***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To compare the effects of night-only to full-time splint wear instructions on symptoms , function , and  impairment  in carpal tunnel syndrome ( CTS ) . DESIGN R and omized clinical trial with 6-week follow-up . SETTING Veterans Administration Medical Center , outpatient clinic . SUBJECTS Out patients with untreated CTS were consecutively recruited from our electrodiagnostics lab . Twenty-one patients ( 30 h and s ) were enrolled , and 17 patients ( 24 h and s ) completed the study . INTERVENTIONS Thermoplastic , custom-molded , neutral wrist splints with subjects receiving either full-time or night-only wear instructions . OUTCOME MEASURES Symptoms and functional deficits were measured by Levine 's self-administered question naire , and physiologic impairment was measured by median nerve sensory and motor distal latency . COMPLIANCE AND CROSSOVER : Almost all ( 92 % ) of the combined sample reported frequent splint use , but their adherence to specific wearing instructions was limited . A majority ( 73 % ) of the full-time group reported splint wear less than one half of waking hours , and some ( 23 % ) of the night-only group reported occasional daytime wear . Despite this tendency for treatment crossover , the two treatment groups differed in daytime wear as intended ( chi2 analysis , p = .004 ) . RESULTS The combined sample improved in three of four outcome measures : sensory distal latency ( mean = .28msec , st and ard deviation [ SD ] = .37 , p = .004 ) , symptom severity ( mean = .64 , SD = .46 , p = .0001 ) , and functional deficits ( mean = .49 , SD = .51 , p = .0001 ) . Severity of CTS was a factor only in sensory distal latency improvement ( more improvement in severe CTS ) . Subjects receiving full-time wear instructions showed superior distal latency improvement , both motor ( .35 vs -.07msec , p = .04 ) and sensory ( .46 vs . 13msec , p = .05 ) when compared with subjects receiving night-only wear instructions . CONCLUSIONS This study provides added scientific evidence to support the efficacy of neutral wrist splints in CTS and suggests that physiologic improvement is best with full-time splint wear instructions This study was design ed to compare the efficacy of ultrasound and laser treatment for mild to moderate idiopathic carpal tunnel syndrome . Ninety h and s in 50 consecutive patients with carpal tunnel syndrome confirmed by electromyography were allocated r and omly in two experimental groups . One group received ultrasound therapy and the other group received low level laser therapy . Ultrasound treatment ( 1 MHz , 1.0 W/cm(2 ) , pulse 1:4 , 15 min/session ) and low level laser therapy ( 9 joules , 830 nm infrared laser at five points ) were applied to the carpal tunnel for 15 daily treatment sessions ( 5 sessions/week ) . Measurements were performed before and after treatment and at follow up four weeks later , and included pain assessment by visual analogue scale ; electroneurographic measurement ( motor and sensory latency , motor and sensory action potential amplitude ) ; and pinch and grip strength . Improvement was significantly more pronounced in the ultrasound group than in low level laser therapy group for motor latency ( mean difference 0.8 m/s , 95 % CI 0.6 to 1.0 ) , motor action potential amplitude ( 2.0 mV , 95 % CI 0.9 to 3.1 ) , finger pinch strength ( 6.7 N , 95 % CI 5.0 to 8.2 ) , and pain relief ( 3.1 points on a 10-point scale , 95 % CI 2.5 to 3.7 ) . Effects were sustained in the follow-up period . Ultrasound treatment was more effective than laser therapy for treatment of carpal tunnel syndrome . Further study is needed to investigate the combination therapy effects of these treatments in carpal tunnel syndrome patients OBJECTIVE To investigate whether real or sham low-level laser therapy ( LLLT ) plus microamperes transcutaneous electric nerve stimulation ( TENS ) applied to acupuncture points significantly reduces pain in carpal tunnel syndrome ( CTS ) . DESIGN R and omized , double-blind , placebo-control , crossover trial . Patients and staff administered outcome measures blinded . SETTING Outpatient , university-affiliated Department of Veterans Affairs medical center . PARTICIPANTS Eleven mild to moderate CTS cases ( nerve conduction study , clinical examination ) who failed st and ard medical or surgical treatment for 3 to 30 months . INTERVENTION Patients received real and sham treatment series ( each for 3 - 4wk ) , in a r and omized order . Real treatments used red-beam laser ( continuous wave , 15mW , 632.8 nm ) on shallow acupuncture points on the affected h and , infrared laser ( pulsed , 9.4W , 904 nm ) on deeper points on upper extremity and cervical paraspinal areas , and microamps TENS on the affected wrist . Devices were painless , noninvasive , and produced no sensation whether they were real or sham . The h and was treated behind a hanging black curtain without the patient knowing if devices were on ( real ) or off ( sham ) . MAIN OUTCOME MEASURES McGill Pain Question naire ( MPQ ) score , sensory and motor latencies , and Phalen and Tinel signs . RESULTS Significant decreases in MPQ score , median nerve sensory latency , and Phalen and Tinel signs after the real treatment series but not after the sham treatment series . Patients could perform their previous work ( computer typist , h and yman ) and were stable for 1 to 3 years . CONCLUSIONS This new , conservative treatment was effective in treating CTS pain ; larger studies are recommended OBJECTIVE To compare the efficacy of conservative medical care with chiropractic care in the treatment of carpal tunnel syndrome . DESIGN Two-group , r and omized , single-blind trial with 9 wk of treatment and a 1-month follow-up interview . SETTING Wolfe-Harris Center for Clinical Studies at Northwestern College of Chiropractic in Bloomington , Minnesota . PATIENTS Ninety-one of 96 eligible subjects who reported symptoms that were confirmed by clinical exam and nerve conduction studies . INTERVENTIONS Interventions included ibuprofen ( 800 mg 3 times a day for 1 wk , 800 mg twice a day for 1 wk and 800 mg as needed to a maximum daily dose of 2400 mg for 7 wk ) and nocturnal wrist supports for medical treatment . Chiropractic treatment included manipulation of the soft tissues and bony joints of the upper extremities and spine ( three treatments/week for 2 wk , two treatments/week for 3 wk and one treatment/week for 4 wk ) , ultrasound over the carpal tunnel and nocturnal wrist supports . MAIN OUTCOME MEASURES Outcome measures were pre- and post assessment s of self-reported physical and mental distress , nerve conduction studies and vibrometry . RESULTS There was significant improvement in perceived comfort and function , nerve conduction and finger sensation overall , but no significant differences between groups in the efficacy of either treatment . CONCLUSIONS Carpal tunnel syndrome associated with median nerve demyelination but not axonal degeneration may be treated with commonly used components of conservative medical or chiropractic care Abstract Objective : To assess the efficacy of ultrasound treatment for mild to moderate idiopathic carpal tunnel syndrome . Design : R and omised , double blind , “ sham ” controlled trial with assessment s at baseline , after 2 weeks ' and 7 weeks ' treatment , and at a follow up assessment 6 months later ( 8 months after baseline evaluation ) . Setting : Outpatient clinic of a university department of physical medicine and rehabilitation in Vienna . Subjects : 45 patients with mild to moderate bilateral carpal tunnel syndrome as verified by electroneurography . Intervention : 20 sessions of ultrasound ( active ) treatment ( 1 MHz , 1.0 W/cm2 , pulsed mode 1:4 , 15 minutes per session ) applied to the area over the carpal tunnel of one wrist , and indistinguishable sham ultrasound treatment applied to the other . The first 10 treatments were performed daily ( 5 sessions/week ) ; 10 further treatments were twice weekly for 5 weeks . Main outcome measures : Score of subjective symptom ratings assessed by visual analogue scale ; electroneurographic measures ( for example , motor distal latency and sensory antidromic nerve conduction velocity ) . Results : Improvement was significantly more pronounced in actively treated than in sham treated wrists for both subjective symptoms ( P<0.001 , paired t test ) and electroneurographic variables ( motor distal latency P<0.001 , paired t test ; sensory antidromic nerve conduction velocity P<0.001 , paired t test ) . Effects were sustained at 6 months ' follow up . Conclusion : Results suggest there are satisfying short to medium term effects due to ultrasound treatment in patients with mild to moderate idiopathic carpal tunnel syndrome . Findings need to be confirmed , and ultrasound treatment will have to be compared with st and ard conservative and invasive treatment options . Key messages Chronic entrapment of the median nerve at the wrist ( the carpal tunnel syndrome ) is probably the most common peripheral nerve lesion No satisfactory conservative treatment is available at present Twenty sessions of ultrasound treatment show good short and medium term efficacy in patients with bilateral , mild to moderate forms of the carpal tunnel syndrome Optimal treatment schedules of ultrasound treatment alone or in combination with other non-surgical treatments await Objectives : To determine the efficacy of a two week and a four week course of oral steroids in the conservative treatment of carpal tunnel syndrome . Methods : 109 patients with carpal tunnel syndrome were r and omly divided into two treatment groups : ( 1 ) two weeks of prednisolone 20 mg daily followed by two weeks of prednisolone 10 mg daily ( n = 53 ) ; ( 2 ) two weeks of prednisolone 20 mg daily and two weeks of placebo ( n = 56 ) . A symptom question naire was used to rate the five major symptoms of carpal tunnel syndrome ( numbness , pain , weakness/clumsiness , tingling , and nocturnal awakening ) on a scale of 0 ( nil ) to 10 ( severe ) ; the result ing global symptom score was used to evaluate the efficacy of treatment . Assessment s were made at baseline and at one , three , six , nine , and 12 months . Electrodiagnosis was repeated at the end of the study to vali date improvement . Results : In an intention to treat analysis at the end of the study , improvement in the four week treatment group was achieved in 66.0 % of the patients after one month and in 49.0 % at the end of the study ; in the two week treatment group , the respective values were 48.2 % and 35.7 % . In the four week treatment group , 51 % were considered treatment failures ( including those lost to follow up , receiving surgery , or with mild or no improvement ) , compared with 64.3 % for the two week group . Though the percentage improvement was higher in the four week group , the difference did not reach a statistical significance . Persistence of improvement was 74.2 % in the four week group v 74.1 % in the two week group , suggesting no difference in the long term effect . Efficacy analysis showed no significant difference in global symptom score reduction between the two groups . Follow up electrodiagnosis showed significant improvement in all measured variables except for the amplitude of compound muscle action potentials . Conclusions : Short term low dose oral steroid are effective treatment for carpal tunnel syndrome . The dose of steroids and the duration treatment are not key determinants of efficacy Several studies have suggested that low-level laser therapy ( LLLT ) is effective in patients with carpal tunnel syndrome ( CTS ) . In a double-blind r and omized controlled trial of LLLT , 15 CTS patients , 34 to 67 years of age , were r and omly assigned to either the control group ( n = 8) or treatment group ( n = 7 ) . Both groups were treated three times per week for 5 weeks . Those in the treatment group received 860 nm galium/aluminum/arsenide laser at a dosage of 6 J/cm2 over the carpal tunnel , whereas those in the control group were treated with sham laser . The primary outcome measure was the Levine Carpal Tunnel Syndrome Question naire , and the secondary outcome measures were electrophysiological data and the Purdue pegboard test .  All patients completed the study without adverse effects .  There was a significant symptomatic improvement in both the control ( P = 0.034 ) and treatment ( P = 0.043 ) groups . However , there was no significant difference in any of the outcome measures between the two groups . Thus , LLLT is no more effective in the reduction of symptoms of CTS than is sham treatment The authors compared the effectiveness of low-dose , short-term oral prednisolone vs local methylprednisolone injection in a prospect i ve , double-blinded , parallel treatment study of carpal tunnel syndrome ( CTS ) . A single injection of 15 mg methylprednisolone result ed in significant improvement in global symptom scores over a 12-week period . This study demonstrated the superiority of local steroid injection to oral steroid in the treatment of CTS Çeliker R , Arslan Ş , İnanıcı F : Corticosteroid injection vs. nonsteroidal antiinflammatory drug and splinting in carpal tunnel syndrome . Am J Phys Med Rehabil 20 
    Output:
    
Our review shows that : ( 1 ) locally injected steroids produce a significant but temporary improvement , ( 2 ) vitamin B6 is ineffective , ( 3 ) steroids are better than non-steroidal anti-inflammatory drugs ( NSAIDs ) and diuretics , but they can produce side-effects , ( 4 ) ultrasound is effective while laser therapy shows variable results , ( 5 ) exercise therapy is not effective , ( 6 ) splints are effective , especially if used full-time .
Conclusion : There is : ( 1 ) strong evidence ( level 1 ) on efficacy of local and oral steroids ; ( 2 ) moderate evidence ( level 2 ) that vitamin B6 is ineffective and splints are effective and ( 3 ) limited or conflicting evidence ( level 3 ) that NSAIDs , diuretics , yoga , laser and ultrasound are effective whereas exercise therapy and botulinum toxin B injection are ineffective