,A. 2014 carpal tunnel syndrome symptoms at 10 Ann.Intern.Med
ID 146)
weeks and surgery at 1 year
Thoma,A.; Chew,R.T.; Application of the CONSORT
2006 Can J Plast.Surg systematic review
Sprague,S.; Veltri,K. statement to randomized controlled
959
Reason for
Exclusion
trials comparing endoscopic and open
A meta-analysis of randomized
Thoma,A.; Veltri,K.; Haines,T.;
2004 controlled trials comparing endoscopic Plast.Reconstr.Surg meta-analysis
Duku,E.
and open carpal tunnel decompression
A systematic review of reviews
Thoma,A.; Veltri,K.; Haines,T.; comparing the effectiveness of
2004 Plast.Reconstr.Surg Systematic review
Duku,E. endoscopic and open carpal tunnel
decompression
Thomas,J.E.; Lambert,E.H.; Electrodiagnostic aspects of the carpal +very low study design;
1967 Arch Neurol
Cseuz,K.A. tunnel syndrome not best evidence
Imaging of common nerve entrapment
Thomas,M.; Heron,C. 2008 CPD Journal Radiology Update Background Information
syndromes
Incorrect patient
Thomas,R.E.; Butterfield,R.K.; Effects of exercise on carpal tunnel
1993 Appl Ergon. population (<10
Hool,J.N.; Herrick,R.T. syndrome symptoms
patients/group)
Repetitive strain injuries. How to deal
Thompson,J.S.; Phelps,T.H. 1990 Postgrad.Med Background Information
with 'the epidemic of the 1990s'
Carpal tunnel syndrome and the use of
Thomsen,J.F.; Gerr,F.;
2008 computer mouse and keyboard: a BMC Musculoskelet.Disord. systematic review
Atroshi,I.
systematic review
Interview data versus questionnaire data
Thomsen,J.F.; Mikkelsen,S. 2003 in the diagnosis of carpal tunnel Occup.Med (Lond) very low study design
syndrome in epidemiological studies
Health-related quality of life 5 years
Thomsen,N.O.; Bjork,J.; after carpal tunnel release among Does not address
2014 BMC Endocr.Disord.
Cederlund,R.I. patients with diabetes: a prospective question of interest
study with matched controls
Clinical outcomes of surgical release
Thomsen,N.O.; Cederlund,R.; among diabetic patients with carpal Does not address
2009 J Hand Surg Am
Rosen,I.; Bjork,J.; Dahlin,L.B. tunnel syndrome: prospective follow-up question of interest
with matched controls
Thomsen,N.O.; Cederlund,R.; Vibrotactile sense in patients with all CTS cases; no
2011 Diabet.Med
Speidel,T.; Dahlin,L.B. diabetes and carpal tunnel syndrome comparison group
960
Reason for
Exclusion
Thomsen,N.O.; Cederlund,R.I.; Carpal tunnel release in patients with
Does not address
Andersson,G.S.; Rosen,I.; 2014 diabetes: a 5-year follow-up with J Hand Surg Am
Bjork,J.; Dahlin,L.B. matched controls
Thomsen,N.O.; Rosen,I.; Neurophysiologic recovery after carpal Does not address
Dahlin,L.B. tunnel release in diabetic patients question of interest
Effects of chronic median nerve
Thonnard,J.; Saels,P.; Van den insufficient data; very
1999 compression at the wrist on sensation Exp.Brain Res.
Bergh,P.; Lejeune,T. low study design
and manual skills
Value of Gilliatt's pneumatic tourniquet +Does not answer a
Thungen,T.; Sadowski,M.;
2012 test for diagnosis of carpal tunnel Chir Main question of interest;
El,Kazzi W.; Schuind,F.
syndrome insufficient data
The possible role of vascular congestion <10 patients after
Thurston,A.J.; Krause,B.L. 1988 J Hand Surg Br
in carpal tunnel syndrome exclusions
Effect of four computer keyboards in
Tittiranonda,P.; Rempel,D.; Not exclusive to CTS; not
1999 computer users with upper extremity Am J Ind.Med
Armstrong,T.; Burastero,S. best available evidence
musculoskeletal disorders
Incorrect patient
Tobin,S.M. 1967 Carpal tunnel syndrome in pregnancy Am J Obstet.Gynecol. population (<10
patients/group)
+Does not answer a
Tobin,W.E.; Jeffreys,D.E. 1973 Detection of carpal tunnel syndrome Arch Phys Med Rehabil. question of interest;
insufficient data
Median nerve recovery in carpal tunnel no patient oriented
Todnem,K.; Lundemo,G. 2000 Muscle Nerve
syndrome outcomes
clinician deemed
Tolonen,U.; Kallio,M.; A handheld nerve conduction
insufficient methods; lack
Ryhanen,J.; Raatikainen,T.; 2007 measuring device in carpal tunnel Acta Neurol Scand.
of training and proper
Honkala,V.; Lesonen,V. syndrome
reporting
Carpal tunnel release for advanced
disease in patients 70 years and older:
Tomaino,M.M.; Weiser,R.W. 2001 J Hand Surg Br Retrospective case series
does outcome from the patient's
perspective justify surgery?
961
Reason for
Exclusion
Warm or refrigerated local anaesthetic
Deemed clinically
Tomlinson,P.J.; Field,J. 2010 for open carpal tunnel release: a single J Hand Surg Eur.Vol.
irrelevant
blind randomized controlled study
Tommaso,M.; Libro,G.;
Clinical neurophysiology :
Difruscolo,O.; Sardaro,M.; Laser evoked potentials in carpal tunnel +Does not answer a
2009 official.journal of the International
Serpino,C.; Calabrese,R.; syndrome question of interest
Federation of Clinical Neurophysiology
Vecchio,E.; Livrea,P.
Effects of computer keyboarding on
Toosi,K.K.; Impink,B.G.; biomechanical study; no
2011 ultrasonographic measures of the Am J Ind.Med
Baker,N.A.; Boninger,M.L. diagnosis of CTS
median nerve
Torpy,J.M.; Lynm,C.; JAMA patient page. Carpal tunnel
2011 background
Golub,R.M. syndrome
Torrens,M.J. 1995 Endoscopic neurosurgery Neurosurgery Quarterly Background article
Nonsurgical management of carpal
Tortland,P.D. 2003 Techniques in Orthopaedics background
tunnel syndrome
Therapeutic techniques to enhance
Totten,P.A.; Hunter,J.M. 1991 nerve gliding in thoracic outlet Hand Clin Background article
syndrome and carpal tunnel syndrome
Tountas,C.P.; MacDonald,C.J.; Carpal tunnel syndrome. A review of
1983 Minn.Med Very Low Quality
Meyerhoff,J.D.; Bihrle,D.M. 507 patients
Townshend,D.N.; Taylor,P.K.; The outcome of carpal tunnel
2005 J Hand Surg Am Retrospective case series
Gwynne-Jones,D.P. decompression in elderly patients
Electromyographic diagnosis of the insufficient data; very
Toyonaga,K.; DeFaria,C.R. 1978 Arq Neuropsiquiatr.
Tremblay,F.; Mireault,A.C.;
Tactile perception and manual dexterity Not relevant, prevalence
Letourneau,J.; Pierrat,A.; 2002 Somatosens.Mot.Res.
in computer users study
Bourrassa,S.
Carpal tunnel syndrome. A note on
Trimm,A.; Evans,J.H. 1966 Retrospective case series
conservative treatment
Trumble,T.E.; Gilbert,M.; Endoscopic versus open surgical
2001 Neurosurg.Clin N.Am background
McCallister,W.V. treatment of carpal tunnel syndrome
Efficacy of botulinum toxin type a in Incorrect patient
Tsai,C.P.; Liu,C.Y.; Lin,K.P.;
2006 the relief of Carpal tunnel syndrome: A Clin Drug Investig. population (<10
Wang,K.C.
preliminary experience patients)
Electrophysiological study of carpal insufficient data; very
Tseng,C.-H.; Wang,P.-Y. 2000 Acta Neurologica Taiwanica
962
Reason for
Exclusion
Tsou,I.Y.Y.; Khoo,J.N. 2012 Ultrasound of the wrist and hand Ultrasound Clinics Background Information
Palmar bowing of the flexor
Tsujii,M.; Hirata,H.; Morita,A.; retinaculum on wrist MRI correlates insufficient data; very
2009 J Magn Reson.Imaging
Uchida,A. with subjective reports of pain in carpal low study design
tunnel syndrome
Tucker,A.T.; White,P.D.; Comparison of vibration perception
Kosek,E.; Pearson,R.M.; thresholds in individuals with diffuse +Does not answer a
2007
Henderson,M.; Coldrick,A.R.; upper limb pain and carpal tunnel question of interest
Cooke,E.D.; Kidd,B.L. syndrome
Turgut,F.; Cetinsahinahin,M.; The management of carpal tunnel
2001 J Clin Neurosci. answer the PICO
Turgut,M.; Bolukbasi,O. syndrome in pregnancy
question
Turgut,S.T.; Icagasioglu,A.;
electrodiagnostic findings and the DN4 insufficient data; no
Selimoglu,E.; Atlig,R.S.; 2013 Journal of Musculoskeletal Pain
questionnaire in patients with carpal comparison group
Adatepe,T.; Mesci,E.
tunnel syndrome
Reaction time and movement time in
not best available
Turhanoglu,A.D.; Beyazova,M. 2003 patients with carpal tunnel syndrome: Clin Biomech.(Bristol., Avon.)
evidence
an electromyographic study
Median nerve excursion in response to Incorrect patient
Tuzuner,S.; Inceoglu,S.;
2008 wrist movement after endoscopic and J Hand Surg Am population (<10
Bilen,F.E.
open carpal tunnel release patients/group)
Tuzuner,S.; Ozkaynak,S.; Median nerve excursion during
Acikbas,C.; Yildirim,A. endoscopic carpal tunnel release
Tzamaloukas,A.H.;
Kunzelman,C.L.; Carroll,L.L.; Carpel tunnel syndrome in patients on insufficient data; no
1988 Dialysis and Transplantation
Scremin,A.E.; Merlin,T.L.; chronic hemodialysis comparison group
Avasthi,P.S.; Bicknell,J.M.
Proximal slowing of nerve conduction insufficient data; very
Tzeng,S.S.; Wu,Z.A.; Chu,F.L. 1990 Zhonghua Yi Xue Za Zhi (Taipei)
velocity in carpal tunnel syndrome low study design
Uar,B.Y.; -Demirta?-A; Carpal tunnel decompression: two duplicate of
2012 Eur.Rev.Med.Pharmacol.Sci.
Bulut,M.; Azboy,I.; Uar,D. different mini-incision techniques PM:22696883
Electrodiagnostic criteria for carpal
Ubogu,E.E.; Benatar,M. 2006 tunnel syndrome in axonal Muscle Nerve not exclusive to CTS
polyneuropathy
963
Reason for
Exclusion
Comparison of responsiveness of the
Uchiyama,S.; Imaeda,T.;
Japanese Society for Surgery of the
Toh,S.; Kusunose,K.;
Hand version of the carpal tunnel +not best available
Sawaizumi,T.; Wada,T.; 2007 J Orthop Sci
syndrome instrument to surgical evidence
Okinaga,S.; Nishida,J.;
treatment with DASH, SF-36, and
Omokawa,S.
physical findings
Uchiyama,S.; Itsubo,T.; Quantitative MRI of the wrist and nerve
Yasutomi,T.; Nakagawa,H.; 2005 conduction studies in patients with J Neurol Neurosurg.Psychiatry
low study design
Kamimura,M.; Kato,H. idiopathic carpal tunnel syndrome
Reducing neurologic and vascular
Uchiyama,S.; Yasutomi,T.;
complications of endoscopic carpal
Fukuzawa,T.; Nakagawa,H.; 2007 very low quality
tunnel release using a modified chow
Kamimura,M.; Kato,H.
technique
Clinical outcome of carpal tunnel
Uemura,T.; Hidaka,N.;
2010 release with and without opposition J Hand Surg Eur.Vol. very low quality
Nakamura,H.
transfer
Development of a "Neuro-orthosis" for
Ugurlu,U.; Ozkan,M.; the control of wrist movements in
2007 Conf.Proc.IEEE Eng Med Biol.Soc. background
Ozdogan,A.H. patients with carpal tunnel syndrome:
preliminary results
The development of a new orthosis
Ugurlu,U.; Ozkan,M.; (neuro-orthosis) for patients with carpal
2008 Prosthet.Orthot.Int. Very Low Quality
Ozdogan,H. tunnel syndrome: its effect on the
function and strength of the hand
Reasons for using swelling ratio in
Ulasli,A.M.; Duymus,M.;
sonographic diagnosis of carpal tunnel insufficient data; very
Nacir,B.; Rana,Erdem H.; 2013 Muscle Nerve
syndrome and a reliable method for its low study design
Kosar,U.
calculation
Median and cubital nerve compression not exclusive to CTS; no
Umbach,I.; Parent,A. 1990 Journal of Rehabilitation Sciences
in paraplegics unexposed group
Uncini,A.; Di,Muzio A.; Sensitivity of three median-to-ulnar
Awad,J.; Manente,G.; 1993 comparative tests in diagnosis of mild Muscle Nerve
low study design
Tafuro,M.; Gambi,D. carpal tunnel syndrome
Uncini,A.; Di,Muzio A.; Orthodromic median and ulnar fourth
Cutarella,R.; Awad,J.; 1990 digit sensory conductions in mild carpal Neurophysiol.Clin
low study design
Gambi,D. tunnel syndrome
964
Reason for
Exclusion
Uncini,A.; Lange,D.J.; Ring finger testing in carpal tunnel
Solomon,M.; Soliven,B.; 1989 syndrome: a comparative study of Muscle Nerve
low study design
Meer,J.; Lovelace,R.E. diagnostic utility
Reliability of Thai version Boston +Does not answer a
Upatham,S.; Kumnerddee,W. 2008 J Med Assoc Thai.
questionnaire question of interest
The double crush in nerve entrapment
Upton,A.R.; McComas,A.J. 1973 not relevant
syndromes
Upton,J.; Littler,J.W.;
1979 Primary care of the injured hand, part 2 Postgrad.Med Background information
Eaton,R.G.
Office diagnosis and treatment of hand
Urbaniak,J.R.; Roth,J.H. 1982 Orthop Clin North Am Background Information
pain
Comparing the results of limited
incision technique and standard
Uygur,F.; Sever,C.; Yuksel,F. 2009 longitudinal incision technique for Turk Neurosurg. very low quality
carpal tunnel decompression by
numerical grading system
Uzar,E.; Tamam,Y.; Acar,A.;
Sensitivity and specificity of terminal
Yucel,Y.; Palanci,Y.; insufficient data; no
2011 latency index and residual latency in the Eur.Rev.Med Pharmacol.Sci
Cansever,S.; Cevik,M.U.; comparison group
Tasdemir,N.
Study of the ulnar nerve compromise at
Vahdatpour,B.; Raissi,G.R.; Not relevant, prevalence
2007 the wrist of patients with carpal tunnel Electromyogr.Clin Neurophysiol.
Hollisaz,M.T. study
syndrome
Generic health instruments do not
Vaile,J.H.; Mathers,D.M.; comprehensively capture patient
1999 J Rheumatol. Very Low Quality
Ramos-Remus,C.; Russell,A.S. perceived improvement in patients with
Hyperparathyroidism due to parathyroid
Valenta,L.J. 1975 Ann.Intern.Med case report
adenoma and carpal tunnel syndrome
Orthodromic study of the sensory fibers insufficient data; very
Valls,J.; Llanas,J.M. 1988 Muscle Nerve
innervating the fourth finger low study design
Limited longitudinal sliding of the
Valls-Sole,J.; Alvarez,R.; insufficient data; very
1995 median nerve in patients with carpal Muscle Nerve
Nunez,M. low study design
tunnel syndrome
Operative Techniques in Plastic and
Van Beek,A.L.; Lim,P. 2003 Nerve compressions syndromes Background Information
Reconstructive Surgery
965
Reason for
Exclusion
Outcome of open versus endoscopic
van den Bekerom,M.P.;
2006 approach for the surgical treatment of Acta Orthop Belg. very low quality
Breemans,E.; Schaffer,K.
Indications for requesting laboratory
van Dijk,M.A.; Reitsma,J.B.; tests for concurrent diseases in patients
2003 Clin Chem. systematic review
Fischer,J.C.; Sanders,G.T. with carpal tunnel syndrome: a
systematic review
Median nerve deformation in
van Doesburg,M.H.;
differential finger motions:
Henderson,J.; Yoshii,Y.; Mink insufficient data; very
2012 ultrasonographic comparison of carpal J Orthop Res.
van der Molen AB; Cha,S.S.; low study design
tunnel syndrome patients and healthy
An,K.N.; Amadio,P.C.
controls
Associations between work-related
van Rijn,R.M.; Huisstede,B.M.;
2009 factors and the carpal tunnel syndrome- Scand.J Work Environ.Health systematic review
Koes,B.W.; Burdorf,A.
-a systematic review
Van Ypersele de,Strihou C.; Effect of dialysis membrane and Does not answer a
Jadoul,M.; Malghem,J.; 1991 patient's age on signs of dialysis-related Kidney Int. question of interest; no
Maldague,B.; Jamart,J. amyloidosis comparison group
bio-study; no comparison
Vanwijck,R.; Bouillenne,C. 1986 HL-A and carpal tunnel syndrome Clin Rheumatol.
group
Failed endoscopic carpal tunnel release. Incorrect patient
Varitimidis,S.E.; Herndon,J.H.;
1999 Operative findings and results of open J Hand Surg Br population (pre-existing
Sotereanos,D.G.
revision surgery invasive treated patients)
Vasen,A.P.; Kuntz,K.M.; Open versus endoscopic carpal tunnel
1999 J Hand Surg Am Decision analysis study
Simmons,B.P.; Katz,J.N. release: a decision analysis
Vasiliadis,H.S.; Georgoulas,P.;
Endoscopic release for carpal tunnel
Shrier,I.; Salanti,G.; 2014 Cochrane Database Syst.Rev. Systematic review
syndrome
Scholten,R.J.
Vasiliadis,H.S.; Xenakis,T.A.;
Mitsionis,G.; Paschos,N.; 2010 very low quality
release
Georgoulis,A.
Vasiliadis,Haris S.;
Georgoulas,Petros; Shrier,Ian; Endoscopic release for carpal tunnel Cochrane Database of Systematic
Salanti,Georgia; Scholten- syndrome Reviews
Rob,J.P.M.
966
Reason for
Exclusion
Vasiliadis,Haris S.;
Sakellaridou,Maria Eleni; Open release for carpal tunnel Cochrane Database of Systematic
Shrier,Ian; Salanti,Georgia; syndrome Reviews
Scholten-Rob,J.P.M.
Postoperative complications of carpal
Vaughan,N.M.; Pease,W.S. 1997 Phys.Med.Rehabil.Clin.N.Am. Case report
tunnel surgery
Vellani,G.; Dallari,D.;
Carpal tunnel syndrome in
Fatone,F.; Martella,D.; 1993 Chir Organi Mov no control group
hemodialyzed patients
Bonomini,V.; Gualtieri,G.
Verdugo,R.J.; Salinas,R.A.; Surgical versus non-surgical treatment
Castillo,J.L.; Cea,J.G. for carpal tunnel syndrome
Verghese,J.;
Autonomic dysfunction in idiopathic all CTS cases; no
Galanopoulou,A.S.; 2000 Muscle Nerve
carpal tunnel syndrome comparison group
Herskovitz,S.
Verhagen,A.P.; Karels,C.;
Ergonomic and physiotherapeutic
Bierma-Zeinstra,S.M.;
interventions for treating work-related
Feleus,A.; Dahaghin,S.; 2007 Eura.Medicophys. Not relevant to CTS
complaints of the arm, neck or shoulder
Burdorf,A.; de Vet,H.C.;
in adults. A Cochrane systematic review
Koes,B.W.
Verhagen,A.P.; Karels,C.;
Exercise proves effective in a
Bierma-Zeinstra,S.M.;
2007 systematic review of work-related J Clin Epidemiol. systematic review
Feleus,A.; Dahaghin,S.;
complaints of the arm, neck, or shoulder
Burdorf,A.; Koes,B.W.
Carpal arch alteration and related
Viegas,S.F.; Pollard,A.; Does not address
1992 clinical status after endoscopic carpal J Hand Surg Am
Kaminksi,K. question of interest
tunnel release
Viera,A.J. 2003 Management of carpal tunnel syndrome Am Fam Physician Background article
Median and ulnar nerve conduction
measurements in patients with
Vinik,A.I.; Emley,M.S.;
2004 symptoms of diabetic peripheral Diabetes Technology and Therapeutics Not relevant to CTS
Megerian,J.T.; Gozani,S.N.
neuropathy using the NC-
Stat(registered trademark) system
Dose-response relation between
exposure to two types of hand-arm
Virokannas,H. 1995 Occup.Environ.Med Not relevant to CTS
vibration and sensorineural perception
of vibration
967
Reason for
Exclusion
Vibration perception thresholds in Does not answer a
Virokannas,H. 1992 Int.Arch Occup.Environ.Health
workers exposed to vibration question of interest
High-resolution sonography versus insufficient data; healthy
Visser,L.H.; Smidt,M.H.;
2008 EMG in the diagnosis of carpal tunnel J Neurol Neurosurg.Psychiatry controls used for
Lee,M.L.
syndrome comparison
Sonographic follow-up of patients with
Vogelin,E.; Nuesch,E.; Juni,P.;
carpal tunnel syndrome undergoing no patient oriented
Reichenbach,S.; Eser,P.; 2010 J Hand Surg Am
surgical or nonsurgical treatment: outcomes
Ziswiler,H.R.
prospective cohort study
Clinical outcome and predictive value
Vogt,T.; Scholz,J. 2002 of electrodiagnostics in endoscopic Neurosurg.Rev. very low quality
carpal tunnel surgery
Voitk,A.J.; Mueller,J.C.; Does not address
1983 Carpal tunnel syndrome in pregnancy Can Med Assoc J
Farlinger,D.E.; Johnston,R.U. question of interest
Upper extremity kinetics in poultry <10 patients per group;
Waddell,D.E.; Wyvill,C.;
2003 processing: A comparison between two Journal of Applied Biomechanics does not answer a
Gregor,R.J.
different cutting tasks question of interest
Carpal tunnel syndrome. A patient's
Wade,J. 1976 Nurs.Mirror Midwives J background
view
Reoperation for carpal tunnel Incorrect patient
Wadstroem,J.; Nigst,H. 1986 syndrome. A retrospective analysis of Ann.Chir Main population (pre-existing
forty cases surgical intervention)
Waegeneers,S.; Haentjens,P.; Operative treatment of carpal tunnel
1993 Acta Orthop Belg. Retrospective case series
Wylock,P. syndrome
Computer work and musculoskeletal
Waersted,M.; Hanvold,T.N.;
2010 disorders of the neck and upper BMC Musculoskelet.Disord. Not relevant to CTS
Veiersted,K.B.
extremity: a systematic review
Wahbeh,H.; Elsas,S.M.; Mind-body interventions: applications
2008 Not relevant to CTS
Oken,B.S. in neurology
Wainapel,S.F.; Davis,L.; Electrodiagnostic study of carpal tunnel all CTS cases; no
1981 Am J Phys Med
Rogoff,J.B. syndrome after Colles fracture comparison group
Walker,F.O.; Cartwright,M.S.; Prevalence of bifid median nerves and
Blocker,J.N.; Arcury,T.A.; 2013 persistent median arteries and their Muscle Nerve
study
Suk,J.I.; Chen,H.; association with carpal tunnel syndrome
968
Reason for
Exclusion
Schultz,M.R.; Grzywacz,J.G.; in a sample of Latino poultry processors
Mora,D.C.; Quandt,S.A. and other manual workers
An evaluation of provocative testing in +not best available

Walters,C.; Rice,V. 2002 Mil.Med
the diagnosis of carpal tunnel syndrome evidence
Transcarpal motor conduction velocity insufficient data; very
Walters,J.L.; Murray,N.M.F. 2001 Muscle Nerve
in carpal tunnel syndrome low study design
Transcarpal motor conduction velocity no comparison group or
Walters,R.J.; Murray,N.M. 2001 Muscle Nerve
in carpal tunnel syndrome reference standard
Carpal tunnel syndrome in pregnancy
Wand,J.S. 1990 J Hand Surg Br Very low quality
and lactation
The natural history of carpal tunnel
Wand,J.S. 1989 J R Soc.Med Retrospective case series
syndrome in lactation
Bilateral simultaneous open carpal
Wang,A.A.; Hutchinson,D.T.; tunnel release: a prospective study of
2003 J Hand Surg Am Very low quality
Vanderhooft,J.E. postoperative activities of daily living
and patient satisfaction
Wang,A.A.; Whitaker,E.; Pain levels after injection of
2003 Am J Orthop (Belle.Mead NJ) Not exclusive to CTS
Hutchinson,D.T.; Coleman,D.A. corticosteroid to hand and elbow
Wang,A.K.; Raynor,E.M.; Heat sensitivity of sensory fibers in +Does not answer a
1999 Muscle Nerve
Blum,A.S.; Rutkove,S.B. carpal tunnel syndrome question of interest
Carpal tunnel syndrome assessed with
Wang,C.K.; Jou,I.M.;
diffusion tensor imaging: comparison insufficient data; very
Huang,H.W.; Chen,P.Y.; 2012 Eur.J Radiol.
with electrophysiological studies of low study design
Tsai,H.M.; Liu,Y.S.; Lin,C.C.
patients and healthy volunteers
Wang,L.Y.; Leong,C.P.; Best diagnostic criterion in high-
Huang,Y.C.; Hung,J.W.; 2008 resolution ultrasonography for carpal Chang Gung Med J
low study design
Cheung,S.M.; Pong,Y.P. tunnel syndrome
Improvement of Diagnostic Rate of
Carpal Tunnel Syndrome with insufficient data; very
Wang,Y.J.; Yan,S.H. 2013 Acta Neurol Taiwan
Additional Median-to-ulnar low study design
Comparative Nerve Conduction Studies
Clinical management of carpal tunnel
+not best available
Waring III,W.P.; Werner,R.A. 1989 syndrome in patients with long-term Journal of Hand Surgery
evidence
sequelae of poliomyelitis
969
Reason for
Exclusion
Clinical management of carpal tunnel
Waring,W.P.,III; Werner,R.A. 1989 syndrome in patients with long-term J Hand Surg Am very low study design
sequelae of poliomyelitis
Watanabe,T.; Sakakibara,N.;
Effect of long-term physical exercise of
Sugimori,H.; Yabumoto,T.; Does not answer a
2012 peripheral nerve: comparison of nerve J Sports Med Phys Fitness
Takeyama,T.; Takemura,M.; question of interest
conduction study and ultrasonography
Seishima,M.; Matsuoka,T.
Watson,B.V.; Brown,W.F.; Frequency-dependent conduction block insufficient data; very
2006 Muscle Nerve
Doherty,T.J. in carpal tunnel syndrome low study design
Mixed median nerve forearm
Watson,J.; DiBenedetto,M.; conduction velocity in the presence of insufficient data; very
Gale,S.D. focal compression neuropathy at the low study design
wrist versus peripheral neuropathy
Predictors of normal electrodiagnostic
insufficient information;
Watson,J.; Zhao,M.; Ring,D. 2010 testing in the evaluation of suspected J Hand Microsurg.
Nonarthritic inflammatory problems of
Watson,Jr 1985 Emerg.Med.Clin.North Am. background
the hand and wrist
The use of a fine-gauge needle to
reduce pain in open carpal tunnel Deemed clinically
Watts,A.C.; McEachan,J. 2005 J Hand Surg Br
decompression: a randomized irrelevant
controlled trial
Common pain syndromes: upper
Webber,J.B. 1981 background
extremities
Consecutive versus simultaneous
Weber,R.A.; Boyer,K.M. 2005 Ann.Plast.Surg Very low quality
bilateral carpal tunnel release
Weber,R.A.; DeSalvo,D.J.; Five-year follow-up of carpal tunnel
Rude,M.J. release in patients over age 65
Clinical outcomes of carpal tunnel
Weber,R.A.; Rude,M.J. 2005 J Hand Surg Am very low quality
release in patients 65 and older
Carpal tunnel syndrome: comparison of
the compound muscle action potentials insufficient data; very
Wee,A.S. 2006 Electromyogr.Clin Neurophysiol.
recorded at the thenar region from ulnar low study design
and median nerve stimulation
970
Reason for
Exclusion
very low study design;
Needle electromyography in carpal
Wee,A.S. 2002 Electromyogr.Clin Neurophysiol. recruitment based on test
tunnel syndrome
results
Carpal tunnel syndrome: a system for
Wee,A.S. 2001 categorizing and grading Electromyogr.Clin Neurophysiol. no CTS
electrophysiologic abnormalities
Noninvasive laser neurolysis in carpal
Weintraub,M.I. 1997 Muscle Nerve Very Low Quality
tunnel syndrome
Changing concepts in the diagnosis and
Weirich,S.D.; Gelberman,R.H. 1993 Current Orthopaedics background
Weis,S.; Stransky,G.;
Morphometric analysis of collagen
Dimitrov,L.; Wenger,E.;
1987 fibrils in idiopathic carpal tunnel Exp.Cell Biol. biopsy; <10 patients
Neumuller,J.; Hakimzadeh,A.;
syndrome: Part 2
Firneis,F.; Partsch,G.; Eberl,R.
Weiss,A.P.; Akelman,E. 1992 Carpal tunnel syndrome: a review R I Med review
Conservative management of carpal
Weiss,A.P.; Sachar,K.;
1994 tunnel syndrome: a reexamination of J Hand Surg Am Very Low Quality
Gendreau,M.
steroid injection and splinting
High-field MR surface-coil imaging of
Weiss,K.L.; Beltran,J.;
1986 the hand and wrist. Part II. Pathologic <10 patients per group
Lubbers,L.M.
correlations and clinical relevance
Work-related carpal tunnel syndrome
Wellman,H.; Davis,L.; (WR-CTS) in Massachusetts, 1992- all CTS cases; no
2004 Am J Ind.Med
Punnett,L.; Dewey,R. 1997: source of WR-CTS, outcomes, comparison group
and employer intervention practices
Werner,C.O.; Elmqvist,D.; Pressure and nerve lesion in the carpal insufficient data; no
1983 Acta Orthop Scand.
Ohlin,P. tunnel comparison group
Relation between needle
electromyography and nerve conduction
Werner,R.A.; Albers,J.W. 1995 Arch Phys Med Rehabil. insufficient data
studies in patients with carpal tunnel
syndrome
The relationship between body mass
Werner,R.A.; Albers,J.W.; Not relevant, prevalence
1994 index and the diagnosis of carpal tunnel Muscle Nerve
Franzblau,A.; Armstrong,T.J. study
syndrome
Werner,R.A.; Bir,C.; Reverse Phalen's maneuver as an aid in insufficient data; no
Armstrong,T.J. diagnosing carpal tunnel syndrome comparison group
971
Reason for
Exclusion
Influence of body mass index and work
Werner,R.A.; Franzblau,A.; Not relevant, CTS
1997 activity on the prevalence of median Occup.Environ.Med.
Albers,J.W.; Armstrong,T.J. diagnosis not made
mononeuropathy at the wrist
Werner,R.A.; Franzblau,A.; Use of screening nerve conduction
Albers,J.W.; Buchele,H.; 1997 studies for predicting future carpal Occup.Environ.Med. Very low study design
Armstrong,T.J. tunnel syndrome
Prolonged median sensory latency as a
Werner,R.A.; Gell,N.; Does not answer a
2001 predictor of future carpal tunnel Muscle Nerve
Franzblau,A.; Armstrong,T.J. question of interest
syndrome
Influence of body mass index on
Werner,R.A.; Jacobson,J.A.; median nerve function, carpal canal
2004 Muscle Nerve answer the PICO
Jamadar,D.A. pressure, and cross-sectional area of the
question
median nerve
Does the presence of the palmaris
Werner,R.A.; Spiegelberg,T. 2012 longus tendon influence median nerve Muscle Nerve
low study design
function?
Compression mononeuropathies in the
Werner,R.A.; Waring,W.P.; European Journal of Physical Medicine Not relevant, prevalence
1993 post-polio population: A cross-sectional
Maynard,F.M. and Rehabilitation study
study
Median nerve anatomy and entrapment
Wertsch,J.J.; Melvin,J. 1982 Arch Phys Med Rehabil. Background Information
syndromes: a review
Westbrook,A.P.; The rapid exchange grip strength test
Does not address
Tredgett,M.W.; Davis,T.R.; 2002 and the detection of submaximal grip J Hand Surg Am
Oni,J.A. effort
Palmar cold threshold test and median
Westerman,R.A.; Delaney,C.A. 1991 nerve electrophysiology in carpal tunnel Clin Exp.Neurol
low study design
compression neuropathy
On the use of upper extremity proximal
nerve action potentials in the insufficient data; very
White,J.C. 1997 Electromyogr.Clin Neurophysiol.
localization of focal nerve lesions low study design
producing axonotmesis
A comparison of EMG procedures in
White,J.C.; Hansen,S.R.; insufficient data; no
1988 the carpal tunnel syndrome with Muscle Nerve
Johnson,R.K. confirmed diagnosis
clinical-EMG correlations
White,R. 1984 Pain in the upper limb Aust.Fam Physician background
Carpal tunnel syndrome. A guide to
Whitley,J.M.; McDonnell,D.E. 1995 Postgrad.Med background
prompt intervention
972
Reason for
Exclusion
Wi,S.M.; Gong,H.S.; Bae,K.J.; Responsiveness of the Korean version already CTS patients;
Roh,Y.H.; Lee,Y.H.; 2014 of the Michigan Hand Outcomes Clin Orthop Surg responsiveness not
Baek,G.H. Questionnaire after carpal tunnel release diagnosis
Wiederien,R.C.; Feldman,T.D.;
The effect of the median nerve
Heusel,L.D.; Loro,W.A.;
2002 compression test on median nerve Electromyogr.Clin Neurophysiol. <10 patients per group
Moore,J.H.; Ernst,G.P.;
conduction across the carpal tunnel
Allison,S.C.
Carpal tunnel syndrome (CTS) and
Wieslander,G.; Norback,D.; exposure to vibration, repetitive wrist not best available
1989 Br J Ind.Med
Gothe,C.J.; Juhlin,L. movements, and heavy manual work: a evidence
case-referent study
Wiesler,E.R.; Chloros,G.D.;
The use of diagnostic ultrasound in insufficient data; very
Cartwright,M.S.; Smith,B.P.; 2006 J Hand Surg Am
Rushing,J.; Walker,F.O.
Wiesman,I.M.; Novak,C.B.; Sensitivity and specificity of clinical +not best available
2003 Can J Plast.Surg
Mackinnon,S.E.; Winograd,J.M. testing for carpal tunnel syndrome evidence
Desk-edge syndrome: Median nerve insufficient data; no
Wigley,R.D. 2004 APLAR Journal of Rheumatology
injury proximal to the carpal tunnel comparison group
Wilder Smith,E.P.; Chan,Y.H.; Medial thenar recording in normal insufficient data; very
Kannan,T.A. subjects and carpal tunnel syndrome low study design
Wilder-Smith,E.P.; Ng,E.S.; Sensory distribution indicates severity
Chan,Y.H.; 2008 of median nerve damage in carpal Clin Neurophysiol.
comparison group
Therimadasamy,A.K. tunnel syndrome
Wilkinson,M.; Grimmer,K.; Ultrasound of the carpal tunnel and Journal of Diagnostic Medical only healthy study
2001
Massy-Westropp,N. median nerve: A reproducibility study Sonography subjects
Williams,A.M.; Baker,P.A.; The impact of dressings on recovery
2008 J Plast.Reconstr.Aesthet.Surg Very low quality
Platt,A.J. from carpal tunnel decompression
WRULDs: Encouraging an ergonomic
Williams,N. 1993 Occup.Health (Lond). Background information
approach
Williams,T.M.;
Verification of the pressure provocative insufficient data; very
Mackinnon,S.E.; Novak,C.B.; 1992 Ann.Plast.Surg
test in carpal tunnel syndrome low study design
McCabe,S.; Kelly,L.
Upper extremity complications in Background Information;
Wilson,G. 1998 Dialysis and Transplantation
hemodialysis patients: review
973
Reason for
Exclusion
Recommendations and a review of the
literature
Immediate surgery is the treatment of
Wilson,J.R.; Sumner,A.J. 1995 Muscle Nerve editorial
choice for carpal tunnel syndrome
Diurnal variation in nerve conduction,
Wilson-MacDonald,J.;
1984 hand volume, and grip strength in the Br Med J (Clin Res.Ed) <10 patients per group
Caughey,M.A.; Myers,D.B.
Vibration thresholds as a function of
Winn,F.J.,Jr.; Putz-Anderson,V. 1990 age and diagnosis of carpal tunnel Exp.Aging Res.
low study design
syndrome: a preliminary report
Cross-sectional comparison of nerve
conduction and vibration threshold
Winn,F.J.; Morrissey,S.J.; testing: do screening tools for insufficient data; very
2000 Disabil.Rehabil.
Huechtker,E.D. occupationally induced cumulative low study design
trauma disorders result in differing
outcomes?
Carpal tunnel area as a risk factor for
Winn,Jr; Habes,D.J. 1990 Muscle Nerve answer the PICO
question
Cross-sectional differences in nerve
Winn,Jr; Morrissey,S.J.; Does not answer a
1999 conduction in the Carpal tunnel Journal of Occupational Rehabilitation
Huechkter,E.D. question of interest
syndrome
examines the effect of
Vibration thresholds as a function of CTS on vibration
Winn,Jr; Putz-Anderson,V. 1990 age and diagnosis of carpal tunnel Exp.Aging Res. threshold, instead of the
syndrome: A preliminary report effect of vibration
threshold on CTS risk
Orthopedic problems of the upper
Winzeler,S.; Rosenstein,B.D. 1997 AAOHN J. background
extremities: Assessment and diagnosis
Carpal tunnel syndrome-try these Background Information;
Wipperman,J.; Potter,L. 2012 J Fam Pract.
diagnostic maneuvers case reports
Resection of the hook of the hamate. Its
Does not address
Wissinger,H.A. 1975 place in the treatment of median and Plast.Reconstr.Surg
ulnar nerve entrapment in the hand
974
Reason for
Exclusion
One approach to acumoxa therapy for
Wolfe,H.L. 1995 pain due to tendinitis of the hand, wrist, American Journal of Acupuncture Case report
and forearm
Won,S.J.; Kim,B.J.; Park,K.S.; Reference values for nerve only healthy study
2013 Muscle Nerve
Yoon,J.S.; Choi,H. ultrasonography in the upper extremity subjects
Successful management of female
office workers with "repetitive stress
Wong,E.; Lee,G.;
1995 injury" or "carpal tunnel syndrome" by Int.J Clin Pharmacol.Ther Very Low Quality
Zucherman,J.; Mason,D.T.
a new treatment modality--application
of low level laser
Wong,K.C.; Hung,L.K.; Journal of Bone and Joint Surgery - duplicate of
2003 Carpal tunnel release
Ho,P.C.; Wong,J.M.W. Series B PM:12931807
Wong,K.H.; Huq,N.S.;
2013 Hand surgery using local anesthesia Clin Plast.Surg Background article
Nakhooda,A.
Wong,S.M.; Griffith,J.F.; Discriminatory sonographic criteria for insufficient data; very
2002 Arthritis Rheum.
Hui,A.C.; Tang,A.; Wong,K.S. the diagnosis of carpal tunnel syndrome low study design
Wongsam,P.E.; Johnson,E.W.; Carpal tunnel syndrome: use of palmar insufficient data; very
Weinerman,J.D. stimulation of sensory fibers low study design
Hydrocortisone injections for carpal
Wood,M.R. 1980 Very Low Quality
tunnel syndrome
Double-crush nerve compression in no comparison group; not
Wood,V.E.; Biondi,J. 1990 J Bone Joint Surg Am
thoracic-outlet syndrome CTS exclusive
Worseg,A.P.; Kuzbari,R.;
Korak,K.; Hocker,K.; Endoscopic carpal tunnel release using
1996 Br J Plast.Surg very low quality
Wiederer,C.; Tschabitscher,M.; a single-portal system
Holle,J.
Carpal tunnel syndrome in the +Does not answer a
Wraith,J.E.; Alani,S.M. 1990 mucopolysaccharidoses and related Arch Dis Child question of interest; very
disorders low study design
The synovial flap as treatment of the
Wulle,C. 1996 Hand Clin Retrospective case series
recurrent carpal tunnel syndrome
Treatment of recurrence of the carpal
Wulle,C. 1987 Ann.Chir Main Retrospective case series
tunnel syndrome
Wyatt,M.C.; Gwynne- Lamb boning -- an occupational cause confounded comparisons;
Jones,D.P.; Veale,G.A. of carpal tunnel syndrome? conflict of interest
975
Reason for
Exclusion
Treatment for carpal tunnel syndrome
Inadequate reporting and
Xu,L.; Huang,F.; Hou,C. 2011 by coronal Z-type lengthening of the J Pak.Med Assoc
use of unvalidated scales.
transverse carpal ligament
The upper extremity neuropathies in
Yalcin,E.; Onder,B.; Selcuk,B.; turkish wheelchair users and the
Does not answer a
Ozer,N.; Kurtaran,A.; 2013 additive/alternative value of Neurosurgery Quarterly
Yildirim,M.O.; Akyuz,M. ultrasonography to the evaluation of
entrapments
The upper extremity neuropathies in
Yalcin,E.; Onder,B.; Selcuk,B.; turkish wheelchair users and the
prevalence study; not
Ozer,N.; Kurtaran,A.; 2014 additive/alternative value of Neurosurgery Quarterly
CTS exclusive
Yildirim,M.O.; Akyuz,M. ultrasonography to the evaluation of
entrapments
Median nerve cross-sectional area and
only healthy study
Yao,L.; Gai,N. 2009 MRI diffusion characteristics: Skeletal Radiol.
subjects
normative values at the carpal tunnel
Yassi,A. 2000 Work-related musculoskeletal disorders Curr.Opin.Rheumatol. Background Information
Physiological observations in the Incorrect patient
Yates,S.K.; Hurst,L.N.;
1981 median nerve during carpal tunnel Ann.Neurol population (N<10
Brown,W.F.
surgery patients)
Relative preservation of lumbrical +Does not answer a
Yates,S.K.; Yaworski,R.;
1981 versus thenar motor fibres in J Neurol Neurosurg.Psychiatry question of interest; not
Brown,W.F.
neurogenic disorders CTS exclusive
Yazgan,P.; Simsek,Z.; Orhan,I.; The reliability and cross-cultured
+Does not answer a
Beachy,L.; Ozul,Y.; 2009 adaptation of the Boston questionnaire; Turkish Journal of Rheumatology
Kurcer,M.A. in Turkish illiterate patients
Yemisci,O.U.; Yalbuzdag,S.A.;
Ulnar nerve conduction abnormalities in insufficient data; very
Cosar,S.N.; Oztop,P.; 2011 Muscle Nerve
Karatas,M.
Comparison of the results of open
Yeo,K.Q.; Yeo,E.M. 2007 carpal tunnel release and KnifeLight Singapore Med J very low quality
Comparison of the results of open
carpal tunnel release and
Yeo,K.Q.; Yeo,E.M.N. 2007 Singapore Med.J. duplicate reference
KnifeLight(registered trademark) carpal
tunnel release
976
Reason for
Exclusion
Yesildag,A.; Kutluhan,S.;
The role of ultrasonographic
Sengul,N.; Koyuncuoglu,H.R.; insufficient data; very
2004 measurements of the median nerve in Clin Radiol.
Oyar,O.; Guler,K.; low study design
Gulsoy,U.K.
Carpal ligament decompression under
local anaesthesia: the effect of lidocaine Deemed clinically
Yiannakopoulos,C.K. 2004 J Hand Surg Br
warming and alkalinisation on irrelevant
infiltration pain
A study of the dynamic relationship of
Yii,N.W.; Elliot,D. 1994 the lumbrical muscles and the carpal J Hand Surg Br case report
tunnel
Yilmaz,N.; Akdemir,G.;
Electrophysiological and clinical
Gezici,A.R.; Basmaci,M.;
2010 assessment of response to surgery in Int.J Neurosci. very low quality
Ergungor,M.F.; Asalanturk,Y.;
carpal tunnel
Beskonakli,E.; Ucar,D.
Nerve cross-sectional area reference
Yoon,J.S.; Won,S.J.;
2012 values in upper extremity Muscle Nerve abstract; no text
Yang,S.N.; Kang,H.J.
ultrasonography
Yorulmaz,S.; Turk,U.; Carpal tunnel syndrome in pregnancy:
1994 Journal of Maternal-Fetal Investigation Very low quality
Yorulmaz,F. A prospective clinical study
+Does not answer a
Yoshida,A.; Okutsu,I.; A new diagnostic provocation test for
2010 Hand Surg question of interest;
Hamanaka,I. carpal tunnel syndrome: Okutsu test
insufficient data
Results of endoscopic management of
Yoshida,A.; Okutsu,I.; primary versus recurrent carpal tunnel
2004 Hand Surg very low quality
Hamanaka,I.; Motomura,T. syndrome in long-term haemodialysis
patients
Median nerve deformation during finger
motion in carpal tunnel syndrome: insufficient data; very
Yoshii,Y.; Ishii,T.; Sakai,S. 2013 Hand Surg
correlation between nerve conduction low study design
and ultrasonographic indices
Median nerve deformation and
Yoshii,Y.; Ishii,T.; Tung,W.L.; insufficient data; very
2013 displacement in the carpal tunnel during J Orthop Res.
Sakai,S.; Amadio,P.C. low study design
finger motion
Meta-analysis: association between
You,D.; Smith,A.H.;
2014 wrist posture and carpal tunnel Saf Health Work meta-analysis
Rempel,D.
syndrome among workers
977
Reason for
Exclusion
Relationships between clinical
You,H.; Simmons,Z.;
symptom severity scales and nerve +Does not answer a
Freivalds,A.; Kothari,M.J.; 1999 Muscle Nerve
conduction measures in carpal tunnel question of interest
Naidu,S.H.
syndrome
Young,V.L.; Seaton,M.K.;
Feely,C.A.; Arfken,C.; Detecting cumulative trauma disorders
1995 Am.J.Ind.Med. Not relevant to CTS
Edwards,D.F.; Baum,C.M.; in workers performing repetitive tasks
Logan,S.
Younger,D.S. 2004 Entrapment neuropathies Primary Care - Clinics in Office Practice background
Effects of low power infra-red laser
Archives of Physical Medicine and Insufficient data
Ysla,R.; McAuley,R. 1985 stimulation on carpal tunnel syndrome:
Rehab (conference abstract)
a double blind study
Yu,J.; Bendler,E.M.; Neurological disorders associated with all CTS cases; no
Mentari,A. carpal tunnel syndrome comparison group
Erratum to "Sonographic findings of the
Yucel,A.; Yilmaz,O.; median nerve and prevalence of carpal Does not answer a
Babaoglu,S.; Acar,M.; 2008 tunnel syndrome in patients with Eur.J Radiol. question of interest;
Degirmenci,B. Parkinson's disease" [Eur. J. Radiol. 67 prevalence study
(3) (2008) 546-550]
Erratum to "Sonographic findings of the
median nerve and prevalence of carpal
Yucel,A.; Yilmaz,O.;
tunnel syndrome in patients with duplicate of pmid
Babaoglu,S.; Acar,M.; 2008 Eur.J.Radiol.
Parkinson's disease" [Eur. J. Radiol. 67 19189431
Degirmenci,B.
(3) (2008) 546-550]
(DOI:10.1016/j.ejrad.2007.08.001)
Yuen,A.; Dowling,G.;
Carpal tunnel syndrome in children <10 patients per group;
Johnstone,B.; Kornberg,A.; 2007 J Child Neurol
with mucopolysaccaridoses no comparison group
Coombs,C.
Idiopathic carpal tunnel syndrome.
Zagnoli,F.; Andre,V.; Le,Dreff Clinical, electrodiagnostic, and insufficient data; very
1999 Rev.Rhum.Engl.Ed
P.; Garcia,J.F.; Bellard,S. magnetic resonance imaging low study design
correlations
Value of contemporary investigation
Zaher,A.A.; Mattar,M.A.; Egyptian Journal of Neurology, insufficient data; no
2012 tools in management of carpal tunnel
Gomaa,M.; Zaher,A.A. Psychiatry and Neurosurgery comparison group
syndrome
978
Reason for
Exclusion
Rates of carpal tunnel syndrome,
+Does not answer a
Zakaria,D. 2004 epicondylitis, and rotator cuff claims in Chronic Dis Can
Ontario workers during 1997
Zalaffi,A.; Mariottini,A.; Wrist median nerve motor conduction
Carangelo,B.; Buric,J.; after end range repeated flexion and +Does not answer a
2005 Acta Neurochir.Suppl
Muzii,V.F.; Alexandre,A.; extension passive movements in Carpal question of interest
Palma,L.; Rovere,A. Tunnel Syndrome. Pilot study
Zambelis,T.; Tsivgoulis,G.; Carpal tunnel syndrome: associations all CTS cases; no
2010 Eur.Neurol
Karandreas,N. between risk factors and laterality comparison group
Oxygen-ozone treatment of carpal
Zambello,A.; Fumagalli,L.; tunnel syndrome. Retrospective study
2008 International Journal of Ozone Therapy Narrative review
Fara,B.; Bianchi,M.M. and literature review of conservative
and surgical techniques
Extra-median spread of sensory
Zanette,G.; Marani,S.; symptoms in carpal tunnel syndrome all CTS cases; no
2006
Tamburin,S. suggests the presence of pain-related comparison group
mechanisms
Erratum: Acupuncture treatment for
carpal tunnel syndrome (Medical Not a study (correction of
Zavela 2011 Medical Acupuncture
Acupuncture (2010) 22: 4 (276) DOI: a study)
10.1089/acu.2010.0752)
Zaza,C.; Fleiszer,M.S.; Beating injury with a different review; not a full
2000 Medical Problems of Performing Artists
Maine,F.W.; Mechefske,C. drumstick: A pilot study structured study
Hand and wrist disorders: How to
Zelouf,D.S.; Posner,M.A. 1995 Background Information
manage pain and improve function
not best available
evidence for most risk
factors. the workstation
analysis for work risk
Carpal tunnel syndrome and other
International Journal of Industrial factors was not
Zetterberg,C.; Ofverholm,T. 1999 wrist/hand symptoms and signs in male
Ergonomics adequately presented for
and female car assembly workers
inclusion in the guideline.
this analysis was more
fully presented in another
paper
979
Reason for
Exclusion
+Does not answer a
Zhang,W.; Johnston,J.A.;
Effects of carpal tunnel syndrome on question of interest;
Ross,M.A.; Sanniec,K.;
2013 dexterous manipulation are grip type- PLoS One Investigates development
Gleason,E.A.; Dueck,A.C.;
dependent of comorbidity rather
Santello,M.
than CTS development
The value of power and pulsed Doppler
Zidan,S.; Tantawy,H.; Egyptian Journal of Radiology and insufficient data; very
2013 in the diagnosis of CTS: Is a solution in
Fouda,N.; Ali,M. Nuclear Medicine low study design
sight
Zimmerman,G.R. 1994 Carpal tunnel syndrome J Athl.Train. background
Magnetic resonance imaging of the
Zlatkin,M.B.; Greenan,T. 1992 Magn Reson.Q. background
wrist
Zuo,D.; Zhou,Z.; Wang,H.;
release for idiopathic carpal tunnel
Liao,Y.; Zheng,L.; Hua,Y.; 2015 J Orthop Surg Res Meta-analysis
syndrome: a meta-analysis of
Cai,Z.
Carpal tunnel syndrome in pregnancy: a
Zyluk,A. 2013 Pol.Orthop Traumatol. Narrative review
review
An assessment of the sympathetic +Does not answer a
Zyluk,A.; Kosovets,L. 2010 function within the hand in patients J Hand Surg Eur.Vol. question of interest; very
with carpal tunnel syndrome low study design
A Comparison of DASH, PEM and
Zyluk,A.; Piotuch,B. 2011 Levine questionnaires in outcome Handchir.Mikrochir.Plast.Chir very low quality
measurement of carpal tunnel release
Retrospective case series
A comparison of outcomes of carpal
(exposure status
Zyluk,A.; Puchalski,P. 2013 tunnel release in diabetic and non- J Hand Surg Eur.Vol.
irrelevant after CT
diabetic patients
release)
A comparison of the results of carpal Retrospective case series
Zyluk,A.; Puchalski,P. 2013 tunnel release in patients in different Neurol Neurochir.Pol. (age as comparison not
age groups applicable)
The results of carpal tunnel release for
carpal tunnel syndrome diagnosed on
Zyluk,A.; Szlosser,Z. 2013 clinical grounds, with or without J Hand Surg Eur.Vol. very low quality
electrophysiological investigations: a
randomized study
980
Reason for
Exclusion
The effect of the involvement of the
dominant or non-dominant hand on
Zyluk,A.; Walaszek,I. 2012 grip/pinch strengths and the Levine J Hand Surg Eur.Vol. Retrospective case series
score in patients with carpal tunnel
syndrome
No correlation between sonographic +Does not answer a
Zyluk,A.; Walaszek,I.;
2014 and electrophysiological parameters in J Hand Surg Eur.Vol. question of interest;
Szlosser,Z.
carpal tunnel syndrome insufficient data
Does ultrasonography contribute
Zyluk,A.; Walaszek,I.; case control; CTS and
2014 significantly to the diagnosis of carpal Handchir.Mikrochir.Plast Chir
Szlosser,Z. healthy
tunnel syndrome?
981
APPENDIX XIII
LETTERS OF ENDORSEMENT FROM EXTERNAL ORGANIZATIONS
982
983

March2,2016
Am mericanAcade emyofOrthop paedicSurgeoons

940 00WestHiggiinsRoad
Rossemont,Illinoois60018497 76
ATTTN:KevinShe ea,MD
AAO OSClinicalPracticeGuidelinesSection Leader
ofttheCommitte eeonEvidencceBasedQuaalityandValue
DeaarKevinSheaa,MD,
The eAmericanCo ollegeofSurggeonshasvottedtoendorssetheAAOSC ClinicalPractice

GuiidelineontheeManagemen ntofCarpalTTunnelSyndro ome.Thisend
dorsementim mplies
perrmissionfortheAAOStoo officiallylisto urorganizatio
onasanendo
orserofthis
guiddelineandreeprintourlogoointheintro ductorysectiionoftheguidelinedocum ment.
Sinccerely,
DavvidB.Hoyt,M
MD,FACS
Exe
ecutiveDirecttor
March 28, 2017
Kevin Shea, M.D.

American Academy of Orthopaedic Surgeons
Clinical Practice Guidelines Section Leader
of the Committee on Evidence-Based Quality and Value
9400 West Higgins Road
Rosemont, Illinois 60018
Dear Dr. Shea,
Thank you for providing the American Society of Anesthesiologists (ASA) the opportunity
to review the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice
Guideline on the Management of Carpal Tunnel Syndrome. I am pleased to share that ASAs
leadership has approved ASAs endorsement of the Clinical Practice Guideline on the
Management of Carpal Tunnel Syndrome.
The following parties reviewed the document: ASAs Committee on Regional Anesthesia,
Administrative Council and Board of Directors.
ASAs Committee on Regional Anesthesia looks forward to providing input on subsequent

versions of the guideline if requested. Thank you again for the opportunity to collaborate
with AAOS and participate in the review of this Clinical Practice Guideline.
Sincerely,
Jeffrey Plagenhoef, M.D.

President
American Society of Anesthesiologists

CTS CPG - 4.13.2017

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MANAGEMENT OF CARPAL TUNNEL SYNDROME

EVIDENCE-BASED CLINICAL PRACTICE GUIDELINE

Adopted by the American Academy of Orthopaedic Surgeons

February 29, 2016

Please cite this guideline as:

This Guideline has been endorsed by the following organizations:

Published 2/29/16 by the American Academy of Orthopaedic Surgeons

Strength of Recommendation Descriptions

Strength of Recommendation: Strong Evidence

Strength of Recommendation: Strong Evidence

Strength of Recommendation: Moderate Evidence

Strength of Recommendation: Moderate Evidence

PATIENT REPORTED NUMBNESS OR PAIN

HAND-HELD NERVE CONDUCTION STUDY (NCS)

Strength of Recommendation: Moderate Evidence

Strength of Recommendation: Moderate Evidence

INCREASED RISK OF CTS

Strength of Recommendation: Strong Evidence

Strength of Recommendation: Moderate Evidence

DECREASED RISK OF CTS

Strength of Recommendation: Moderate Evidence

Strength of Recommendation: Moderate Evidence

Strength of Recommendation: Limited Evidence

FACTORS SHOWING CONFLICTING RISK OF CTS

Strength of Recommendation: Strong Evidence

Strength of Recommendation: Strong Evidence

Strength of Recommendation: Strong Evidence

Strength of Recommendation: Moderate Evidence

Strength of Recommendation: Moderate Evidence

Strength of Recommendation: Moderate Evidence

SURGICAL RELEASE LOCATION

Strength of Recommendation: Strong Evidence

SURGICAL RELEASE PROCEDURE

SURGICAL VERSUS NONOPERATIVE

BILATERAL VERSUS STAGED CARPAL TUNNEL RELEASE

LOCAL VERSUS IV REGIONAL ANESTHESIA

BUFFERED VERSUS PLAIN LIDOCAINE

Strength of Recommendation: Moderate Evidence

SUPERVISED VERSUS HOME THERAPY

Goals and Rationale

Musculoskeletal care is provided in many different settings by many different providers. We

Potential Benefits, Harms, and Contraindications

FORMULATING PICO QUESTIONS

STUDY SELECTION CRITERIA

Study must be of an CTS injury or prevention thereof

Standard Criteria for all CPGs

BEST EVIDENCE SYNTHESIS

MINIMALLY CLINICALLY IMPORTANT IMPROVEMENT

METHODS FOR EVALUATING EVIDENCE

DIAGNOSTIC STUDY QUALITY APPRAISAL QUESTIONS

Diagnostic Study Design Quality Key

High Quality Study <1 Flaw

Prognostic Study Design Quality Key

High Quality Study <1 Flaw

RANDOMIZED STUDY QUALITY APPRAISAL QUESTIONS

1. Random Sequence Generation

Upgrading Randomized Study Quality Questions

1. Is there a large magnitude of effect?

High Quality Study <2 Flaw

OBSERVATIONAL STUDY DESIGN QUALITY APPRAISAL QUESTIONS

1. Is this observational study a prospective case series?

Upgrading Observational Study Quality Questions

Observational Study Design Quality Key