# Improvement in Nighttime Awakening Symptoms After Bracing, Injections, and Carpal Tunnel Release

## TL;DR

This study compares how bracing, injections, and surgery affect nighttime awakening symptoms in carpal tunnel syndrome patients.

## Contribution

It provides new evidence on the effectiveness of non-surgical and surgical treatments for improving insomnia severity in CTS patients.

## Key findings

- All treatment groups showed improvements in insomnia severity scores.
- Injections and surgery showed significant improvements in univariate analysis.
- Multivariable analysis found no significant difference between treatment groups.

## Abstract

Background

Carpal tunnel syndrome (CTS) is the most common peripheral compressive neuropathy, and nighttime awakening (NTA) symptoms commonly impact patients with CTS. While carpal tunnel release (CTR) is known to improve NTA, the effect of bracing and corticosteroid injections on NTA remains understudied. We hypothesized that injections and CTR would yield greater early Insomnia Severity Index (ISI) score improvements than bracing.

Methodology

We conducted a prospective, observational, cohort study on patients with CTS treated with bracing (n = 6, 17%), injections (n = 8, 22%), or mini-open CTR (n = 22, 61%) at a single institution between January 2022 and April 2023. All patients received an online questionnaire before treatment and approximately two weeks post-treatment. Questionnaires included the ISI and the Boston Carpal Tunnel Syndrome Questionnaire, including the symptom severity scale and functional status scale.

Results

A total of 36 patients were enrolled, including 11 men (mean age = 65.4) and 25 women (mean age = 56.5). At baseline, the cohort included 78% overweight/obese patients and 6% (n = 2) with diabetes. After a mean of 19.6 days of follow-up, all groups demonstrated improvements in ISI scores (bracing group = 14.7 to 12.7, p = 0.218, injection group = 21.5 to 13.6, p = 0.001, and surgery group = 16.5 to 13.2, p = 0.017). The injection and CTR groups demonstrated significant improvements in univariate analysis. On a multivariable analysis, there was no significant difference between bracing, injections, and CTR in the overall change in symptom scores from baseline.

Conclusions

In this single-institution, prospective study, patients treated with bracing, injections, and surgery for CTS experienced early improvements in NTA and CTS symptoms. On multivariable analysis, neither intervention performed significantly better than the other groups when controlling for comorbidities; however, the analysis was limited by small cohorts, especially in the non-surgical groups.