Decompressive surgery and steroid injection are widely used forms of treatment for carpal tunnel syndrome (CTS) but there is no consensus on their effectiveness in comparison to each other. The authors evaluated the efficacy of surgery vs steroid injection in relieving symptoms in patients with CTS. The authors conducted a randomized, single blind, controlled trial. Fifty patients with electrophysiologically confirmed idiopathic CTS were randomized and assigned to open carpal tunnel release (25 patients) or to a single injection of steroid (25 patients). Patients were followed up at 6 and 20 weeks. The primary outcome was symptom relief in terms of the Global Symptom Score (GSS), which rates symptoms on a scale of 0 (no symptoms) to 50 (most severe). Nerve conduction studies and grip strength measurements were used as secondary outcome assessments. At 20 weeks after randomization, patients who underwent surgery had greater symptomatic improvement than those who were injected. The mean improvement in GSS after 20 weeks was 24.2 (SD 11.0) in the surgery group vs 8.7 (SD 13.0) in the injection group (p < 0.001); surgical decompression also resulted in greater improvement in median nerve distal motor latencies and sensory nerve conduction velocity. Mean grip strength in the surgical group was reduced by 1.7 kg (SD 5.1) compared with a gain of 2.4 kg (SD 5.5) in the injection group. Compared with steroid injection, open carpal tunnel release resulted in better symptomatic and neurophysiologic outcome but not grip strength in patients with idiopathic carpal tunnel syndrome over a 20-week period.

To investigate the effect of pressure therapy (PG), silicone gel sheeting (SGS), and combined therapy on the management of posttraumatic hypertrophic scar (HS) using a randomized controlled clinical trial. A total of 104 subjects with HS mostly resulting from burns and scald injuries (63 men and 41 women; average age: 21.8 +/- 18.7 years) were recruited from Jiangsu People's First Affiliated Hospital in Nanjing, China. The mean scar formation period was 14.9 +/- 30.8 months. All subjects were randomly allocated into four groups, namely the PG, SGS, combined PG and SGS groups, and single-blinded control group for the treatment of 6 months. Standardized scar assessments (pigmentation, vascularity, thickness, pain, and itchiness) were conducted before the intervention, 2, 4, and 6 months of the intervention, and 1 month after completion of the program, respectively, to observe the progress of the treatments. The results showed that the combined therapy seemed to be more effective in improving the thickness of scar after 2 months of intervention (P < .001). After 6 months of intervention, both the combined therapy group and the PG group showed significant improvement in scar thickness. The improvement in scar thickness was most significant in the combined therapy group. SGS was found to be more effective in alleviating the pain and pruritus rather than the scar thickness. This randomized clinical trial has demonstrated the evidence of the effect of combined PG and gel intervention on posttraumatic HS. The PG group showed an improvement in scar thickness too. Further studies are needed to investigate the biomechanical and physiological effect that PG and gel sheeting would exert on the scar tissues.

A systematic review of the effectiveness of rehabilitation for persons with unilateral neglect (UN) after stroke was conducted by searching the computerized databases from 1997 through 2012. Randomized controlled trials (RCTs) of neglect treatment strategies for stroke patients which used the Behavioral Inattention Test (BIT) as the primary outcome measure were eligible for inclusion. Out of 201 studies initially identified, 12 RCTs covering 277 participants were selected for analysis. All had the same weakness of low power with smaller samples and limitation in the blinding of the design. Prism Adaptation (PA) was the most commonly used intervention while continuous Theta-burst stimulation (cTBS) appeared to be a new approach. Meta-analysis showed that for immediate effects, the BIT conventional subscore had a significant and large mean effect size (ES=0.76; 95% CI 0.28-1.23; p=0.002) whereas the BIT total score showed a modestly significant mean ES (ES=0.55; 95% CI 0.16-0.94; p=0.006). No significant mean ES in sensitivity analysis was found for long-lasting effects across all BIT outcomes. PA appeared to be the most effective intervention based on the results of pooled analysis. More rigorous studies should be done on repetitive transcranial magnetic stimulation (rTMS) before it can be concluded that it is a promising treatment for UN.