Document Type : Original Article
1 Department of Orthopedics, Kermanshah University of Medical Sciences, Kermanshah, Iran
2 Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran Shiraz Geriatrics Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Background: Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy. Due to the results of recent studies about the protective effects of L-carnitine on nerves, this study was conducted to evaluate the effects L-carnitine on CTS improvement in terms of patient's function, electrodiagnostic study (EDX), and median nerve sonography.
Methods: In this double-blind, randomized, controlled trial, patients with CTS were selected based on the inclusion and exclusion criteria, and then, divided into two groups of placebo and L-carnitine at a dose of 500 mg twice daily for 6 weeks. They were assessed at baseline, and 4 and 6 weeks later using Boston Carpal Tunnel Questionnaire (BCTQ), median nerve conduction study (EDX), and sonography.
Results: There was no statistically significant difference between the intervention and control groups in terms of BCTQ scores, electrodiagnostic findings, and sonographic indexes. Although based on the results of the repeated measures test of the intervention and control groups separately, there was a statistically significant difference in some electrodiagnostic criteria and BCTQ scores. These indexes improved after the intervention.
Conclusion: The effectiveness of L-carnitine on mild to moderate CTS improvement cannot be approve based on the findings of this study and more studies and systematic reviews are required in this regard.
- Moosazadeh M, Asadi-Aliabadi M, Rostami F, Farshidi F, Karimi N. Prevalence of carpal tunnel syndrome in Iran: A systematic review and meta-analysis. J Mazandaran Univ Med Sci 2018; 28(161): 144-53. [In Persian].
- Karimi N, Tabrizi N, Moosavi M, Yadani charatti J. Prevalence of carpal tunnel syndrome and associated risk factors. J Mazandaran Univ Med Sci 2017; 26(146): 179-84. [In Persian].
- Rhee SY, Cho HE, Kim JH, Kim HS. Incidence and reappraisal of known risk factors associated with carpal tunnel syndrome: A nationwide, 11-year, population-based study in South Korea. J Clin Neurol 2021; 17(4): 524-33.
- Habib KR, Estimation of carpal tunnel syndrome (CTS) prevalence in adult population in western european countries: a systematic review. Eur J Clin Bioimed Sci 2017; 3(1): 13-18.
- Dale AM, Harris-Adamson C, Rempel D, Gerr F, Hegmann K, Silverstein B, et al. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health 2013; 39(5): 495-505.
- Farzan M, Mazoochy H, Sobhani A, Shajirat Z, Zolfaghari R, Espandar, Carpal tunnel syndrome and contributing factors in 362 hospitalized patients. Tehran Univ Med J 2012; 70(1): 27-32. [In Persian].
- Carlson H, Colbert A, Frydl J, Arnall E, Elliot M, Carlson N. Current options for nonsurgical management of carpal tunnel syndrome. Int J Clin Rheumtol 2010; 5(1): 129-42.
- Shi Q, MacDermid JC. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. J Orthop Surg Res 2011; 6: 17.
- Rogers MJ, Stephens AR, Yoo M, Nelson RE, Kazmers NH. Optimizing costs and outcomes for carpal tunnel release surgery: A cost-effectiveness analysis from societal and health-care system perspectives. J Bone Joint Surg Am 2021.
- Curran MW, Olson J, Morhart M, Sample D, Chan KM. Acetyl-L-carnitine (ALCAR) to enhance nerve regeneration in carpal tunnel syndrome: Study protocol for a randomized, placebo-controlled trial. Trials 2016; 17: 200.
- Notartomaso S, Mascio G, Bernabucci M, Zappulla C, Scarselli P, Cannella M, et al. Analgesia induced by the epigenetic drug, L-acetylcarnitine, outlasts the end of treatment in mouse models of chronic inflammatory and neuropathic pain. Mol Pain 2017; 13: 1744806917697009.
- Surai P. Antioxidant action of carnitine: Molecular mechanisms and practical applications. EC Veterinary Science 2015; 2(1): 66-84.
- Zhang R, Zhang H, Zhang Z, Wang T, Niu J, Cui D, et al. Neuroprotective effects of pre-treatment with l-carnitine and acetyl-L-carnitine on ischemic injury in vivo and in vitro. Int J Mol Sci 2012; 13(2): 2078-90.
- Sima AA, Calvani M, Mehra M, Amato A. Acetyl-L-carnitine improves pain, nerve regeneration, and vibratory perception in patients with chronic diabetic neuropathy: An analysis of two randomized placebo-controlled trials. Diabetes Care 2005; 28(1): 89-94.
- Dejaco C, Stradner M, Zauner D, Seel W, Simmet NE, Klammer A, et al. Ultrasound for diagnosis of carpal tunnel syndrome: Comparison of different methods to determine median nerve volume and value of power Doppler sonography. Ann Rheum Dis 2013; 72(12): 1934-9.
- Cruccu G, Di SG, Fattapposta F, Jann S, Padua L, Schenone A, et al. L-acetyl-carnitine in patients with carpal tunnel syndrome: Effects on nerve protection, hand function and pain. CNS Drugs 2017; 31(12): 1103-11.
- Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011; 44(4): 597-607.
- Bland JD. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve 2000; 23(8): 1280-3.
- Hassankhani GG, Moradi A, Birjandinejad A, Vahedi E, Kachooei AR, Ebrahimzadeh MH. Translation and Validation of the Persian Version the Boston Carpal Tunnel Syndrome Questionnaire. Arch Bone Jt Surg 2018; 6(1): 71-7.
- Dalili Ar, Mardani--¡kivi M, Alizadeh A, Hatamian Hr, Hoseininejad M, Peyrazm H, et al. Comparison between sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Anesth Pain 2011; 2(3): 43-51. [In Persian].
- Maleki N, Azami A, Anari H, Iranparvar Alamdari M, Tavosi Z, Hajaty S. Value of ultrasonography in the diagnosis of carpal tunnel syndrome confirmed by nerve conduction study. Sci J Kurdistan Univ Med Sci 2014; 19(4): 58-66. [In Persian].
- Di SG, Di LA, Galosi E, Truini A, Cruccu G. Acetyl-L-carnitine in painful peripheral neuropathy: a systematic review. J Pain Res 2019; 12: 1341-51.
- Rolim LC, da Silva EM, Flumignan RL, Abreu MM, Dib SA. Acetyl-L-carnitine for the treatment of diabetic peripheral neuropathy. Cochrane Database Syst Rev 2019; 6: CD011265.
- Li S, Chen X, Li Q, Du J, Liu Z, Peng Y, et al. Effects of acetyl-L-carnitine and methylcobalamin for diabetic peripheral neuropathy: A multicenter, randomized, double-blind, controlled trial. J Diabetes Investig 2016; 7(5): 777-85.
- Kapuscinska K, Urbanik A. High-frequency ultrasound in carpal tunnel syndrome: Assessment of patient eligibility for surgical treatment. J Ultrason 2015; 15(62): 283-91.
- Kerasnoudis A, Pitarokoili K, Yoon MS. Role of the neuromuscular ultrasound in the diagnostic of the multifocal motor neuropathy. Neuroimmunology and Neuroinflammation 2014; 1(3): 103-8.
- Claes F, Kasius KM, Meulstee J, Verhagen WI. Comparing a new ultrasound approach with electrodiagnostic studies to confirm clinically defined carpal tunnel syndrome: A prospective, blinded study. Am J Phys Med Rehabil 2013; 92(11): 1005-11.
- Kwon BC, Jung KI, Baek GH. Comparison of sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Hand Surg Am 2008; 33(1): 65-71.