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Carpal Tunnel Syndrome: Hand Surgeons, Hand Therapists, and Physical Medicine and Rehabilitation Physicians Agree on a Multidisciplinary Treatment Guideline—Results From the European HANDGUIDE Study

  • Bionka M. Huisstede
    Correspondence
    Corresponding author Bionka M. Huisstede, PhD, Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Building W01.121, PO Box 85500, 3508 GA Utrecht, The Netherlands.
    Affiliations
    Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands

    Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
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  • Jan Fridén
    Affiliations
    Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden

    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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  • J. Henk Coert
    Affiliations
    Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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  • Peter Hoogvliet
    Affiliations
    Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands

    Rijndam Rehabilitation Center, Rotterdam, The Netherlands
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  • theEuropean HANDGUIDE Group
Published:August 12, 2014DOI:https://doi.org/10.1016/j.apmr.2014.06.022

      Abstract

      Objective

      To achieve consensus on a multidisciplinary treatment guideline for carpal tunnel syndrome (CTS).

      Design

      Delphi consensus strategy.

      Setting

      Systematic reviews reporting on the effectiveness of surgical and nonsurgical interventions were conducted and used as an evidence-based starting point for a European Delphi consensus strategy.

      Participants

      In total, 35 experts (hand surgeons selected from the Federation of European Societies for Surgery of the Hand, hand therapists selected from the European Federation of Societies for Hand Therapy, physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy.

      Interventions

      Not applicable.

      Main Outcome Measures

      Each Delphi round consisted of a questionnaire, analysis, and feedback report.

      Results

      After 3 Delphi rounds, consensus was achieved on the description, symptoms, and diagnosis of CTS. The experts agreed that patients with CTS should always be instructed, and instructions combined with splinting, corticosteroid injection, corticosteroid injections plus splinting, and surgery are suitable treatments for CTS. Relevant details for the use of instructions, splinting, corticosteroid injections, and surgery were described. Main factors for selecting one of the aforementioned treatment options were identified as follows: severity and duration of the disorder and previous treatments received. A relation between the severity/duration and choice of therapy was found by the experts and reported in the guideline.

      Conclusions

      This multidisciplinary treatment guideline may help physicians and allied health care professionals to provide patients with CTS with the most effective and efficient treatment available.

      Keywords

      List of abbreviations:

      CTS (carpal tunnel syndrome), EFSHT (European Federation of Societies for Hand Therapy), FESSH (Federation of European Societies for Surgery of the Hand), IC (instructions plus corticosteroid injection), ICS (instructions plus corticosteroid injections plus splinting), IO (instructions plus operative treatment/surgery), IS (instructions plus splinting), NSAID (nonsteroidal anti-inflammatory drug), PM&R (physical medicine and rehabilitation)
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