Participants in this group will given an N-acetylcysteine 500mg oral tablet daily in addition to wearing a standard carpal tunnel splint nightly (worn approximately 6-8 hours/day). Both interventions will take place concurrently for a total of 8 consecutive weeks.

Participants in this group will be given a placebo table to be taken orally daily in addition to wearing a standard carpal tunnel splint nightly (worn approximately 6-8 hours/day). Both interventions will take place concurrently for a total of 8 consecutive weeks.

Carpal Tunnel Syndrome

Hand Injuries and Disorders

Nerve Compression

Splints

Carpal Tunnel

Carpal Tunnel Release

In addition to splinting, both groups will receive an oral tablet to take daily for 8 weeks. Participants assigned to the experimental group will receive oral NAC (500 mg PO daily for eight weeks; based on recommended daily dose for use as an antioxidant and dosing in previous human clinical trials and animal studies), and those assigned to the control group will be given a similar looking placebo with identical instructions. Tablets will be provided in a blister pack to assist with compliance.

N-Acetyl cysteine

Participants in both arms will be given a standard prescription for a prefabricated night splint which keeps the wrist in a neutral position and instructed on proper use and the importance of consistent use. To limit splint variability, we will ensure that splint prescriptions are written such that a MedSpec Wrist Lacer II splint is obtained from the patient's pharmacy. This is the most commonly available brand locally and meets the criteria for wrist, metacarpophalangeal, and interphalangeal joint positioning. They will be advised to wear the splint consistently during sleeping hours on their affected wrist for eight weeks, as is the standard of practice.

Wrist Splint

Queen Elizabeth II Health Sciences Center, Halifax Infirmary Site

The ACTS Trial: N-acetylcysteine (NAC) and Night-splinting as a Non-operative Treatment for Carpal Tunnel Syndrome

The Use of N-acetylcysteine Supplementation in Addition to Night Splinting for Treatment of Mild to Moderate Carpal Tunnel Syndrome: A Randomized, Double-blind, Placebo-controlled Trial

The Boston Carpal Tunnel Questionnaire (BCTQ) is a validated tool for patient-reported outcomes with respect to symptoms and functional impact of carpal tunnel syndrome. It consists of both a symptom severity scale (SSS) (11 items) and functional status scale (FSS) (8 items). Each item on both of these scales is scored on a 5-point rating system, with higher numbers indicating more severe symptoms and higher functional disability. The possible range of both the FSS and SSS combined is from 19-95. A baseline BCTQ will be administered at the first visit, which will be used to calculate the overall change in BCTQ score at 8 weeks.

The participant's decision to continue with conservative treatment or to elect to have a carpal tunnel release procedure at 8-weeks post-treatment will be a secondary outcome measure.

If at 8-weeks, the participant decides not to have carpal tunnel release surgery, an additional follow up visit will be scheduled at 6 months time. At this point in time, the participants decision to have carpal tunnel release surgery or to continue to conservative modalities will be a subgroup analysis.

If the participant decides not have have a carpal tunnel release at 8 weeks, an additional follow up visit will be scheduled in 6 months. At this time, a third BCTQ will be completed to assess change in long-term BCTQ compared to baseline.

David Tang

Principal Investigator, Associate Professor, Division of Plastic Surgery, Dalhousie University

Randomized, double-blind, placebo-controlled trial

Participants will undergo permutated block randomization to either the placebo controlled or experimental group in a 1:1 ratio. This method will be computer-generated. The allocation sequence will be concealed to research staff. The participants, clinic nurses, research assistants, and physician investigators as well as outcome assessors will be masked to participant group allocation. Unblinding will be permissible in extenuating circumstances only, such as if a participant experiences a severe adverse reaction secondary to the tablet and requires confirmation of the contents.

Patient will receive sacrospinous ligament suspension surgery without any additional interventions

Patient will have sacrospinous ligament suspension procedure with addition of a trigger point injection (9cc of 0.5% marcaine and 1 cc kenalog) over area of suture placement

Postoperative Pain

Pelvic Organ Prolapse

Trigger Point Injection

Sacrospinous Ligament Fixation

Trigger point injection (consisting of 9 cc 0.5% Marcaine and 1 cc kenalog) may be given at time of surgery if patient is randomized to receive the injection

marcaine and kenalog

Kettering Health Network

The Effect of Local Analgesia on Postoperative Gluteal Pain in Patients Undergoing Sacrospinous Ligament Fixation: A Randomized Trial

Ashley Seidner

OB/GYN resident

Surgical transection of transverse ligament

Standard therapy for CTS. An incision is made at the base of the palm of the hand. Then the transverse ligament is cut, which releases the compression of the median nerve and improves the symptoms.

Krakowska Akademia Neurologii Centrum Neurologii Klinicznej

Validation of the Polish Version of the Boston Carpal Tunnel Syndrome Questionnaire

Consistency between two subscales of pBCTQ (Symptom severity scale and Functional status scale) will be evaluated using Cronbach alfa test.

Validity will be tested by calculating the correlation of the subscore of each of two parts of the questionnaire with the electrophysiologic, six-grade severity level according to Padua et al. (1997).

The reactivity will be evaluated as correlation between change in electrophysiologic severity level of CTS and changes in both pBCTQ subscales after treatment.

Jakub Antczak

Principal Investigator

Centrum Neurologii Klinicznej Krakowska Akademia Neurologii

The hand that was subject to thread carpal tunnel release surgery

Ultrasound-guided percutaneous minimally invasive thread carpal tunnel release using a looped thread technique

Thread carpal tunnel release

A Pilot Study to Evaluate the Effectiveness of Ultrasound Guided Looped Thread Carpal Tunnel Release

At weekly intervals for the 1st month ,each subject will also be contacted to report on their recovery (return to everyday activities including work) and any adverse effects/complications

subjective measure of symptom and functional limitation severity. Symptom and function subscale scores were summed (score range 2-10 with 2=asymptomatic and 10=severely symptomatic).

Grip strength measured using a hand grip dynamometer; pinch strength measured with a pinch dynamometer

median nerve cross-sectional area measurement at the carpal tunnel inlet using ultrasound

electrophysiologic function of the median nerve across the carpal tunnel (motor and sensory conduction velocities and amplitudes).

nerve compression syndromes/asthenia

The ACTS Trial: N-acetylcysteine (NAC) and Night-splinting as a Non-operative Treatment for Carpal Tunnel Syndrome

The Effect of Local Analgesia on Postoperative Gluteal Pain in Patients Undergoing Sacrospinous Ligament Fixation: A Randomized Trial

Validation of the Polish Version of the Boston Carpal Tunnel Syndrome Questionnaire

A Pilot Study to Evaluate the Effectiveness of Ultrasound Guided Looped Thread Carpal Tunnel Release

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