Post-Operative Splinting After Short-Incision Carpal Tunnel Release: a Prospective Study

Study Overview
=================
Brief Summary
-----------------
This research study is for patients who are schedule to have carpal tunnel release surgery. The investigators have developed this study in order to determine if post-operative splinting is effective in improvement of patient outcomes after this surgical procedure. The study is being conducted under the direction of Huey Tien, MD. The purpose of this study is to determine if post-operative splinting is effective in improving patient outcomes after having short-incision carpal tunnel release. The investigators will randomize each patient into group 1, splinting after surgery or group 2 no splinting after surgery. Each group will have the same outcome measurements done to determine the best outcome of the two groups.

Detailed Description
-----------------
Your participation in this study will last for five office visits of approximately 30 minutes each. If you decide to participate in this study, we would first have you come to clinic where you would undergo some standard measurements. This includes measuring grip and key pinch strength and completing a patient questionnaire. During your visits we will scan the cross-sectional area of the median nerve at the pisiform bone level to determine the level of CTS with the Ultrasound Biomiscroscopy machine (Vevo 2100). This is a new technique with a machine similar to a regular ultrasound machine. The primary difference is that the frequency of soundwaves is higher than a standard ultrasound machine. There are no known significant risks associated with the use of this machine. At this time the machine is experimental, and is not currently approved by the FDA for clinical use. However, this device is not considered to pose significant risk. Candidates for this study must have been diagnosed with single carpal tunnel syndrome and are going to receive nerve decompression with short incision, over the age of 18, and able to give informed consent to participate in a research study.

Official Title
-----------------
Post-Operative Splinting After Short-Incision Carpal Tunnel Release: a Prospective, Randomized Study

Conditions
-----------------
Carpal Tunnel Syndrome

Intervention / Treatment
-----------------
* Behavioral: Splinting


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients who were diagnosed with carpal tunnel syndrome and are going to receive nerve decompression with short incision The Criteria of CTS Numbness, tingling, pain and night symptoms in median nerve distribution Positive Tinel signs over the median nerve at the Carpal Tunnel Negative Tinel signs at the Supraclavicular and Infraclavicular areas Positive Carpal Tunnel Tests Electrophysiological changes (confirmed with NCT) Over the age of 18 Ability to give informed consent to participate in a research study Exclusion Criteria: Patients with peripheral neuropathy of the median nerve secondary to trauma, external compressions (tumours, bone malunion) or other non-compressive causes. Patients with the presence of Thoracic Outlet Syndrome (Tinel must be negative at the Supraclavicular and Infraclavicular areas) Patients with the presence of Cervical Disc disease Patients with another site of compression (such as pronator teres compression) Patients who have had previous carpal tunnel release on the same hand Patients under the age of 18

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Splinting After Surgery<br>This group will be fitted for a splint and given instructions on wearing their splint after their short-incision Carpal Tunnel Release | Behavioral: Splinting<br>* One group will have their wrist splinted after their carpal tunnel release surgery.<br>|
| No Splinting After Surgery<br>This group will not be splinted after the short-incision carpal tunnel release | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ultrasound Biomicroscopy of the cross section area of the median nerve at the pisiform level | This is a high resolution ultrasound used to determine the distance between the surface and the median nerve. This device is a research device not approved for clinical use, but is considered a non-significant risk (NSR) device. This machine is just like a regular ultrasound machine. The primary difference is that the frequence of the soundwaves is higher than a standard ultrasound machine. At this time, the machine is experimental, and it is not currently approved by the FDA for clinical use. However, this same technology is used in similar devices by opthamologists to image retinas. It has been used on hudnreds of humans for research studies. | Up to two years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Key Pinch Strength |  | Up to two years | 
| Grip Strength |  | Up to two years | 
| DASH questionnaire |  | Up to two years | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
carpal tunnel syndrome, splinting, nerve decompression