Page 143 - Hospital Authority Convention 2017

Service Enhancement Presentations

F4.4 Clinical Safety and Quality Service II 16:15 Room 421

The Effectiveness of Conservative Treatment on Patient of Different Onset Time with Carpal Tunnel Syndrome
Lam CY
Occupational therapy department, Queen Elizabeth Hospital, Hong Kong HOSPITAL AUTHORITY CONVENTION 2017
Introduction
Carpal tunnel syndrome (CTS) is one of the most common medical conditions presented in outpatient clinic of our
department. General practice for treating CTS are customised resting splint with wrist in neutral position, nerve and tendon
gliding exercises, and work tasks advice. However, the effectiveness of these treatment combinations on patient with
different onset time is not well-documented.

Objective
To evaluate the effectiveness of conservative treatment on CTS patient of different onset time.

Methodology
385 new cases of carpal tunnel syndrome in Occupational Therapy Department of Queen Elizabeth Hospital were reviewed
by convenience sampling from April 2013 to March 2015. Data were taken at baseline, three months, six months and upon
discharge. The selected cases will be allocated into three groups (Group one: 0 to three months; Group two: three to
six months; Group three: more than six months) according to onset time. Treatment outcome will then be analysed with
combination of treatment modalities (Treatment one: Night wrist splint; Treatment two: Night wrist splint + advice on work;
Treatment three: Night wrist splint + tendon gliding exercise; Treatment four: Night wrist splint + advice on work + tendon
gliding exercise). Outcome measures include night numbness, day numbness, Phalen’s test, Reverse Phalen’s test, Tinel sign,
static 2-point discrimination and strength. Tuesday, 16 May

Results
Significant improvement was found in night numbness with treatment two and treatment four within first three months
in group one. Day numbness was significantly improved with treatment four, whereas thumb 2 point discrimination was
improved with treatment two. Similarly, improvement in day and night numbness was found with treatment two and four within
first three months in group two. The effect sustained for six months. Day and night numbness was found to be improved with
all treatment combinations in group three. Moreover, treatment four was also effective in improving strength in this group of
patient.

This study demonstrated that treatment with night splint combining work advice is the most effective treatment programme in
improving day and night numbness in patient with disease onset time less than six months. Whereas using night splint alone
is already effective in improving day and night numbness in patient group with onset time more than half a year. The results
suggest a clearer direction for programme planning on treating CTS patients.

141