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Кисти рук

DGANA Дата: Среда, 14.08.2013, 15:17 | Сообщение # 106 Зачастивший Группа: Проверенные Сообщений: 78 Награды: 0 Репутация: 0 Статус: У моего мужа очень сильно болят запястья они немного отечные и с отеками пальцы.Сегодня еще начались боли в паху.Он находится на ПД 2 месяц ,заливается 4 раза по 2 литра ,вес 80 кг. Заливает 7 утра желтый,13 зеленый 18 желтый ,22 фиолетовай (красный) .Утром сливает почти по 2,5,а вот днем 1,9; 1,8.Моча отходит около 2 литров в сутки.В больнице давали принимать карбонат кальция .Вчера нашли где купить (спасибо форуму) начал принимать.Подскажите ,что может влиять на боли в суставах и чем можно облегчить боль? Нам на плановый осмотр только 29 августа.

ssarata Дата: Суббота, 17.08.2013, 15:45 | Сообщение # 107 Заглянувший Группа: Проверенные Сообщений: 12 Награды: 0 Репутация: 0 Статус: Здравствуйте ! На гемодиализе больше 20 лет. ВСЕ проблемы начались после 15 лет. Сейчас главная проблема ( гемодиализная остеодистрофия) . Когда все это начиналось (я имею в виду кошмар в котором живу) мне говорили что так у всех которые так долго ходят на диализ. A я смотрю у нас в отделении я одна такая" Квазимода ." Изменилась осанка и боли выносимые, которые очень редко удается сбивать и не каждый раз тем же. Где-то 3 месяца начались проблемы с руками. У меня на левой руке10 фистул из которых работала 1 и один гортекс который работал ровно год . На левой руке 6 фистул, суйчас удалена вена от запястья до локтя ,выше локтя 5 см гортекса + вена которую можно колоть 3см 3 раза катетер . Сначала очень чесались ладони, потом как будто мурашки сечас мурашки + боль как после обмороженияи. Болит ВСЕЕЕЕЕ, болит постоянно не могу сбить боль ничем ,жизнь стала в тягость, стала противна сама себе. Перестала общатся с друзьями.Знаю, знаю что и с головой уже не все в порядке. Пишу не потому чтобы пожалели, а потому что только Вы меня поймете. И поздно уже что-либо делать

Vasiliy Дата: Суббота, 17.08.2013, 15:59 | Сообщение # 108 Виртуализированный Группа: Проверенные Сообщений: 4125 Награды: 30 Репутация: 105 Статус: Цитата (ssarata) ВСЕ проблемы начались после 15 лет. Это правда. Именно так и бывает сейчас у тех, кто начинал диализ в начале 90-х. Возможно, у тех, кто начинал диализ уже в 2000-х, этот срок увеличится. Цитата (ssarata) И поздно уже что-либо делать Это не совсем так. Вы почитайте анналы форума. Много уже тут написано про ситуацию, которая у вас сложилась. Тридцать пять лет я озвучивал фильм, но это было немое кино. (С)

Pringles Дата: Пятница, 10.04.2015, 01:39 | Сообщение # 109 Виртуализированный Группа: Проверенные Сообщений: 5312 Награды: 14 Репутация: 44 Статус: в чем может быть причина пока небольшой боли, но мешающий при каких нибудь движениях у кистей рук?

D-r_Karlson Дата: Пятница, 10.04.2015, 17:48 | Сообщение # 110 Виртуализированный Группа: Врач Сообщений: 4027 Награды: 40 Репутация: 99 Статус: Pringles, На вскидку сложно сказать не видя.Не исключено сдавление срединного нерва (карпальный туннельный синдром) . Помогает в диагностике исследование Nerve conduction study .Наверное в Москве должно где то выполняться. УЗИ и иногда МРТ помогают диагностировать,если результат электропроводимости нормальный,что не исключает диагноз. Все в руках Всевышнего, кроме страха перед Всевышним Сообщение отредактировал D-r_Karlson - Пятница, 10.04.2015, 17:55

Marina1961 Дата: Пятница, 10.04.2015, 21:35 | Сообщение # 111 Группа: Нет с нами Сообщений: 1478 Награды: 77 Репутация: 115 Уважаемый D-r_Karlson, на основании этого исследования, указанного вами выше, мне диагностировали выраженный карпальный туннельный синдром с 2х сторон. Понимаю, что советовать, не видя пациента, не дело), и все-таки, операция неизбежна или возможно попробовать пролечится другими методами? Улыбайтесь, господа! Все глупости мира делаются с серьезным выражением лица

D-r_Karlson Дата: Пятница, 10.04.2015, 22:37 | Сообщение # 112 Виртуализированный Группа: Врач Сообщений: 4027 Награды: 40 Репутация: 99 Статус: Цитата Marina1961 () советовать, не видя пациента, не дело), и все-таки И в правду невозможно что то сказать. У нас это лечат ортопеды ,которые прошли специализацию по "Хирургия кисти". Из некоторого личного опыта наблюдения за больными,могу немного сказать,что есть некоторая часть больных,которая стабилизировалась на физиотерапии,там где процесс не зашел слишком далеко.. Вполне допустимы нетрадиционные методы(или традиционно-восточные) ,такие как акупунктура, лазер, иногда аппликации стероидов- в российском варианте это может быть какой нибудь электрофорез с гидрокортизоном и т.п. Но часто это проблему не решает,дает временное облегчение. Радикально ,на долгое время решает проблему операция, в хороших руках она выполняется достаточно быстро ,в течение нескольких минут,проводится рассечение и высвобождение ущемленного нерва. Все в руках Всевышнего, кроме страха перед Всевышним

Pringles Дата: Суббота, 11.04.2015, 00:43 | Сообщение # 113 Виртуализированный Группа: Проверенные Сообщений: 5312 Награды: 14 Репутация: 44 Статус: у меня на обеих руках такое началось, фистула только на одной, ерунда какая то. Утром сильно болело, сейчас немного

Pringles Дата: Суббота, 11.04.2015, 00:44 | Сообщение # 114 Виртуализированный Группа: Проверенные Сообщений: 5312 Награды: 14 Репутация: 44 Статус: просто у нас в ДЦ врачи вряд ли скажут что это, а если это что то, что требует определенных диагностик или не дай Бог дорогих лекарств положенных бесплатно - точно не будут разбираться.

Pringles Дата: Суббота, 11.04.2015, 00:44 | Сообщение # 115 Виртуализированный Группа: Проверенные Сообщений: 5312 Награды: 14 Репутация: 44 Статус: Мне доктор хотела мазь посоветовать, но это не выход же.

Gella-972 Дата: Суббота, 11.04.2015, 05:41 | Сообщение # 116 Втянувшийся Группа: Проверенные Сообщений: 719 Награды: 24 Репутация: 26 Статус: все-таки, операция неизбежна или возможно попробовать пролечится другими методами? Марина, Василий правильно пишет. Попробуй до минимума снизить поступление кальция. Вместо фосфатбиндера, используй препараты не содержащие кальций и добавь время диализа. Мне это помогло, кстати. Совсем боли не прошли, но интенсивность их сильно снизилась. С операцией пока решила погодить. Тем более у нас те, кому операции делали года 2 назад, начали жаловаться на те же симптомы. ЖИВИ ПОЛНОЙ ЖИЗНЬЮ! НЕ ВАЖНО СКОЛЬКО ДНЕЙ В ТВОЕЙ ЖИЗНИ! ВАЖНО СКОЛЬКО ЖИЗНИ В ТВОИХ ДНЯХ!!!

D-r_Karlson Дата: Суббота, 11.04.2015, 13:59 | Сообщение # 117 Виртуализированный Группа: Врач Сообщений: 4027 Награды: 40 Репутация: 99 Статус: Цитата Gella-972 () или возможно попробовать пролечится другими методами? Иногда помогает и консервативное лчение.Далеко не всех оперируют. Все в руках Всевышнего, кроме страха перед Всевышним

Gella-972 Дата: Суббота, 11.04.2015, 14:23 | Сообщение # 118 Втянувшийся Группа: Проверенные Сообщений: 719 Награды: 24 Репутация: 26 Статус: У нас всем предлагают только операцию. Альтернативы нет. Не хочешь операцию, разводят руками: тогда терпи. А что можно в таком случае еще предпринять? Мне это тоже интересно. ЖИВИ ПОЛНОЙ ЖИЗНЬЮ! НЕ ВАЖНО СКОЛЬКО ДНЕЙ В ТВОЕЙ ЖИЗНИ! ВАЖНО СКОЛЬКО ЖИЗНИ В ТВОИХ ДНЯХ!!!

Marina1961 Дата: Суббота, 11.04.2015, 14:33 | Сообщение # 119 Группа: Нет с нами Сообщений: 1478 Награды: 77 Репутация: 115 D-r_Karlson, спасибо вам! Наташа, я после трансплантации, на диализе не была, фосфатбиндеры тоже не принимала никогда. Болей в кистях почти нет, только сильное онемение. Думала, что карпальный туннельный синдром бывает только у диализных пациентов. Улыбайтесь, господа! Все глупости мира делаются с серьезным выражением лица

D-r_Karlson Дата: Суббота, 11.04.2015, 14:35 | Сообщение # 120 Виртуализированный Группа: Врач Сообщений: 4027 Награды: 40 Репутация: 99 Статус: Gella-972, Вот все что в мире существует по лечению CTS , я скопировал с рабочего стола из UPTODATE . Очень много ссылок и статей,когда в оригинале смотришь,то можешь сразу перейти на статью.Я думаю,что справитесь.Современные средства перевода помогут вам справиться со статьей. TREATMENT — Many options are available for the treatment of patients with CTS and the modality chosen depends on the severity of nerve dysfunction (ie, mild, moderate, or severe) [13]. The specific choice of therapy will also vary according to patient preference and availability. For patients with mild to moderate CTS, conservative therapy is generally considered to be a reasonable first option with successful outcomes ranging from 20 to 93 percent [14,15]. Conservative options include splinting, oral glucocorticoid or injections, ultrasound, nerve-gliding exercises, and yoga. Combined therapy may be more effective than the use of any single modality [14,16-18]. Predictors associated with failure of conservative therapy include the following features [14,15,19]: ●Long duration of symptoms (>10 months) ●Age greater than 50 ●Constant paresthesias ●Impaired two-point discrimination (>6 mm) ●Positive Phalen's sign <30 seconds ●Prolonged motor and sensory latencies demonstrated by electrodiagnostic testing A variety of patient factors including heredity, size of the carpal tunnel, associated local and systemic diseases, and habits may contribute to the etiology of CTS. Evaluation and treatment of potential predisposing conditions, including obesity, diabetes, rheumatoid arthritis, other connective tissue diseases, and thyroid disease, is warranted in patients with CTS, although there is no proof that treating these conditions will improve the symptoms or the course of CTS. (See "Etiology of carpal tunnel syndrome" and "Neurologic manifestations of hypothyroidism", section on 'Carpal tunnel syndrome'.) Wrist splinting — A wrist splint or brace maintains the wrist in a neutral position, thus preventing prolonged flexion or extension of the wrist. Splinting may limit activities that raise pressure within the carpal tunnel or reduce its cross sectional area. Splinting is generally thought to be effective in reducing CTS symptoms, and it may delay or eliminate the need for surgery in mildly symptomatic patients [14,17,20,21]. A 2012 systematic review [22] found only two low-quality trials [23,24] that evaluated nocturnal wrist splinting versus no treatment. Based on this limited evidence, the review concluded that nocturnal use of wrist splints is more effective than no treatment for short-term symptom benefit [22]. Clinical features that may favor a long-term clinical response to splinting are shorter duration of symptoms (one year or less) and less severe nocturnal paresthesias [25]. Similarly, when splinting and glucocorticoid injections (see 'Glucocorticoid injection' below) are combined, symptom duration of less than three months and absence of sensory impairment at presentation may be predictive of a lasting response to conservative treatment [26]. Splints are usually worn at night, but they can be worn continuously. Night splinting alone can reduce symptom severity and improve median nerve conduction velocities [16,23,27]. Full-time splinting has been reported to improve median nerve conduction, but it may not improve symptoms when compared with night-only splinting [16,21]. Splints can be purchased over the counter (OTC) or be custom made by an occupational therapist with subspecialty certification in hand therapy. There are no studies comparing treatment outcomes with custom splints versus OTC models. Splinting versus surgery — Surgical treatment of CTS appears to be more effective than splinting, although the evidence is limited to a few relatively low-quality trials. A 2008 systematic review [28] identified only two randomized trials [20,29] that compared splinting with surgery and neither trial employed blinded assessment of outcomes. In one trial, 176 patients with CTS, documented by nerve conduction studies, were randomly assigned to either nocturnal wrist splinting or surgical decompression [20]. There was less rapid, but more complete and longer lasting relief of symptoms with surgery than splinting. At one month, complete or marked improvement was seen in 29 percent treated with surgery versus 42 percent treated with splinting. However, at one year, complete or marked improvement was seen in 92 percent treated with surgery versus 72 percent treated with splinting. In the systematic review of this trial, significantly more patients experienced clinical improvement at three months with surgery than with splinting (71 versus 51.6 percent) with a relative risk (RR) for clinical improvement favoring surgery of 1.38 (95% CI 1.08-1.75) [28]. Pooled data for clinical improvement at one year also favored surgery (RR 1.27; 95% CI 1.05-1.53) [28]. In addition, pooled data regarding the need for surgery in the splinting group or reoperation in the surgery group during follow-up favored surgery (RR 0.04, 95% CI 0.01-0.17). Glucocorticoid injection — Injection of glucocorticoids into the region of the carpal tunnel is intended to reduce tissue inflammation and aid recovery. Its value relative to conservative treatment (eg, splinting) has been controversial [30,31] because no well-controlled comparative studies have been performed, and because a prominent histological inflammatory response is not usually seen with CTS [2,32-35]. In general, glucocorticoid injections appear effective in reducing subjective symptoms of CTS for one to three months when compared with placebo [36,37]. The clinical impression that glucocorticoid injection provides short-term symptomatic relief is supported by the following observations: ●A 2007 systematic review evaluated 12 trials, including two high-quality randomized controlled trials, and concluded that glucocorticoid injections provided greater symptom improvement at one month than placebo, but relief beyond one month was not established [36]. ●A controlled trial, included in the 2007 systematic review cited above, randomly assigned 81 patients with nerve conduction study proven CTS refractory to splinting to injection with glucocorticoid (betamethasone 6 mg in 1 mL and 1 mL of 1 percent lidocaine) or sham (saline plus lidocaine) [38]. At two weeks following the initial injection, significantly more of the glucocorticoid-injected than sham-injected patients were "somewhat or highly satisfied" (70 versus 34 percent, respectively). When nonresponders to sham injection subsequently received a betamethasone injection, the proportion reporting improvement was 73 percent. In an uncontrolled extension of this trial, only 4 of 46 patients (9 percent) whose CTS symptoms improved following an initial injection had good symptomatic control for up to 18 months [38]. Additional injections (two to seven) controlled symptoms in 13 others (28 percent); surgical referral was requested by 18 patients (43 percent). ●A subsequent single-center trial randomly assigned 111 patients with CTS to treatment with injections of methylprednisolone 80 mg, methylprednisolone 40 mg, and placebo in a 1:1:1 ratio [37]. At 10 weeks, improvement in CTS symptom severity score was significantly greater for the methylprednisolone 80 mg and methylprednisolone 40 mg groups compared with placebo, but at one year there were no significant differences between groups. Although there is no clear consensus, we suggest limiting glucocorticoid injections for CTS to no more frequently than once every six months per wrist. For patients who have recurrent symptoms after two injections, we suggest other conservative treatments (if not already tried) or surgical evaluation. Glucocorticoids can be injected proximal to or distal to the carpal tunnel. Injections appear to be generally safe. However, injection therapy is associated with several risks, including exacerbation of median nerve compression, accidental injection into the median or ulnar nerves, and digital flexor tendon rupture [31,39]. Glucocorticoid injection versus surgery — Surgery appears to be more effective for sustained relief of symptoms from CTS than local glucocorticoid injection. While short-term results of glucocorticoid injection may be better than those following carpal tunnel release surgery, the advantage is lost over the course of one year following the procedure. These points are illustrated by the following studies: ●One prospective, open study randomly assigned 163 patients with symptomatic CTS to glucocorticoid injection into the carpal tunnel (20 mg of paramethasone acetonide) or surgical release (via a limited palmar incision) [40]. The main outcome was the proportion of patients in each group who had at least 20 percent improvement in nocturnal paresthesias. Significantly more of those who were assigned to injection than surgery were improved at three months (approximately 95 versus 75 percent, respectively). Over the ensuing nine months of observation, the advantage of injection over surgery was lost, while those treated surgically generally maintained the degree of improvement noted at the three-month point. The patients in this study were predominantly Spanish housewives, and compensation for disability due to CTS was rarely an issue. Thus, the applicability of these results to patients with work-related CTS is uncertain. ●A subsequent assessor-blinded controlled trial randomly assigned 50 patients (48 were female) with CTS to a single injection of methylprednisolone 15 mg or open surgical carpal tunnel decompression [41]. At 20 weeks, surgical treatment was associated with significantly greater symptomatic improvement in the global symptom score (GSS) score, the primary outcome, than local glucocorticoid injection (24.2 versus 8.7, respectively). The dose of methylprednisolone (15 mg) used in the trial is much less than the 40 mg most commonly used in practice. Oral glucocorticoids — Oral glucocorticoids appear to be effective for short-term improvement of CTS symptoms. In a 2003 systematic review, analysis of pooled data from three trials of high and moderate methodologic quality showed that two weeks of oral glucocorticoid treatment was associated with a statistically significant reduction in symptoms as measured by the GSS compared with placebo (weighted mean difference [WMD] -7.23; 95% CI -10.31 to -4.14); one trial showed that four weeks of oral glucocorticoid treatment was associated with a statistically significant reduction in symptoms (WMD -10.8; 95% CI -15.26 to -6.34) [42]. There are only limited data regarding the long-term effect of oral glucocorticoids for CTS treatment. In one clinical trial that evaluated two to four weeks of treatment with up to 20 mg per day of oral prednisolone, patients showed clinical and electrodiagnostic improvement for up to 12 months [43]. However, this study did not have a placebo control group. In another clinical trial, patients treated with oral prednisolone 25 mg daily for 10 days showed symptomatic improvement in CTS for up to eight weeks [44]. However, oral prednisolone was less effective than glucocorticoid injection. In a placebo-controlled trial that evaluated patients with mild to moderate CTS, two weeks of oral prednisone (20 mg daily for seven days, followed by 10 mg per day for seven days) was associated with significant improvement in symptoms as measured by the GSS, but the benefit gradually waned over eight weeks of observation [11]. Yoga — Limited evidence suggests that yoga may be beneficial for pain control in patients with CTS. A preliminary assessor-blinded controlled trial randomly assigned 42 patients with CTS to eight weeks of treatment with yoga or wrist splinting. The yoga intervention consisted of 11 yoga postures designed for strengthening, stretching, and balancing each joint in the upper body along with relaxation given twice weekly [45]. Patients in the yoga group had statistically significant pain reduction compared with patients in the wrist splint group. Carpal bone mobilization — Carpal bone mobilization is a physical and occupational therapy technique that involves movement of the bones and joints in the wrist. Data are limited, but a small unblinded trial involving 21 people found that carpal bone mobilization significantly improved symptoms (assessed using a symptom diary with a visual analog scale) after three weeks compared with no treatment [46,47]. However, there was no significant benefit in hand function. Nerve gliding — Nerve and tendon gliding exercises or maneuvers are performed under the direction of an occupational therapist with subspecialty certification in hand therapy. Nerve gliding is predicated on restoring normal movement of the median nerve. It is thought that nerve compression may lead to "tethering" of the median nerve, resulting in decreased nerve excursion and increased mechanical strain [2]. Reduced sliding of the median nerve in the transverse [14,48,49] and longitudinal [14,50] planes has been observed in patients with CTS [2,14]. There is only limited and low-quality evidence regarding the efficacy of nerve and/or tendon gliding interventions for CTS [47]. As an example, a prospective, randomized, unblinded trial involving 36 patients found that nerve and tendon gliding exercises for four weeks provided no statistically significant benefit at eight weeks compared with wrist splinting for symptom improvement or patient satisfaction [17]. Ultrasound therapy — Ultrasound and electrical stimulation have been used to promote recovery after nerve and tendon injuries [51]. Ultrasound is used to promote soft tissue healing and the transdermal delivery of medications at intensities ranging from 0.5 to 1.5 w/cm2. At its lower intensity range, ultrasound induces changes in cell permeability, termed "microstreaming," that are thought to enhance the healing response. At its upper range, ultrasound raises tissue temperature while reducing pain, increases tissue elasticity, and decreases tissue viscosity [51]. Data regarding the benefit of ultrasound for CTS are conflicting, although its effectiveness may depend on the duration of therapy. A 2013 systematic review concluded that the available data from clinical trials provide only low quality evidence [52]. An analysis of pooled data from two trials with 63 participants found that ultrasound treatment for two weeks was not significantly beneficial. In one of these trials [53], ultrasound treatment for seven weeks led to significant symptom improvement at six months, but a high loss to follow-up renders this finding inconclusive [52]. The effectiveness of ultrasound may depend on the characteristics of the ultrasound used [16,42]. Deep, pulsed ultrasound has been reported to decrease pain and improve sensory loss, nerve conduction parameters, and strength [16,53]. Continuous superficial ultrasound does not improve patients' symptoms or median nerve conduction parameters [16,54]. NSAIDs and other oral medications — A 2003 systematic review [42] found one randomized controlled trial [12] that demonstrated no significant benefit for nonsteroidal anti-inflammatory drugs (NSAIDs) when compared with placebo for improving CTS symptoms. The available data suggest no benefit for diuretics [12,42] or vitamin B6 [42] for improving CTS symptoms. Electrical, magnetic, and laser therapy — No clear hypotheses have been generated to support the use of any of these modalities for the treatment of CTS. Only anecdotal evidence exists regarding electrical stimulation for the treatment of CTS. A single session of magnetic therapy was not effective when compared with sham therapy [16,55], and prolonged magnetic therapy was not effective compared with placebo [16,42,56]. Similarly, low-level laser therapy has not been proven in a controlled study design [16,42,57]. Conservative treatment choices — For patients with mild to moderate symptomatic CTS, we recommend nocturnal wrist splinting as preferred initial medical therapy because limited evidence suggests it is effective for short-term symptom relief. It is also safe and well-tolerated. (See 'Wrist splinting' above.) Although evidence is limited, combined treatment employing splinting in combination with glucocorticoid injection(s), oral glucocorticoids, or other conservative interventions may provide additional symptomatic relief and avoid the need for surgical decompression. (See 'Treatment' above.) For patients with mild to moderate symptomatic CTS who do not tolerate or respond to splinting, we suggest treatment with glucocorticoid injection or oral glucocorticoid treatment. Oral glucocorticoid treatment should not extend beyond four weeks duration because of the deleterious side effects of prolonged glucocorticoid therapy. (See 'Glucocorticoid injection' above and 'Oral glucocorticoids' above.) Limited and low quality data suggest that yoga and carpal bone mobilization may be reasonable alternative options for conservative treatment if available. (See 'Yoga' above and 'Carpal bone mobilization' above.) Pregnancy — CTS may develop during pregnancy, particularly during the third trimester. In most cases, the symptoms gradually resolve over a period of weeks after delivery. For women who develop CTS during pregnancy, we recommend nocturnal wrist splinting. Surgical decompression is rarely indicated during pregnancy since the disease often resolves postpartum. (See "Neurologic disorders complicating pregnancy", section on 'Carpal tunnel syndrome'.) Surgery — Surgical decompression is effective treatment for CTS, as evidenced by improved subjective and objective long-term measures [20,28,58-62]. The most rigorous controlled trial enrolled 116 patients who were randomly assigned to carpal tunnel surgery (open or endoscopic at the surgeons discretion) or to nonsurgical treatment [60]. Patients with severe CTS who had electrodiagnostic evidence of denervation were excluded. Nonsurgical treatment involved multimodal interventions; patients were offered nonsteroidal anti-inflammatory drugs, hand therapy sessions including tendon gliding, and continued splinting at night; ultrasound was offered to those who did not respond by six weeks. Assessors were blinded to treatment allocation. On intention-to-treat analysis at 12 months, both groups showed improvement, but patients assigned to surgery had a significantly better mean functional score on the Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ) than those assigned to nonsurgical therapy (-0.4, 95% CI 0.11-0.70) [60]. In addition, the surgery group had greater mean improvement in the CTSAQ symptoms score (-0.34, 95% CI 0.02-0.65). However, the difference for scores of functional status and symptoms between the two groups was small and of modest clinical significance. Additional evidence supporting the utility of surgery comes from a study that systematically reviewed 209 articles published from 2000 to 2006 with patient-reported outcomes for 32,936 operations for CTS [61]. Surgery was considered successful for the outcomes of "cure," "much better," "80 percent improvement," and "satisfactory." Although there was wide variation in success rates among individual studies (range, 27 to 100 percent), the pooled success rate of surgery was 75 percent. Studies comparing surgery with splinting and glucocorticoid injection therapy are discussed in detail above. (See 'Splinting versus surgery' above and 'Glucocorticoid injection versus surgery' above.) For patients with moderate to severe persistent CTS symptoms (eg, numbness and pain, diminished hand function, or thenar eminence atrophy), particularly those with long duration of symptoms (greater than six months) and confirmatory electrodiagnostic evidence of median nerve injury, we suggest surgical decompression. Surgery prior to six months may be reasonable for patients who do not improve despite adequate trials of conservative therapy, or whose symptoms recur after initial improvement with conservative therapy. Surgical techniques for CTS are discussed separately. (See "Surgery for carpal tunnel syndrome".) INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.) ●Basics topic (see "Patient information: Carpal tunnel syndrome (The Basics)") SUMMARY AND RECOMMENDATIONS ●For patients with mild to moderate carpal tunnel syndrome (CTS), effective conservative treatment options for short-term improvement include splinting, glucocorticoids injected into the carpal tunnel, and oral glucocorticoids. Carpal bone mobilization and yoga may also be beneficial. Combined therapy may be more effective than the use of any single modality. Referral to an occupational therapist with subspecialty certification in hand therapy may improve outcomes. (See 'Treatment' above.) ●Unproven CTS treatments include nerve-gliding maneuvers, ultrasound, electrical stimulation, low-level laser therapy, magnetic therapy, contrast baths, and myofascial massage. Ineffective CTS treatments include nonsteroidal anti-inflammatory medications (NSAIDs), vitamin B6, and diuretics. (See 'Treatment' above.) ●Clinical features associated with failure of conservative CTS therapy include duration of symptoms >10 months, age >50, constant paresthesias, impaired two-point discrimination (>6 mm), positive Phalen's sign <30 seconds, and prolonged motor and sensory latencies. (See 'Treatment' above.) ●For untreated patients with mild to moderate symptomatic CTS of ≤10 months duration, we recommend nocturnal wrist splinting in the neutral position as initial therapy in preference to other conservative measures (Grade 1B). (See 'Wrist splinting' above.) ●For patients who comply with nocturnal splinting, but remain symptomatic at one month, we suggest continuation of splinting for another one to two months while adding a different conservative modality as discussed below, rather than stopping splinting (Grade 2C). (See 'Treatment' above.) ●For patients with CTS with an inadequate response to wrist splinting, we suggest a single injection with methylprednisolone (40 mg) as the next therapeutic option rather than oral glucocorticoids (Grade 2B). For patients who decline injection therapy, we suggest treatment with oral glucocorticoids (Grade 2B). We use prednisone 20 mg daily for 10 to 14 days. (See 'Glucocorticoid injection' above and 'Oral glucocorticoids' above.) ●For patients with mild to moderate CTS who decline treatment with glucocorticoids, we suggest treatment with other conservative measures including carpal bone mobilization or yoga (Grade 2C). (See 'Carpal bone mobilization' above and 'Yoga' above.) ●We recommend not using nonsteroidal anti-inflammatory medication for the treatment of CTS (Grade 1B). (See 'NSAIDs and other oral medications' above.) ●Surgery appears to be more effective than splinting or glucocorticoid injection for sustained CTS symptom relief. For patients with moderate to severe CTS that is refractory to conservative measures, we suggest surgical decompression (Grade 2B). (See 'Splinting versus surgery' above and 'Glucocorticoid injection versus surgery' above and 'Surgery' above.) Все в руках Всевышнего, кроме страха перед Всевышним

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