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Conditioning Electrical Stimulation Improves Nerve Regeneration and Functional Outcomes in Carpal Tunnel Syndrome; A Randomized Controlled Trial.
Matthew WT Curran, MD
1, Hollie A Power, MD FRCSC
2, Adil Ladak, MD MSc FRCSC
2, Mithun Rajshekar, Ph.D
3, Jaret Olson, MD
1, Michael J. Morhart, MD
4; K. Ming Chan, MD
5(1)Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, AB, Canada, (2)University of Alberta Division of Plastic Surgery, Edmonton, AB, Canada, (3)University of Alberta, Edmonton, AB, Canada, (4)Department of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, AB, Canada, (5)Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, AB, Canada
Hypothesis: Electrical stimulation for improving nerve regeneration is a clinically adopted strategy that has been applied to compression neuropathies, traction nerve injuries and nerve repair. Traditionally, the electrical stimulation has been applied intra- or post-operatively. Conditioning electrical stimulation (CES) refers to the application of electrical stimulation to a peripheral nerve up to 7 days prior to surgery to "condition" the nerve for regeneration. In animal models CES is superior to post-operative electrical (PES) stimulation at improving nerve regeneration. In this initial clinical study of CES we hypothesize that the application of CES will improve outcomes after carpal tunnel release (CTR) in patients with severe carpal tunnel syndrome (CTS).
Methods: A randomized control trial was designed to evaluate the impact of CES with CTR. Adult patients with severe CTS were recruited. Patients were randomized to sham stimulation or 1 h of CES at 20 Hz to the median nerve through a Grass SD9 stimulator. Seven days after stimulation patients underwent an open CTR. Outcome assessment included electrophysiologic, sensory and functional outcomes. Outcomes were assessed at baseline, 3 months, 6 months and 12 months by an independent blinded assessor. Statistical analysis was conducted with parametric and non-parametric tests according to the normality of the data as determined by the Shapiro-Wilk test. Significance was defined as a p-value < 0.05.
Results: 63 patients were recruited for the study; 31 in the control group and 32 in the CES group. There was no difference in patient demographics or baseline characteristics. At 12 months the CES group demonstrated a statistically significant increase in motor unit number estimation (86+/-11 to 146+/-16) compared to CTR alone (84+/-13 to 109 +/-13; p< 0.05). Similar findings were found for recovery of sensory nerve action potential (Figure 1; p<0.05). Clinical findings mirrored the electrophysiologic sensory recovery this with the CES group demonstrating statistically significant improvement in Semmes Weinstein Monofilament (Figure 2; p<0.05). Patients receiving CES + CTR demonstrate improved functional recovery as evident by statistically significant improvements in the Moberg Pickup Test (41+/-4 to 32+/-3) compared to CTR (45+/-4 to 42+/-5; p< 0.05).
Conclusions: Conditioning electrical stimulation with CTR significantly improves electrophysiologic and functional outcomes in severe CTS.
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