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Nakamichi R, Saito T, Shimamura Y, Hamada M, Nishida K, Ozaki T. Comparison of early clinical outcome in carpal tunnel release - mini-open technique with palmar incision vs. endoscopic technique with wrist crease incision. BMC Musculoskelet Disord 2024; 25:251. [PMID: 38561698 PMCID: PMC10983724 DOI: 10.1186/s12891-023-07151-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/23/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The purpose of this study was to examine two techniques for Carpal Tunnel Syndrome, mini-Open Carpal Tunnel Release (mini-OCTR) and Endoscopic Carpal Tunnel Release (ECTR), to compare their therapeutic efficacy. METHODS Sixteen patients who underwent mini-OCTR in palmar incision and 17 patients who underwent ECTR in the wrist crease incision were included in the study. All patients presented preoperatively and at 1, 3, and 6 months postoperatively and were assessed with the Visual Analogue Scale (VAS) and the Disabilities of Arm, Shoulder and Hand Score (DASH). We also assessed the pain and cosmetic VAS of the entire affected hand or surgical wound, and the patient's satisfaction with the surgery. RESULTS In the objective evaluation, both surgical techniques showed improvement at 6 months postoperatively. The DASH score was significantly lower in the ECTR group (average = 3 months: 13.6, 6 months: 11.9) than in the mini-OCTR group (average = 3 months: 27.3, 6 months: 20.6) at 3 and 6 months postoperatively. Also, the pain VAS score was significantly lower in the ECTR group (average = 17.1) than in the mini-OCTR group (average = 36.6) at 3 months postoperatively. The cosmetic VAS was significantly lower in the ECTR group (average = 1 month: 15.3, 3 months: 12.2, 6 months: 5.41) than in the mini-OCTR group (average = 1 month: 33.3, 3 months: 31.2, 6 months: 24.8) at all time points postoperatively. Patient satisfaction scores tended to be higher in the ECTR group (average = 3.3) compared to the mini-OCTR group (average = 2.7). CONCLUSIONS ECTR in wrist increase incision resulted in better pain and cosmetic recovery in an early postoperative phase compared with mini-OCTR in palmar incision. Our findings suggest that ECTR is an effective technique for patient satisfaction.
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Affiliation(s)
- Ryo Nakamichi
- Department of Rehabilitation Medicine, Okayama University Hospital, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
| | - Taichi Saito
- Department of Sports Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan.
| | - Yasunori Shimamura
- Department of Sports Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
| | - Masanori Hamada
- Department of Rehabilitation Medicine, Okayama University Hospital, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
| | - Keiichiro Nishida
- Department of Sports Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Sports Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
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Blough CL, Kuschner SH, Berihun H, Tseng CC, Kulber DA. Carpal Tunnel Syndrome: As Seen from the Perspective of the Patient. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5146. [PMID: 37483890 PMCID: PMC10358804 DOI: 10.1097/gox.0000000000005146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/12/2023] [Indexed: 07/25/2023]
Abstract
Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome in the upper extremity and is one of the most common problems treated by hand surgeons. Despite its ubiquity-or perhaps because of it-there is a lack of unanimity regarding how best to treat CTS and what the options for treatment are. This study aimed to explore what patients find important when deciding on treatment of CTS in an effort to improve the physician-patient shared decision-making process. Methods An online crowdsourcing platform was used to recruit participants for this study. Study participants were first led through a clinical scenario in which the symptoms of CTS were explained. They were then asked a series of questions regarding what was important to them when deciding upon treatment. A Likert scale was used for responses. Results In total, 268 participant responses were included in the study. A majority of patients responded that all surveyed factors were either very important or important when considering treatment. The risk of surgery was most important, whereas postoperative pain was least important. The risk of surgery was significantly more important to patients than postoperative pain and time out of work. The cost of surgery was significantly more important to patients than postoperative pain. Conclusions Given the lack of consensus regarding an algorithm for the treatment of CTS, the patient's preference is increasingly important when formulating a treatment plan. The results of this study may better help physicians frame the discussion of treatment options for CTS with their patients.
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Affiliation(s)
- Christian L. Blough
- From the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Stuart H. Kuschner
- From the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Haben Berihun
- From the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Cassie C. Tseng
- The Department of Outpatient Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - David A. Kulber
- From the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
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Ly-Pen D, Andreu JL, de Blas G, Sánchez-Olaso A, Millán I. Response to local corticosteroid injections in carpal tunnel syndrome with normal conduction studies. REUMATOLOGIA CLINICA 2022; 18:393-398. [PMID: 35940672 DOI: 10.1016/j.reumae.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/19/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Nerve conduction studies (NCS) have been considered as the gold standard in carpal tunnel syndrome (CTS) diagnosis, despite correlation between clinical symptomatology and NCS severity has shown to be poor. In fact, clinical symptoms precede NCS changes in months or years. Few papers have been published about the clinical response to treatment of clinically typical CTS, but with normal NCS (NNCS). OBJECTIVE To compare the clinical response to local corticosteroid injections (LCI) in clinically typical CTS, with NNCS and abnormal NCS (ANCS). METHOD We included patients older than 18, with typical CTS symptoms (ongoing daily nocturnal pain/paresthesias in hand, at least during 3 months). Follow-up was done at 3, 6 and 12 months. Primary outcome was the visual analog scale for pain (p-VAS), comparing NNCS CTS wrists with ANCS CTS wrists. Statistic signification was established by the Student's t test, Mann-Whitney's "U", χ2 test and Yates' correction. RESULTS We included 44 wrists in the NNCS group, and 83 in the ANCS group. There was no statistical significance between data in both groups, except in the 12-month follow-up, where the NNCS group achieved better results than the ANCS group in the 20% response (p=0.006). There was a trend toward a better 50% response in the 12-month follow-up. CONCLUSIONS Our data suggest that LCI are similarly effective in both CTS with NNCS and ANCS. Nonetheless, there is a mild better effect in NNCS than in ANCS at 12-month follow-up.
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Affiliation(s)
- Domingo Ly-Pen
- Abbey House Medical Centre, Navan, Co Meath C15 D290, Ireland.
| | - José-Luis Andreu
- Rheumatology Department, University Hospital Puerta de Hierro Majadahonda, Madrid 28222, Spain
| | - Gema de Blas
- Neurophysiology Department, University Hospital Ramón y Cajal, Madrid 28034, Spain
| | | | - Isabel Millán
- Biostatistics Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid 28222, Spain
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Ise M, Saito T, Katayama Y, Nakahara R, Shimamura Y, Hamada M, Senda M, Ozaki T. Relationship between clinical outcomes and nerve conduction studies before and after surgery in patients with carpal tunnel syndrome. BMC Musculoskelet Disord 2021; 22:882. [PMID: 34656102 PMCID: PMC8520296 DOI: 10.1186/s12891-021-04771-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background Nerve conduction study (NCS) is the only useful test for objective assessment of carpal tunnel syndrome (CTS). However, the relationship between pre- and postoperative NCS and clinical outcomes was unclear. This study aimed to determine whether pre- and postoperative (6 months) NCS could predict patient-oriented and motor outcomes (6 and 12 months postoperatively) in patients with CTS. Method Of the 85 patients with CTS, 107 hands were analyzed from March 2011 to March 2020. All patients underwent open carpal tunnel release and were examined using the disabilities of the arm, shoulder and hand (DASH) questionnaire and grip strength (GS) preoperatively and 6 and 12 months postoperatively. Moreover, NCS was examined preoperatively and 6 months postoperatively. Distal motor latency (DML) and sensory conduction velocity (SCV) were the parameters used for NCS. The correlation coefficient between NCS and DASH or GS was calculated. A receiver operating characteristic curve was utilized to determine the NCS threshold value to predict DASH and GS improvement. Results The average scores of GS preoperatively and 6 and 12 months postoperatively were 21.3, 22.3, and 22.8, respectively. On the other hand, the average scores of DASH preoperatively and 6 and 12 months postoperatively were 28.8, 18.3, and 12.2, respectively. The average NCS scores (DML and SCV) preoperatively/6 months postoperatively were 7.3/5.4 and 27.8/36.7, respectively. Preoperative NCS did not correlate with DASH and GS. Postoperative SCV correlated with the change in grip strength (6–12 months, r = 0.67; 0–12 months, r = 0.60) and DASH (0–12 months, r = 0.77). Moreover, postoperative DML correlated with the change in DASH (6–12 months, r = − 0.33; 0–12 months, r = − 0.59). The prediction for the improvement of GS/DASH achieved a sensitivity of 50.0%/66.7% and a specificity of 100%/100%, at an SCV cutoff score of 38.5/45.0 or above. The prediction for improvement of GS/DASH achieved a sensitivity of 83.3%/66.7% and a specificity of 100%/66.7% at a DML cutoff score of 4.4/4.4 or below. Conclusion NCS at 6 months postoperatively can be used to predict the improvement of clinical outcome after 6 months postoperatively in patients with CTS. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04771-y.
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Affiliation(s)
- Masato Ise
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kitaku, Okayama, 700-8558, Japan.,Department of Rehabilitation Medicine, Okayama University Hospital, Okayama, Japan
| | - Taichi Saito
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Yoshimi Katayama
- Department of Rehabilitation Medicine, Okayama University Hospital, Okayama, Japan
| | - Ryuichi Nakahara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yasunori Shimamura
- Department of Sports Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masanori Hamada
- Department of Rehabilitation Medicine, Okayama University Hospital, Okayama, Japan
| | - Masuo Senda
- Department of Rehabilitation Medicine, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kitaku, Okayama, 700-8558, Japan
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Ly-Pen D, Andreu JL, de Blas G, Sánchez-Olaso A, Millán I. Response to Local Corticosteroid Injections in Carpal Tunnel Syndrome With Normal Conduction Studies. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00134-0. [PMID: 34147354 DOI: 10.1016/j.reuma.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/02/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Nerve conduction studies (NCS) have been considered as the gold standard in carpal tunnel syndrome (CTS) diagnosis, despite correlation between clinical symptomatology and NCS severity has shown to be poor. In fact, clinical symptoms precede NCS changes in months or years. Few papers have been published about the clinical response to treatment of clinically typical CTS, but with normal NCS (NNCS). OBJECTIVE To compare the clinical response to local corticosteroid injections (LCI) in clinically typical CTS, with NNCS and abnormal NCS (ANCS). METHOD We included patients older than 18, with typical CTS symptoms (ongoing daily nocturnal pain/paresthesias in hand, at least during 3 months). Follow-up was done at 3, 6 and 12 months. Primary outcome was the visual analog scale for pain (p-VAS), comparing NNCS CTS wrists with ANCS CTS wrists. Statistic signification was established by the Student's t test, Mann-Whitney's "U", χ2 test and Yates' correction. RESULTS We included 44 wrists in the NNCS group, and 83 in the ANCS group. There was no statistical significance between data in both groups, except in the 12-month follow-up, where the NNCS group achieved better results than the ANCS group in the 20% response (p=0.006). There was a trend toward a better 50% response in the 12-month follow-up. CONCLUSIONS Our data suggest that LCI are similarly effective in both CTS with NNCS and ANCS. Nonetheless, there is a mild better effect in NNCS than in ANCS at 12-month follow-up.
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Affiliation(s)
- Domingo Ly-Pen
- Abbey House Medical Centre, Navan, Co Meath C15 D290, Ireland.
| | - José-Luis Andreu
- Rheumatology Department, University Hospital Puerta de Hierro Majadahonda, Madrid 28222, Spain
| | - Gema de Blas
- Neurophysiology Department, University Hospital Ramón y Cajal, Madrid 28034, Spain
| | | | - Isabel Millán
- Biostatistics Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid 28222, Spain
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Corticosteroid Injections for Carpal Tunnel Syndrome: Long-Term Follow-Up in a Population-Based Cohort. Plast Reconstr Surg 2017; 140:338-347. [PMID: 28746281 DOI: 10.1097/prs.0000000000003511] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Corticosteroid injection is a recommended treatment option for carpal tunnel syndrome, before considering surgery. Nevertheless, injections remain controversial because there is strong evidence of only short-term benefits. This study aimed to determine the reintervention rate and to identify prognostic indicators for subsequent treatment after corticosteroid injection for carpal tunnel syndrome. METHODS This study evaluated residents of Olmsted County treated with a corticosteroid injection for carpal tunnel syndrome between 2001 and 2010. Treatment failure was the primary outcome of interest. Two definitions for failure were examined: (1) the patient receiving subsequent procedural intervention and (2) the patient undergoing carpal tunnel release. Survival was estimated using Kaplan-Meier methods, and association of covariates with increased failure was modeled using Cox proportional hazards regression. RESULTS The study included 774 affected hands in 595 patients. The median follow-up period was 7.4 years. Reintervention was performed in 68 percent of cases, of which 63 percent resulted in eventual surgery. Injectate volume was significant for the outcome of any retreatment [hazard ratio, 0.879 (95 percent CI, 0.804 to 0.96)] and surgery [hazard ratio, 0.906 (95 percent CI, 0.827 to 0.99)]. Rheumatoid arthritis was also significant in both models, with a hazard ratio of 0.627 (95 percent CI, 0.404 to 0.97) for any retreatment and 0.493 (95 percent CI, 0.292 to 0.83) for surgery. CONCLUSIONS In this cohort, 32 percent of patients did not receive subsequent treatment after a single injection, which indicates that there is a therapeutic role for corticosteroid injections in treating carpal tunnel syndrome. Further research is necessary to identify those patients who will benefit from an injection, to provide more individually tailored treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Corticosteroid Injections for Carpal Tunnel Syndrome: Long-Term Follow-Up in a Population-Based Cohort. Plast Reconstr Surg 2017. [PMID: 28746281 DOI: 10.1097/prs.0000000000003511.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Corticosteroid injection is a recommended treatment option for carpal tunnel syndrome, before considering surgery. Nevertheless, injections remain controversial because there is strong evidence of only short-term benefits. This study aimed to determine the reintervention rate and to identify prognostic indicators for subsequent treatment after corticosteroid injection for carpal tunnel syndrome. METHODS This study evaluated residents of Olmsted County treated with a corticosteroid injection for carpal tunnel syndrome between 2001 and 2010. Treatment failure was the primary outcome of interest. Two definitions for failure were examined: (1) the patient receiving subsequent procedural intervention and (2) the patient undergoing carpal tunnel release. Survival was estimated using Kaplan-Meier methods, and association of covariates with increased failure was modeled using Cox proportional hazards regression. RESULTS The study included 774 affected hands in 595 patients. The median follow-up period was 7.4 years. Reintervention was performed in 68 percent of cases, of which 63 percent resulted in eventual surgery. Injectate volume was significant for the outcome of any retreatment [hazard ratio, 0.879 (95 percent CI, 0.804 to 0.96)] and surgery [hazard ratio, 0.906 (95 percent CI, 0.827 to 0.99)]. Rheumatoid arthritis was also significant in both models, with a hazard ratio of 0.627 (95 percent CI, 0.404 to 0.97) for any retreatment and 0.493 (95 percent CI, 0.292 to 0.83) for surgery. CONCLUSIONS In this cohort, 32 percent of patients did not receive subsequent treatment after a single injection, which indicates that there is a therapeutic role for corticosteroid injections in treating carpal tunnel syndrome. Further research is necessary to identify those patients who will benefit from an injection, to provide more individually tailored treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Dahlin E, Zimmerman M, Björkman A, Thomsen NOB, Andersson GS, Dahlin LB. Impact of smoking and preoperative electrophysiology on outcome after open carpal tunnel release. J Plast Surg Hand Surg 2016; 51:329-335. [PMID: 27957868 DOI: 10.1080/2000656x.2016.1265531] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim was to evaluate the influence of smoking and preoperative electrophysiology on the outcome of open carpal tunnel release. METHODS This retrospective observational study evaluated the outcome in 493 patients (531 hands) primary operated for carpal tunnel syndrome. Data were collected from medical records, health evaluations, and QuickDASH questionnaires before surgery and 1 year after. RESULTS Smokers had a higher QuickDASH score preoperatively as well as postoperatively, but the change in total score did not differ. The odds of having a postoperative QuickDASH score >10 were 2.5 times higher in smoking patients than in non-smoking patients. In 124/493 patients (25%), no clinically significant improvement was seen. Normal and extreme preoperative electrophysiology values were associated with higher postoperative scores. No correlation was found between preoperative QuickDASH scores and preoperative electrophysiology values. CONCLUSIONS Smokers with carpal tunnel syndrome experience more symptoms preoperatively. Smokers have remaining symptoms after surgery. There is no correlation between preoperative QuickDASH scores and preoperative electrophysiology values. Patients with normal or near to normal preoperative electrophysiology results have limited improvement after surgery.
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Affiliation(s)
- Erik Dahlin
- a Department of Hand Surgery , Lund University, Skåne University Hospital , Malmö , Sweden
| | - Malin Zimmerman
- a Department of Hand Surgery , Lund University, Skåne University Hospital , Malmö , Sweden
| | - Anders Björkman
- a Department of Hand Surgery , Lund University, Skåne University Hospital , Malmö , Sweden
| | - Niels O B Thomsen
- a Department of Hand Surgery , Lund University, Skåne University Hospital , Malmö , Sweden
| | - Gert S Andersson
- b Department of Clinical Sciences Lund, Clinical Neurophysiology , Lund University and Skåne University Hospital , Sweden
| | - Lars B Dahlin
- a Department of Hand Surgery , Lund University, Skåne University Hospital , Malmö , Sweden.,c Department of Translational Medicine-Hand Surgery , Lund University , Malmö , Sweden
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Evanoff B, Gardner BT, Strickland JR, Buckner-Petty S, Franzblau A, Dale AM. Long-term symptomatic, functional, and work outcomes of carpal tunnel syndrome among construction workers. Am J Ind Med 2016; 59:357-68. [PMID: 26909521 DOI: 10.1002/ajim.22564] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND The long-term outcomes of carpal tunnel syndrome (CTS) including symptoms, functional status, work disability, and economic impact are unknown. METHODS We conducted a retrospective study of 234 active construction workers with medical claims for CTS and 249 workers without CTS claims; non-cases were matched on age, trade, and insurance eligibility. We conducted telephone interviews with cases and non-cases and collected administrative data on work hours. RESULTS Compared to non-cases, CTS cases were more likely to report recurrent hand symptoms, decreased work productivity/quality, decreased performance of physical work demands, and greater functional limitations. Surgical cases showed larger improvements on multiple outcomes than non-surgical cases. Minimal differences in paid work hours were seen between cases and non-cases in the years preceding and following CTS claims. CONCLUSIONS Persistent symptoms and functional impairments were present several years after CTS diagnosis. Long-term functional limitations shown by this and other studies indicate the need for improved prevention and treatment.
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Affiliation(s)
- Bradley Evanoff
- Division of General Medical Sciences; Washington University School of Medicine; Saint Louis Missouri
| | - Bethany T. Gardner
- Division of General Medical Sciences; Washington University School of Medicine; Saint Louis Missouri
| | - Jaime R. Strickland
- Division of General Medical Sciences; Washington University School of Medicine; Saint Louis Missouri
| | - Skye Buckner-Petty
- Division of General Medical Sciences; Washington University School of Medicine; Saint Louis Missouri
| | - Alfred Franzblau
- Department of Environmental Health Sciences; University of Michigan School of Public Health; Ann Arbor Michigan
| | - Ann Marie Dale
- Division of General Medical Sciences; Washington University School of Medicine; Saint Louis Missouri
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Unno F, Lucchina S, Bosson D, Fusetti C. Immediate and durable clinical improvement in the non-operated hand after contralateral surgery for patients with bilateral Carpal Tunnel Syndrome. Hand (N Y) 2015; 10:381-7. [PMID: 26330767 PMCID: PMC4551640 DOI: 10.1007/s11552-014-9719-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about clinical improvement in the non-operated hand after unilateral surgery for patients who present with bilateral carpal tunnel syndrome (CTS). In this prospective study of patients with bilateral CTS, we evaluated the clinical effects on the non-operated hand following unilateral contralateral carpal tunnel surgical release. MATERIAL AND METHODS During a consecutive period of 22 months, 69 patients with bilateral CTS underwent unilateral open carpal tunnel release. Bilateral subjective and objective evaluations were performed pre-operatively, at days 2, 15 and 180 after surgery. Subjective evaluations, analysed with Student t test, included the Boston-Levine symptom severity score and a visual analogue scale including pain, nocturnal symptoms and numbness. A telephone survey was conducted 12 months after surgery. RESULTS The Boston-Levine severity score of the contralateral non-operated hand decreased from 2.70 pre-operatively to 1.70 at 2 days (p < 0.001). The visual analogue pain score decreased at 2 days for 61 patients (88 %), whereas the nocturnal symptoms decreased or disappeared in 63 cases (91 %) and the paresthesia in 52 cases (75 %) (ps < 0.001). These beneficial effects were stable in time with no statistically significant change at 180 days. Overall, 58 patients (84 %) observed a total resolution or a significant improvement in their symptoms at 6 months. At 12 months, 100 % of patients responded to a telephone survey. Fifty one of them (74 %) reported minimal or no symptoms on the non-operated hand. Linear regression (analysis of variance [ANOVA]) showed that gender, age, professional status, duration of pre-operative symptoms and severity of electrophysiological disturbances were not predictive of post-operative evolution in the non-operated hand after unilateral surgery for CTS.
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Affiliation(s)
- F. Unno
- />Department of Trauma and Orthopaedic Surgery, Nyon Hospital (GHOL), 1260 Nyon, Switzerland
| | - S. Lucchina
- />Hand Surgery Unit, Department of Trauma and Orthopaedic Surgery, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - D. Bosson
- />Department of Trauma and Orthopaedic Surgery, Nyon Hospital (GHOL), 1260 Nyon, Switzerland
| | - C. Fusetti
- />Hand Surgery Unit, Department of Trauma and Orthopaedic Surgery, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
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D’Angelo K, Sutton D, Côté P, Dion S, Wong JJ, Yu H, Randhawa K, Southerst D, Varatharajan S, Cox (Dresser) J, Brown C, Menta R, Nordin M, Shearer HM, Ameis A, Stupar M, Carroll LJ, Taylor-Vaisey A. The Effectiveness of Passive Physical Modalities for the Management of Soft Tissue Injuries and Neuropathies of the Wrist and Hand: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. J Manipulative Physiol Ther 2015; 38:493-506. [DOI: 10.1016/j.jmpt.2015.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/05/2015] [Accepted: 06/05/2015] [Indexed: 01/18/2023]
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Uchiyama S, Sekijima Y, Tojo K, Sano K, Imaeda T, Moriizumi T, Ikeda SI, Kato H. Effect of synovial transthyretin amyloid deposition on preoperative symptoms and postoperative recovery of median nerve function among patients with idiopathic carpal tunnel syndrome. J Orthop Sci 2014; 19:913-9. [PMID: 25146002 DOI: 10.1007/s00776-014-0635-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 08/05/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND The clinical characteristics of wild-type transthyretin amyloid deposition among patients with carpal tunnel syndrome (CTS) have not been well investigated. METHODS One-hundred and seven patients with idiopathic CTS who underwent carpal tunnel release were enrolled. They underwent physical examination of the hand, nerve-conduction study, and magnetic resonance imaging (MRI) study of the wrist, and completed a patient-oriented questionnaire. The tests, except for MRI, were repeated 1, 3, and 6 months postoperatively. Synovial tissue was obtained during surgery and analyzed by Congo red and immunohistochemical staining. Ordinal logistic regression analysis was used to evaluate the significance of different clinical and subjective findings between patients with and without amyloid deposition. Postoperative improvements were also compared. RESULTS Wild-type transthyretin amyloid deposition was observed for 38 patients. Greater symptom severity and 2-point discrimination scores, and larger cross-sectional areas of the carpal tunnel, were significantly correlated with a larger amount of preoperative amyloid deposition. However, the presence and amount of preoperative amyloid deposition did not affect postoperative improvements in physical findings and nerve-conduction studies. CONCLUSIONS Although transthyretin amyloid deposition can worsen CTS symptoms, postoperative improvements were similar for patients with and without this deposition.
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Affiliation(s)
- Shigeharu Uchiyama
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan,
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Naraghi A, da Gama Lobo L, Menezes R, Khanna M, Sussman M, Anastakis D, White LM. Diffusion tensor imaging of the median nerve before and after carpal tunnel release in patients with carpal tunnel syndrome: feasibility study. Skeletal Radiol 2013; 42:1403-12. [PMID: 23842572 DOI: 10.1007/s00256-013-1670-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 05/20/2013] [Accepted: 06/03/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate diffusion tensor imaging (DTI) indices of the median nerve pre and postoperatively in patients with carpal tunnel syndrome (CTS) to determine whether indices acquired prior to surgery differ from those acquired postoperatively. METHODS Following IRB approval, ten patients with a diagnosis of CTS were prospectively recruited. Eight patients completed the study (seven women, one man). All had bilateral asymmetric symptoms, with subsequent carpal tunnel release on the more symptomatic side. DTI of both wrists were performed using single-shot spin-echo echo-planar imaging (TR/TE, 7,000/103 ms; b value 1,025 s/mm(2)) preoperatively, 6 weeks and 6 months after carpal tunnel release. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the median nerve at the level of the distal radioulnar joint and pisiform were determined by one investigator blinded to clinical data, side, and time relative to surgery. RESULTS All patients had resolution of symptoms on the surgical side at 6 months. A significant increase in FA (p = 0.018) and decrease in ADC (p = 0.017) were found proximally at 6 months compared to baseline on the operative side. A significant increase in FA was observed on the operative side distally at 6 weeks (p = 0.012) and 6 months (p = 0.017). There was a significant difference in the percentage change in FA values from baseline to 6 months on the operative side in comparison with the non-operative side (p = 0.017). CONCLUSIONS A significant increase in FA and decrease in ADC of the median nerve are seen following decompression surgery in patients with CTS.
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Affiliation(s)
- Ali Naraghi
- Department of Medical Imaging, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada.
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Louie DL, Earp BE, Collins JE, Losina E, Katz JN, Black EM, Simmons BP, Blazar PE. Outcomes of open carpal tunnel release at a minimum of ten years. J Bone Joint Surg Am 2013; 95:1067-73. [PMID: 23783202 PMCID: PMC3748987 DOI: 10.2106/jbjs.l.00903] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is little research on the long-term outcomes of open carpal tunnel release. The purpose of this retrospective study was to determine the functional and symptomatic outcomes of patients at a minimum of ten years postoperatively. METHODS Two hundred and eleven patients underwent open carpal tunnel release from 1996 to 2000 performed by the same hand fellowship-trained surgeon. Follow-up with validated self-administered questionnaire instruments was conducted an average of thirteen years after surgery. The principal outcomes included the Levine-Katz symptom and function scores, ranging from 1 point (best) to 5 points (worst), and satisfaction with the results of surgery. The patients self-reported current comorbidities. RESULTS After a mean follow-up of thirteen years (range, eleven to seventeen years), 92% (194) of 211 patients were located. They included 140 who were still living and fifty-four who had died. Seventy-two percent (113) of the 157 located, surviving patients responded to the questionnaire. The mean Levine-Katz symptom score (and standard deviation) was 1.3 ± 0.5 points, and 13% of patients had a poor symptom score (≥2 points). The mean Levine-Katz function score was 1.6 ± 0.8 points, and 26% had a poor function score (≥2 points). The most common symptom-related complaint was weakness in the hand, followed by diurnal pain, numbness, and tingling. The least common symptoms were nocturnal pain and tenderness at the incision. Eighty-eight percent of the patients were either completely satisfied or very satisfied with the surgery. Seventy-four percent reported their symptoms to be completely resolved. Thirty-three percent of men were classified as having poor function compared with 23% of women. Two (1.8%) of 113 patients underwent repeat surgery. CONCLUSIONS At an average of thirteen years after open carpal tunnel release, the majority of patients are satisfied and free of symptoms of carpal tunnel syndrome.
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Affiliation(s)
- Dexter L. Louie
- Department of Orthopedic Surgery (D.L.L., B.E.E., J.E.C., E.L., J.N.K., E.M.B., B.P.S., and P.E.B.), Division of Rheumatology, Immunology and Allergy (J.N.K.), and Department of Biostatistics (J.E.C. and E.L.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Brandon E. Earp
- Department of Orthopedic Surgery (D.L.L., B.E.E., J.E.C., E.L., J.N.K., E.M.B., B.P.S., and P.E.B.), Division of Rheumatology, Immunology and Allergy (J.N.K.), and Department of Biostatistics (J.E.C. and E.L.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Jamie E. Collins
- Department of Orthopedic Surgery (D.L.L., B.E.E., J.E.C., E.L., J.N.K., E.M.B., B.P.S., and P.E.B.), Division of Rheumatology, Immunology and Allergy (J.N.K.), and Department of Biostatistics (J.E.C. and E.L.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Elena Losina
- Department of Orthopedic Surgery (D.L.L., B.E.E., J.E.C., E.L., J.N.K., E.M.B., B.P.S., and P.E.B.), Division of Rheumatology, Immunology and Allergy (J.N.K.), and Department of Biostatistics (J.E.C. and E.L.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Jeffrey N. Katz
- Department of Orthopedic Surgery (D.L.L., B.E.E., J.E.C., E.L., J.N.K., E.M.B., B.P.S., and P.E.B.), Division of Rheumatology, Immunology and Allergy (J.N.K.), and Department of Biostatistics (J.E.C. and E.L.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Eric M. Black
- Department of Orthopedic Surgery (D.L.L., B.E.E., J.E.C., E.L., J.N.K., E.M.B., B.P.S., and P.E.B.), Division of Rheumatology, Immunology and Allergy (J.N.K.), and Department of Biostatistics (J.E.C. and E.L.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Barry P. Simmons
- Department of Orthopedic Surgery (D.L.L., B.E.E., J.E.C., E.L., J.N.K., E.M.B., B.P.S., and P.E.B.), Division of Rheumatology, Immunology and Allergy (J.N.K.), and Department of Biostatistics (J.E.C. and E.L.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Philip E. Blazar
- Department of Orthopedic Surgery (D.L.L., B.E.E., J.E.C., E.L., J.N.K., E.M.B., B.P.S., and P.E.B.), Division of Rheumatology, Immunology and Allergy (J.N.K.), and Department of Biostatistics (J.E.C. and E.L.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
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Arnander M, Teoh V, Barabas A, Umarji S, Fleming A. Improved patient awareness and satisfaction using procedure specific consent forms in carpal tunnel decompression surgery. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2013; 18:53-7. [PMID: 23413851 DOI: 10.1142/s021881041350010x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Carpal tunnel decompression (CTD) is a common procedure amenable to procedure specific consent forms (PSCFs). These may help better inform patients and so increase patient satisfaction with the consent process. We assessed the use of a PSCF for CTD. The PSCF mentions eight complications of carpal tunnel surgery and alternative non-operative treatments. Two groups of 40 patients each were compared prospectively. Patients in one group were issued with a PSCF prior to admission whereas those in the other group were not. After standard pre-operative consent, patients were interviewed prior to surgery and assessed for their awareness of complications and alternative treatment options. The patients who received a PSCF showed greater awareness of different complications and alternative treatments and reported greater satisfaction with the consent process. We conclude that using PSCFs is a very useful and inexpensive adjunct to improve patient awareness and satisfaction with the consent process.
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Affiliation(s)
- M Arnander
- Department of Orthopaedic Surgery, St. George's Healthcare NHS Trust, Blackshaw Road, Tooting, London SW17 0QT, UK.
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Natural history and predictors of long-term pain and function among workers with hand symptoms. Arch Phys Med Rehabil 2013; 94:1293-9. [PMID: 23416766 DOI: 10.1016/j.apmr.2013.01.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/29/2013] [Accepted: 01/29/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate predictors of hand symptoms and functional impairment after 3 years of follow-up among workers with different types of hand symptoms including carpal tunnel syndrome (CTS). Functional status and job limitations were also analyzed as key secondary objectives. DESIGN Cohort design of 3 years duration. SETTING Working population-based study. PARTICIPANTS Newly employed workers without a preexisting diagnosis of CTS (N=1107). Subjects were categorized into 4 groups at baseline examination: no hand symptoms, any hand symptoms but not CTS (recurring symptoms in hands, wrist, or fingers without neuropathic symptoms), any hand symptoms of CTS (neuropathic symptoms in the fingers and normal nerve conduction study), or confirmed CTS (CTS symptoms and abnormal nerve conduction study). Among workers with hand pain at baseline, subject and job characteristics were assessed as prognostic factors for outcomes, using bivariate and multivariate regression models. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The primary outcome assessed by questionnaire at 3 years was "severe hand pain" in the past 30 days. RESULTS At baseline, 155 workers (17.5% of 888 followed workers) reported hand symptoms, of which 21 had confirmed CTS. Presence of hand pain at baseline was a strong predictor of future hand pain and job impairment. Subjects with confirmed CTS at baseline were more likely than workers with other hand pain to report severe hand pain (adjusted prevalence ratios 1.98 [95% confidence interval 1.11-3.52]) and functional status impairment (adjusted prevalence ratios 3.37 [95% confidence interval 1.01-11.29]). Among subjects meeting our case definition for CTS at baseline, only 4 (19.1%) reported seeing a physician in the 3-year period. CONCLUSIONS Hand symptoms persisted among many workers after 3-year follow-up, especially among those with CTS, yet few symptomatic workers had seen a physician.
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Abstract
BACKGROUND Carpal tunnel release (CTR) is widely accepted as an effective surgical treatment method for idiopathic carpal tunnel syndrome. While the short-term literature is well substantiated, the "long-term" literature has rarely exceeded 2 years of follow-up, which may be inadequate for a chronic and potentially recurring disease such as carpal tunnel syndrome. METHODS An English language literature search for long-term outcomes research on carpal tunnel release was made. Long-term is defined as 2 years or more after surgery. RESULTS CTR is a highly effective procedure, but important aspects remain poorly understood, including recurrence and existing electromyographic data. Some study design issues exist with the current literature. CONCLUSIONS Further high-quality research is needed.
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Affiliation(s)
- Dexter Louie
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital Hand and Upper Extremity Service, Brigham and Women’s Hospital, 75 Francis Street, Orthopedics A-Main, Boston, MA 02115 USA
| | - Brandon Earp
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital Hand and Upper Extremity Service, Brigham and Women’s Hospital, 75 Francis Street, Orthopedics A-Main, Boston, MA 02115 USA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital Hand and Upper Extremity Service, Brigham and Women’s Hospital, 75 Francis Street, Orthopedics A-Main, Boston, MA 02115 USA
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