518139 research-article2014

JHS0010.1177/1753193413518139The Journal of Hand SurgeryEditorial



The Journal of Hand Surgery (European Volume) 2014, Vol. 39E(2) 131­ © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1753193413518139 jhs.sagepub.com

Editorial The theme for this issue is carpal tunnel syndrome (CTS). A simple search of Pubmed lists over 400 articles and no doubt there are many more elsewhere. It would be easy to imagine that every possible study has been done. Yet there are many good ideas not yet explored or not well explored. Reading many of these studies I have thought either ‘I wish I had thought of doing that’ or simply ‘I could have done that study’ (but I did not). I have also thought ‘that question never occurred to me but is rather good’. Although our speciality can trace its origins to at least the late 1940s and we are privileged to have had many brilliant pioneers go before us, there are many questions as yet unanswered. Work elsewhere has answered some. In particular I would encourage you to read the latest work of Atroshi et al. (2013), where they have shown that steroid injections for CTS are better than placebo, but most patients require surgery within one year. There is still much work to do: why do some patients suffer marked scar tenderness and others none? Does the morphology of the carpal tunnel matter in causing CTS? Why do most patients progress gradually and some very quickly, especially the elderly? How often does thenar wasting resolve? What are the key factors in the familial tendency to CTS? You may already know the answers as I have overlooked published results and you will undoubtedly have other questions you would like answered. I encourage you all to ask more questions and then challenge yourself and your colleagues to answer

them. Although we can do great good for each individual patient we treat, we can be even more effective by providing new knowledge to guide other clinicians and so indirectly help many more patients. As well as thinking of new ideas, do plan any new study thoroughly. The main causes of articles being rejected by this Journal are poor ideas or poorly planned studies. The latter is particularly frustrating as it represents wasted effort often by well-meaning clinicians. When you read the articles in this issue read the methods they use and judge for yourself their strengths and weaknesses. Only then read the commentaries. You will learn about the design of studies as well as the science they have reported. We know about the importance of outcome measures and have an excellent commentary making that even clearer. The role of ultrasound in hand surgery is much less clear. Some of the arguments for and against are outlined in two articles and a commentary. Like all tests it is easy to overuse or simply to restrict to proven practice such as the assessment of tendon integrity. Again I challenge you to wonder where else you may use it. Reference Atroshi I, Flondell M, Hofer M, Ranstam J. Methylprednisolone injections for the carpal tunnel syndrome: a randomized, placebo-controlled trial. Ann Intern Med. 2013, 159: 309–17.

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G. Giddins Editor-in-Chief

Editorial: carpal tunnel syndrome.

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