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Westenberg RF, DiGiovanni PL, Schep NWL, Eberlin KR, Chen NC, Coert JH. Does Revision Carpal Tunnel Release Result in Long-Term Outcomes Equivalent to Single Carpal Tunnel Release? A Matched Case-Control Analysis. Plast Reconstr Surg 2024; 153:746e-757e. [PMID: 37189245 DOI: 10.1097/prs.0000000000010682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND The aims of this study were to evaluate long-term patient-reported outcomes after revision carpal tunnel release (CTR); compare these outcomes with those of patients who had a single CTR and a comparable age, sex, race, type of initial surgery, and follow-up time; and assess which factors are associated with worse patient-reported outcomes after revision CTR. METHODS The authors retrospectively identified 7351 patients who had a single CTR and 113 patients who had a revision CTR for carpal tunnel syndrome between January of 2002 and December of 2015 at five academic urban hospitals. Of these 113 revision CTR cases, 37 patients completed a follow-up questionnaire including the Boston Carpal Tunnel Questionnaire (BCTQ), the Numerical Rating Scale for Pain Intensity, and satisfaction score. Those who completed the follow-up questionnaire were randomly matched to five controls (patients who had a single CTR) based on age, sex, race, type of initial surgery, and follow-up time. Of these 185 matched controls, 65 completed the follow-up questionnaire. RESULTS A linear mixed effects model using matched sets as a random effect showed that patients who had a revision CTR had a higher total BCTQ score, Numerical Rating Scale for Pain Intensity score, and a lower satisfaction score at time of follow-up than patients who had a single CTR. Multivariable linear regression showed that thenar muscle atrophy before the revision surgery was independently associated with more pain after revision surgery. CONCLUSION Patients improve after revision CTR, but generally have more pain, have a higher BCTQ score, and are less satisfied at long-term follow-up compared with patients who had a single CTR.
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Affiliation(s)
- Ritsaart F Westenberg
- From the Massachusetts General Hospital
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht
| | | | | | | | | | - J Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht
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2
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Saglam G, Turgut MC, Semis HS, Toy S. Ultrasonographic Measurement of Median Nerve Cross-Sectional Area in Evaluating Carpal Tunnel Release Outcomes. J Hand Surg Am 2023; 48:1060.e1-1060.e8. [PMID: 35534326 DOI: 10.1016/j.jhsa.2022.03.007] [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: 03/27/2021] [Revised: 02/01/2022] [Accepted: 03/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Earlier research has explored carpal tunnel release (CTR) surgery outcomes using electrodiagnostic tests (EDX). However, evaluation of the median nerve before and after CTR by ultrasound (US) is understudied. This study aimed to establish the outcomes of CTR by EDX and US, and examine the correlation between the clinical improvement and US after CTR. METHODS The sample consisted of 172 wrists that underwent CTR. Pain was assessed using the visual analog scale (VAS). The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), including the symptom severity and function subscales, was applied before and 3 months after CTR. The proximal and distal cross-sectional areas (CSAs) of the median nerve were measured using US, and EDX was performed before and 3 months after CTR. RESULTS Patients had mean preoperative and postoperative VAS scores of 7.7 ± 1.2 and 1.7 ± 1.2, respectively. The mean preoperative and postoperative proximal CSA measurements were 16.4 ± 4.5 mm2 and 12.1 ± 3.9 mm2, respectively. The mean preoperative and postoperative distal CSA measurements were 13.6 ± 3.7 mm2 and 11.0 ± 3.1 mm2, respectively. A significant improvement was observed in VAS, BCTQ, and EDX 3 months after CTR. A weak, positive correlation was observed between the improvement in the BCTQ symptom severity and function subscales and CSAs following CTR. CONCLUSIONS The results of this study demonstrate that preoperative median nerve CSA values may be used in evaluating CTR outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Gonca Saglam
- Karadeniz Technical University, Faculty of Medicine, Clinic of Physical Medicine and Rehabilitation, Trabzon, Turkey
| | - Mehmet Cenk Turgut
- Department of Orthopedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Halil Sezgin Semis
- Private Erzurum Buhara Hospital, Clinic of Orthopedics and Traumatology, Erzurum, Turkey
| | - Serdar Toy
- Department of Orthopedics and Traumatology, Basaksehir Pine and Sakura City Hospital, Istanbul, Turkey.
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Al-Zamil M, Minenko IA, Kulikova NG, Mansur N, Nuvakhova MB, Khripunova OV, Shurygina IP, Topolyanskaya SV, Trefilova VV, Petrova MM, Narodova EA, Soloveva IA, Nasyrova RF, Shnayder NA. Efficiency of Direct Transcutaneous Electroneurostimulation of the Median Nerve in the Regression of Residual Neurological Symptoms after Carpal Tunnel Decompression Surgery. Biomedicines 2023; 11:2396. [PMID: 37760837 PMCID: PMC10525175 DOI: 10.3390/biomedicines11092396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/28/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy. CTS therapy includes wrist immobilization, kinesiotherapy, non-steroidal anti-inflammatory drugs, carpal tunnel steroid injection, acupuncture, and physical therapy. Carpal tunnel decompression surgery (CTDS) is recommended after failure of conservative therapy. In many cases, neurological disorders continue despite CTDS. The aim of this study was to investigate the efficiency of direct transcutaneous electroneurostimulation (TENS) of the median nerve in the regression of residual neurological symptoms after CTDS. Material and Methods: 60 patients aged 28-62 years with persisting sensory and motor disorders after CTDS were studied; 15 patients received sham stimulation with a duration 30 min.; 15 patients received high-frequency low-amplitude TENS (HF TENS) with a duration 30 min; 15 patients received low-frequency high-amplitude TENS (LF TENS) with a duration 30 min; and 15 patients received a co-administration of HF TENS (with a duration of15 min) and LF TENS (with a duration of 15 min). Results: Our research showed that TENS significantly decreased the pain syndrome, sensory disorders, and motor deficits in the patients after CTDS. Predominantly, negative and positive sensory symptoms and the pain syndrome improved after the HF TENS course. Motor deficits, reduction of fine motor skill performance, electromyography changes, and affective responses to chronic pain syndrome regressed significantly after the LF TENS course. Co-administration of HF TENS and LF TENS was significantly more effective than use of sham stimulation, HF TENS, or LF TENS in patients with residual neurological symptoms after CTDS.
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Affiliation(s)
- Mustafa Al-Zamil
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia, 117198 Moscow, Russia; (N.G.K.); (N.M.)
- Department of Restorative Medicine and Neurorehabilitation, Medical Dental Institute, 127253 Moscow, Russia;
| | - Inessa A. Minenko
- Department of Restorative Medicine and Neurorehabilitation, Medical Dental Institute, 127253 Moscow, Russia;
- Department of Sports Medicine and Medical Rehabilitation, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia;
| | - Natalia G. Kulikova
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia, 117198 Moscow, Russia; (N.G.K.); (N.M.)
- National Medical Research Center for Rehabilitation and Balneology, 121099 Moscow, Russia;
| | - Numman Mansur
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia, 117198 Moscow, Russia; (N.G.K.); (N.M.)
- Department of Restorative Medicine and Neurorehabilitation, Medical Dental Institute, 127253 Moscow, Russia;
- City Clinical Hospital Named after V. V. Vinogradov, 117292 Moscow, Russia
| | - Margarita B. Nuvakhova
- National Medical Research Center for Rehabilitation and Balneology, 121099 Moscow, Russia;
| | - Olga V. Khripunova
- Department of Sports Medicine and Medical Rehabilitation, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia;
| | - Irina P. Shurygina
- Department of Ophthalmology, Rostov State Medical University, 344022 Rostov, Russia;
| | - Svetlana V. Topolyanskaya
- Department of Hospital Therapy No. 2, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia;
| | - Vera V. Trefilova
- Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia; (V.V.T.); (R.F.N.)
| | - Marina M. Petrova
- Shared Core Facilities “Molecular and Cell Technologies”, Professor V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.N.); (I.A.S.)
| | - Ekaterina A. Narodova
- Shared Core Facilities “Molecular and Cell Technologies”, Professor V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.N.); (I.A.S.)
| | - Irina A. Soloveva
- Shared Core Facilities “Molecular and Cell Technologies”, Professor V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.N.); (I.A.S.)
| | - Regina F. Nasyrova
- Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia; (V.V.T.); (R.F.N.)
| | - Natalia A. Shnayder
- Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia; (V.V.T.); (R.F.N.)
- Shared Core Facilities “Molecular and Cell Technologies”, Professor V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.N.); (I.A.S.)
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Sears ED, Evans R, Burns J, Chung KC, Hayward RA, Kerr EA. Carpal Tunnel Syndrome as a Test Case for Value Assessment During the Presurgical Period: The Impact of Structure and Processes of Care. Med Care 2023; 61:36-44. [PMID: 36477618 PMCID: PMC9743137 DOI: 10.1097/mlr.0000000000001790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Few performance measures assess presurgical value (quality and utilization). OBJECTIVES Using carpal tunnel syndrome (CTS) as a case study: (1) develop a model to evaluate presurgical quality and utilization and (2) identify opportunities for value improvement. RESEARCH DESIGN A retrospective cohort study utilizing Veterans Affairs (VA) national administrative data. SUBJECTS Patients who were evaluated in a VA primary care clinic on at least 1 occasion for CTS and received carpal tunnel release over a 7-year period. MEASURES We modeled facility-level performance on 2 outcomes: surgical delay (marker of quality) and number of presurgical encounters (utilization) for CTS, and examined association between patient, facility, and care process variables and performance. RESULTS Among 41,912 Veterans undergoing carpal tunnel release at 127 VA medical centers, the median facility-level predicted probability of surgical delay was 48%, with 16 (13%) facilities having significantly less delay than the median and 13 (10%) facilities having greater delay. The median facility-level predicted number of presurgical encounters was 8.8 visits, with 22 (17%) facilities having significantly fewer encounters and 22 (17%) facilities having more. Care processes had a stronger association with both outcomes than structural variables included in the models. Processes associated with the greatest deviations in predicted delay and utilization included receipt of repeat electrodiagnostic testing, use of 2 or more nonoperative treatments, and community referral outside of VA. CONCLUSIONS Using CTS as a test case, this study demonstrates the potential to assess presurgical value and identify modifiable care processes associated with presurgical delay and utilization performance.
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Affiliation(s)
- Erika D. Sears
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, Michigan
- Institute of Health Policy and Innovation, Michigan Medicine, Ann Arbor, MI
| | - Richard Evans
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System
| | - Jennifer Burns
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System
| | - Kevin C. Chung
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, Michigan
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI
| | - Rodney A. Hayward
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System
- Institute of Health Policy and Innovation, Michigan Medicine, Ann Arbor, MI
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI
| | - Eve A. Kerr
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System
- Institute of Health Policy and Innovation, Michigan Medicine, Ann Arbor, MI
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI
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Aloi NF, Kohls MR, Wera JC, Fowler JR. Ultrasound Cross-Sectional Area of the Median Nerve Is Not a Predictor of Patient Reported Outcomes After Carpal Tunnel Release. Hand (N Y) 2023; 18:114S-118S. [PMID: 35611507 PMCID: PMC9896290 DOI: 10.1177/15589447221093677] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the relationship between cross sectional area (CSA) of the median nerve on ultrasound (US) with pre- and postoperative Boston Carpal Tunnel Questionnaire (BCTQ) scores. We hypothesize that there is a positive correlation between CSA and the ΔBCTQ after carpal tunnel release (CTR). METHODS This was a single center study. During a 6-year period (2014-2020), CSA of the median nerve on US and BCTQ scores were collected prospectively for patients presenting with the chief complaint of numbness and tingling in the upper extremity. Patients who underwent CTR and presented for their 6-week follow-up had repeat measurements of the CSA and BCTQ. These patients were included in this study. Patients were then divided into ultrasound positive (CSA ≥ 10) and ultrasound negative (CSA < 10) groups. These groups were compared on the basis of demographics, preoperative BCTQ scores, postoperative BCTQ scores, and 6-week ΔBCTQ score. RESULTS US-positive and-negative groups did not differ significantly in their preoperative BCTQ, postoperative BCTQ, or ΔBCTQ scores. Both groups did, however, experience significant improvement when comparing preoperative to postoperative BCTQ scores within their respective US group. CONCLUSION Regardless of the preoperative CSA of the median nerve, patients who underwent CTR experienced a significant improvement in their BCTQ results. US-positive patients experienced no greater improvement than US-negative patients. These results would suggest that US is not a good predictor of subjective surgical outcome measures such as the BCTQ.
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Aversano FJ, Goldfarb CA, Gelberman RH, Calfee RP. The Utility of the Carpal Tunnel Syndrome-6 for Predicting the Outcomes of Carpal Tunnel Release. J Hand Surg Am 2022; 47:944-952. [PMID: 35941000 DOI: 10.1016/j.jhsa.2022.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/29/2022] [Accepted: 06/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Considering the cost of, discomfort with, and time required for nerve conduction testing, the Carpal Tunnel Syndrome-6 (CTS-6) is often used to determine the likelihood of the presence of carpal tunnel syndrome. We sought to determine whether the CTS-6, designed as a diagnostic instrument, could serve a dual purpose and predict the outcome of carpal tunnel release (CTR) based on postoperative changes in the Boston Carpal Tunnel Questionnaire (BCTQ) score. METHODS This prospective observational study enrolled 118 adults before they underwent open CTR at a tertiary center. A primary regression analysis was used to determine the association between preoperative CTS-6 scores and changes in the BCTQ score at ≥6 months after surgery. Additional demographic, social, electrodiagnostic, and mental health variables were assessed for associations with changes in the BCTQ score. The secondary outcomes included single questions rating satisfaction with the result of CTR as well as symptom changes and the Decision Regret Scale. Noneffective CTR was defined as a BCTQ score change of <1.0 point or reported dissatisfaction. RESULTS Postoperatively, the BCTQ score improvement averaged 1.38 ± 0.77. Although 102 of 109 patients (94%) noted symptom improvement, 94 of 109 (86%) were satisfied with the result of CTR, and 78 of 109 patients (72%) demonstrated a meaningful change in the BCTQ score. Preoperative CTS-6 scores were not correlated with changes in BCTQ scores. CTS-6 scores were not associated with Decision Regret Scale scores, reported satisfaction, or the single-question assessment of symptom changes. Satisfaction, decision regret, and the single symptom change question were correlated with changes in the BCTQ score and each other. Dissatisfied patients were distinguished by a differential improvement in the BCTQ score (1.5 vs 0.7), but no preoperative variable consistently predicted noneffective CTR. CONCLUSIONS The CTS-6 score does not predict changes in BCTQ scores after CTR. Patient satisfaction with surgical results is associated with postoperative changes in carpal tunnel symptoms but is not predictable using preoperative information. A single question of symptom change may offer an efficient assessment of CTR outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Francis J Aversano
- Department of Orthopedic Surgery, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Charles A Goldfarb
- Department of Orthopedic Surgery, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Richard H Gelberman
- Department of Orthopedic Surgery, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Ryan P Calfee
- Department of Orthopedic Surgery, Washington University in St. Louis, School of Medicine, St. Louis, MO.
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7
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Izmalkov SN, Semenkin OM, Bratiichuk AN. Carpal tunnel syndrome: Does preoperative disease severity influence the outcome of mini-open surgery? HAND SURGERY & REHABILITATION 2022; 41:470-476. [PMID: 35513243 DOI: 10.1016/j.hansur.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 10/18/2022]
Abstract
In the practice of carpal tunnel surgery, open decompression of the median nerve in carpal tunnel syndrome (CTS) is recognized as the therapeutic priority. However, the speed and completeness of postoperative recovery of sensitivity and function depend on the initial clinical manifestations of the disease and the severity of the electrophysiological disorder. The aim of this study was to investigate the influence of preoperative clinical and electrophysiological factors on the outcome of surgical treatment of patients with CTS of varying severity. One-hundred and eighty-nine open decompressions of the median nerve via a mini-open incision were performed in 161 patients with idiopathic CTS. Clinical observations were classified in 5 groups, according to severity. Treatment results were evaluated per group at 6 weeks and 3, 6 and 12 months after surgery. In all cases, there was improvement and positive dynamics according to clinical and electroneuromyographic data. Open decompression of the median nerve via mini-open incision can achieve significant clinical and functional improvement in the majority of patients with CTS. However, the most favorable results were mainly seen in patients with initial severity classified in the first, second and third (lower severity) groups.
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Affiliation(s)
- Sergey N Izmalkov
- Department of Traumatology, Orthopedics and Polyclinic Surgery, Samara State Medical University, 89 Chapayevskaya Str., 443099 Samara, Russian Federation
| | - Oleg M Semenkin
- Traumatological and Orthopedic Department, Mother & Child Samara Hospital ("IDK Hospital"), 70 Volzhskoe Highway, 443072 Samara, Russian Federation
| | - Aleksandr N Bratiichuk
- Department of Traumatology, Orthopedics and Polyclinic Surgery, Samara State Medical University, 89 Chapayevskaya Str., 443099 Samara, Russian Federation.
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8
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Meyers A, Annunziata MJ, Rampazzo A, Bassiri Gharb B. A Systematic Review of the Outcomes of Carpal Ligament Release in Severe Carpal Tunnel Syndrome. J Hand Surg Am 2022; 48:408.e1-408.e18. [PMID: 35058091 DOI: 10.1016/j.jhsa.2021.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/12/2021] [Accepted: 11/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Indications for surgical treatment of severe carpal tunnel syndrome (CTS) are controversial. The aim of this study was to review the outcomes reported in the literature of carpal tunnel release in patients with severe CTS. METHODS A systematic review of the outcomes of carpal tunnel release in patients with severe CTS was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome measures included change in symptoms, sensation (2-point discrimination, light touch), thenar atrophy, strength (power and pinch grip), electrophysiology, median nerve morphology, and patient-reported outcome measures. Outcomes are reported by ranges of the percentage of patients/hands improved in the included studies. RESULTS Thirty-eight papers were selected, representing 2,531 patients and 2,712 hands. Demographic information on age and sex were available for a total of 1,542 patients. Mean age ranged from 49.8 to 83 years and 72% were female. All studies that assessed patient-reported outcome measures before and after surgery reported significant improvements. Complete resolution of paresthesia occurred in 55%-98% of hands across different studies. Resolution of numbness occurred in between 39% and 94% of hands. Pain completely resolved in 64%-100% and weakness in 60%-75% of hands. Two-point discrimination and light touch improved postoperatively. Power grip, key, tripod, index-thumb pulp pinch, and thumb opposition increased. Motor and sensory amplitudes, distal motor latencies, and sensory conduction velocities improved. Patient-reported outcomes indicated symptomatic improvement and reduced disability. CONCLUSIONS Symptomatic improvement following carpal tunnel release in patients with severe CTS can occur. Patients should be counseled about the unpredictability of the outcomes and factors that might affect outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Abigail Meyers
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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9
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Schulze DG, Nilsen KB, Killingmo RM, Zwart JA, Grotle M. Clinical Utility of the 6-Item CTS, Boston-CTS, and Hand-Diagram for Carpal Tunnel Syndrome. Front Neurol 2021; 12:683807. [PMID: 34385969 PMCID: PMC8353366 DOI: 10.3389/fneur.2021.683807] [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] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Self-reported measures are often used in research and clinical practice to diagnose carpal tunnel syndrome (CTS) and guide therapeutic choices. We aimed to assess the clinical utility of the Norwegian versions of two self-reported outcome measures for symptom severity assessment, the 6-item CTS (CTS-6), and Boston-CTS (BCTQ), and of one diagnostic measure, the hand-diagram, by evaluating measurement properties including discriminative ability for severity assessment (CTS-6, BCTQ), and diagnosis of CTS (hand-diagram). Methods: We performed forward and backward translation and cultural adaptation of the Norwegian CTS-6 and BCTQ. Following COSMIN guidelines, we investigated internal consistency, reliability, construct validity, and discriminative ability for distinguishing between severity levels of CTS in patients with confirmed CTS for the CTS-6 and BCTQ and reliability and discriminative ability for diagnosing CTS for the hand-diagram. Results: Two hundred and fifty-one patients referred for diagnostic work-up for CTS with nerve conduction studies (NCS) participated. The CTS-6 and BCTQ had acceptable internal consistency (Crohnbach's α = 0.82 and 0.86, respectively), reliability (ICC = 0.86 and 0.90; SEM = 0.24 and 0.20; SDC95% = 0.68 and 0.55, respectively), construct validity (all eight pre-defined hypotheses confirmed) and discriminative ability to distinguish between severity levels of CTS [Area under the curve (AUC) = 0.75, 95% CI 0.64–0.85]. The hand-diagram had acceptable reliability (Cohen's kappa = 0.69) and discriminative ability to diagnose CTS (sensitivity = 0.72, specificity = 0.90). Conclusion: Our findings support the clinical utility of the CTS-6 and BCTQ for symptom severity assessment and of the hand-diagram for diagnostic screening.
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Affiliation(s)
- Daniel Gregor Schulze
- Department of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Kristian Bernhard Nilsen
- Department of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway.,Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | | | - John Anker Zwart
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Margreth Grotle
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.,Oslo Metropolitan University, Oslo, Norway
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Martikkala L, Himanen SL, Virtanen K, Mäkelä K. The Neurophysiological Severity of Carpal Tunnel Syndrome Cannot Be Predicted by Median Nerve Cross-Sectional Area and Wrist-to-Forearm Ratio. J Clin Neurophysiol 2021; 38:312-316. [PMID: 32224714 DOI: 10.1097/wnp.0000000000000696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The median nerve cross-sectional area at the wrist (CSA) and the wrist-to-forearm ratio of the cross-sectional areas (WFR) are ultrasound parameters used in the diagnosis and grading of carpal tunnel syndrome. This study aimed to determine the diagnostic accuracy of the CSA and WFR as well as to compare their diagnostic value. METHODS A retrospective evaluation was conducted of a cohort of 218 patients who had undergone nerve conduction studies (NCSs) and an ultrasound of the median nerve. The examined wrists were classified into an NCS negative and three NCS positive (mild, moderate, and severe) categories. The CSA and WFR were compared across the categories. RESULTS The CSA and WFR were significantly smaller in the NCS negative category than in the NCS positive categories. The WFR was significantly smaller in the mild category than in the moderate category. The CSA could not be used to differentiate across the NCS positive categories. CONCLUSIONS The CSA and WFR are satisfactorily reliable in detecting carpal tunnel syndrome, but they cannot be considered as surrogate indicators of electrophysiological severity.
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Affiliation(s)
- Lauri Martikkala
- Department of Clinical Neurophysiology, Pirkanmaa Hospital District, Medical Imaging Centre and Hospital Pharmacy, Tampere University Hospital, Tampere, Finland ; and
| | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Pirkanmaa Hospital District, Medical Imaging Centre and Hospital Pharmacy, Tampere University Hospital, Tampere, Finland ; and
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Katja Virtanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Katri Mäkelä
- Department of Clinical Neurophysiology, Pirkanmaa Hospital District, Medical Imaging Centre and Hospital Pharmacy, Tampere University Hospital, Tampere, Finland ; and
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Osiak K, Mazurek A, Pękala P, Koziej M, Walocha JA, Pasternak A. Electrodiagnostic Studies in the Surgical Treatment of Carpal Tunnel Syndrome-A Systematic Review. J Clin Med 2021; 10:jcm10122691. [PMID: 34207345 PMCID: PMC8235020 DOI: 10.3390/jcm10122691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 01/11/2023] Open
Abstract
The aim of our paper was to provide comprehensive data on the role of electrodiagnostic (EDX) studies in the surgical treatment of carpal tunnel syndrome (CTS). An extensive search was conducted through the major electronic database to identify eligible articles. Data extracted included grade of CTS based on neurophysiological testing, preoperative data of EDX studies, time of complete or partial resolution after surgery, postoperative Boston carpal tunnel questionnaire (CTQ) scores, age, sex, intraoperative and postoperative data of EDX studies, time to complete or partial resolution of symptoms, and number of patients without postsurgical improvement. Our main findings revealed that that electrodiagnostic testing is still a powerful tool for diagnosis of CTS. Moreover, it can also detect other pathologies. EDX testing provides a quantitative measure of the physiological function of the median nerve, which may be used to guide surgical treatment. Thirdly, when the outcome of surgery is unsatisfactory, NCS can assist in determining the reason for failure.
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Affiliation(s)
- Katarzyna Osiak
- Medical Centre for Postgraduate Education, Department of Plastic Surgery, Professor W. Orlowski Memorial Hospital, 231st Czerniakowska Street, 00-416 Warsaw, Poland;
| | - Agata Mazurek
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
| | - Przemysław Pękala
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
| | - Jerzy A. Walocha
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
| | - Artur Pasternak
- Medical Centre for Postgraduate Education, Department of Plastic Surgery, Professor W. Orlowski Memorial Hospital, 231st Czerniakowska Street, 00-416 Warsaw, Poland;
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
- Correspondence: ; Tel./Fax: +48-12-422-95-11
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Park D, Kim BH, Lee SE, Kim DY, Eom YS, Cho JM, Yang JW, Kim M, Kwon HD. Electrodiagnostic, Sonographic, and Clinical Features of Carpal Tunnel Syndrome with Bifid Median Nerve. J Pain Res 2021; 14:1259-1269. [PMID: 34040430 PMCID: PMC8140939 DOI: 10.2147/jpr.s303142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/28/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose A bifid median nerve (BMN) is not a rare variant. This study aimed to investigate the features of carpal tunnel syndrome (CTS) accompanied by BMN. Patients and Methods In this retrospective study, we defined a BMN group as CTS with BMN and a non-bifid median nerve (NMN) group as CTS without BMN. All hands were assigned to four severity grades according to the findings of electrodiagnosis (EDx): very mild, mild, moderate, and severe. The cross-sectional area (CSA) of the median nerve, palmar bowing of the flexor retinaculum, and persistent median artery (PMA) were assessed by ultrasonography. Numerical pain rating scale (NRS) and symptom duration were assessed as clinical variables. Results Sixty-four hands (57 patients) and 442 hands (341 patients) were enrolled in the BMN and the NMN groups, respectively. BMN was prevalent in 12.6% of all CTS hands. The distribution of EDx severity grade was milder in the BMN group than in the NMN group (P<0.001). The CSA of the BMN group was 16.2±4.1 mm2, slightly larger than 15.1±4.2 mm2 in the NMN group (P=0.056). The BMN group showed higher NRS than the NMN group (5.5±1.5 and 4.4±1.7, respectively; P<0.001). In the subgroup analysis, NRS was significantly higher in the BMN group than in the NMN group at all EDx severity grades. In the BMN group, the PMA group showed greater EDx severity (P=0.037) and higher NRS (6.0 and 5.0, respectively; P=0.012) than the non-PMA group. The radial side branch's CSA was larger than that of the ulnar side branch (10.0 mm2 and 6.0 mm2, respectively; P<0.001). Conclusion CTS with BMN presented more severe symptoms and relatively milder EDx severity. When assessing the severity of CTS with BMN, the clinical symptoms should primarily be considered, as well as we should complementarily evaluate the EDx and ultrasonography.
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Affiliation(s)
- Dougho Park
- Department of Rehabilitation Medicine, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Byung Hee Kim
- Department of Rehabilitation Medicine, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Sang-Eok Lee
- Department of Rehabilitation Medicine, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Dong Young Kim
- Department of Orthopedic Surgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Yoon Sik Eom
- Department of Orthopedic Surgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Jae Man Cho
- Department of Neurosurgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Joong Won Yang
- Department of Neurosurgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Mansu Kim
- Department of Neurosurgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Heum Dai Kwon
- Department of Neurosurgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
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Zhang D, Ostergaard P, Cefalu C, Hall M, Earp BE, Blazar P. Outcomes of Mini-Open Carpal Tunnel Release in Patients With Unrecordable Preoperative Nerve Conduction Potentials at a Minimum of 5 Years. Hand (N Y) 2021; 16:292-297. [PMID: 31230473 PMCID: PMC8120583 DOI: 10.1177/1558944719857815] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: The aim of this study is to assess the outcomes of carpal tunnel release (CTR) in a cohort of patients with preoperatively unrecordable median nerve sensory and motor potentials in comparison with historical controls at minimum 5-year follow-up. Methods: We retrospectively identified 1297 patients who underwent CTR at a tertiary care referral center from July 2008 to June 2013. After exclusion criteria and review of available preoperative nerve conduction studies, 24 patients who underwent CTR with preoperative unrecordable sensory and motor nerve potentials were identified. Fifteen living, mentally capable patients were contacted by telephone for follow-up. Our primary outcome measure was the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Secondary outcome measures included Disabilities of the Arm, Shoulder, and Hand (DASH) score, pain on a 0 to 10 Likert scale, and satisfaction on a 0 to 10 Likert scale. Results: Our response rate was 80% (12 out of 15) of eligible patients. Mean follow-up was 6.9 years in our study (range, 5.4-9.5 years). The mean BCTQ symptom score was 1.4, and the mean BCTQ functional score was 1.8. Mean DASH score was 15.2. On average, patient-reported pain was 0.3 and satisfaction was 8.3. No difference was found in outcomes of CTR in patients with end-stage carpal tunnel syndrome compared with historical means. Conclusions: Patients with end-stage carpal tunnel syndrome do not have worse long-term patient-reported outcomes after CTR compared with the general population. Unrecordable nerve potentials are not a contraindication for CTR.
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Affiliation(s)
- Dafang Zhang
- Brigham and Women’s Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Dafang Zhang, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Peter Ostergaard
- Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital, Boston, USA
| | - Charles Cefalu
- Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital, Boston, USA
| | - Matthew Hall
- Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital, Boston, USA
| | - Brandon E. Earp
- Brigham and Women’s Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Philip Blazar
- Brigham and Women’s Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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14
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Lu YT, Deol AK, Sears ED. The Association Between Electrodiagnostic Severity and Treatment Recommendations for Carpal Tunnel Syndrome. J Hand Surg Am 2021; 46:92-98. [PMID: 33131978 PMCID: PMC7864860 DOI: 10.1016/j.jhsa.2020.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 06/27/2020] [Accepted: 08/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Our study aimed to evaluate the relationship between electrodiagnostic study (EDS) severity and utilization of treatments for carpal tunnel syndrome (CTS) as well as the duration of time between EDS and carpal tunnel release (CTR). METHODS We conducted a retrospective medical chart review at a single tertiary hand center to evaluate CTS-related care that patients received after EDS. We recorded patient age, sex, race/ethnicity, insurance type, CTS-related surgical and nonsurgical healthcare utilization after EDS testing, and number of days between EDS and CTR. RESULTS Among all patients with an eventual diagnosis of CTS who received EDS (n = 210), nearly half had normal or mild severity (23%, n = 48; and 28%, n = 58, respectively) and the other half had moderate or severe EDS findings (26%, n = 55; and 23%, n = 49, respectively). Patients with severe findings had the highest rate of receiving surgery (53%) compared with patients with mild and moderate findings (33% vs 46%, respectively). Among the patients who received CTR (n = 73), patients with severe EDS findings had the shortest time to CTR (59.5 days; interquartile range [IQR], 30-81), compared with mild severity (170 days; IQR, 87-415) and moderate severity (77 day; IQR, 42-292). Moderate and severe EDS findings were associated with significantly higher odds of receiving CTR in adjusted analyses (odds ratio, 2.48, 95% confidence interval, 1.04-5.93 and odds ratio 3.79, 95% confidence interval, 1.51-9.50, respectively) compared with patients with mild EDS findings. However, the odds of receiving steroid injection and hand therapy/orthosis were not significantly different based on severity. CONCLUSIONS Electrodiagnostic study severity had a direct relationship to the probability of receiving surgery but did not correlate with use of nonsurgical treatment. The study findings signal a need to evaluate the value of nonsurgical treatments in patients with severe EDS findings. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Yu-Ting Lu
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI,Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Amrit K. Deol
- Chicago Medical School, Rosalind Franklin University of Medicine and Science
| | - Erika D. Sears
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI,Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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15
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Fernandes CH, Santos JBGD, Schwartz-Fernandes F, Ostermann AL, Faloppa F. Fatores de insucesso do tratamento cirúrgico da síndrome do túnel do carpo: Quando e como revisar a cirurgia de descompressão do túnel do carpo. Rev Bras Ortop 2020; 57:718-725. [PMID: 36226206 PMCID: PMC9550358 DOI: 10.1055/s-0040-1713759] [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: 12/20/2019] [Accepted: 04/20/2020] [Indexed: 12/04/2022] Open
Abstract
Despite being a procedure widely used all over the world with high rates of symptom remission, surgical treatment of carpal tunnel syndrome may present unsatisfactory outcomes. Such outcomes may be manifested clinically by non-remission of symptoms, remission of symptoms with recurrence a time after surgery or appearance of different symptoms after surgery. Different factors are related to this unsuccessful surgical treatment of carpal tunnel syndrome. Prevention can be achieved through a thorough preoperative clinical evaluation of the patient. As such, the surgeon will be able to make differential or concomitant diagnoses, as well as determine factors related to patient dissatisfaction. Perioperative factors include the correct identification of anatomical structures for complete median nerve decompression. Numerous procedures have been described for managing postoperative factors. Among them, the most common is adhesion around the median nerve, which has been treated with relative success using different vascularized flaps or autologous or homologous tissue coverage. The approach to cases with unsuccessful surgical treatment of carpal tunnel syndrome is discussed in more detail in the text.
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Affiliation(s)
- Carlos Henrique Fernandes
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - João Baptista Gomes dos Santos
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | - A. Lee Ostermann
- Hand and Orthopaedic Surgery Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Flávio Faloppa
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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16
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Matsis R, Chou J, Clode N. Outcome of carpal tunnel decompression with pre-surgical diagnosis determined on general practitioner assessment and nerve conduction study. J Clin Orthop Trauma 2020; 13:15-18. [PMID: 33717870 PMCID: PMC7919971 DOI: 10.1016/j.jcot.2020.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/09/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Accurate diagnosis of carpal tunnel syndrome is key to successful treatment. At our center a treatment pathway was recently established for patients with carpal tunnel syndrome. Within this pathway patients are assessed by their community practitioner. Patients who fail to improve with conservative treatment and have a positive nerve conduction study are put forward for surgery without a specialist assessment. Recent literature has shown nerve conduction study may produce a high rate of false-positive results when used to diagnose carpal tunnel syndrome. The aim of this study was to retrospectively review outcomes of carpal tunnel decompression surgery in patients whose diagnoses was based on a community practitioner assessment and positive nerve conduction study. METHODS All patients who had carpal tunnel release surgery between August 1, 2017 and August 31, 2018 at our center were screened for eligibility. Data from hospital records and a standardized telephone questionnaire was used to assess surgical outcome. RESULTS The final study population included 128 operated hands. The mean follow up time after surgery was 9.6 months. We found 79% of patients reported significant improvement of their symptoms following carpal tunnel release. The overall complication rate was 2.3%. CONCLUSION This study has demonstrated good outcomes from carpal tunnel decompressive surgery are possible in a cohort of patients whose diagnosis was made on the basis of a positive nerve conduction study and community practitioner assessment.
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Affiliation(s)
- Raphael Matsis
- Corresponding author. 23 Mein Street, Newtown, Wellington, 6021, New Zealand.
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17
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Pourmokhtari M, Mazrooyi M, Vosoughi AR. Conservative or surgical treatment of carpal tunnel syndrome based on the severity and patient risk factors. Musculoskelet Surg 2020; 105:315-319. [PMID: 32394276 DOI: 10.1007/s12306-020-00663-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/02/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The carpal tunnel syndrome (CTS) is the most common median nerve compression disease which may result in impaired nerve function. This study was carried out to determine which treatment is more appropriate for moderate or severe CTS patients with or without risk factors. MATERIALS AND METHODS In a cohort prospective study, the patients with moderate CTS received a conservative treatment including night splint for 3 months, one methyl prednisolone injection whereas patients with severe CTS underwent surgical release. They were followed for 1 year using the bland scale based on the electromyography and nerve conduction velocity studies and five-point global assessment outcome scale. RESULTS Totally, 68 moderate CTS cases (32 patients with risk factors and 36 without any risk factors) and 32 cases with severe CTS (16 patients with risk factors and 16 without any risk factors) were assess at 6 months and 1 year following the treatment. Although about 22% of moderate CTS patients with risk factors changed to mild CTS after 6 months of conservative treatment, about 75% showed mild CTS or complete remedy following 1 year (P value < 0.001). This result was about 30% at 6 months and about 95% at 1 year following conservative treatment in patients with moderate CTS without risk factors. None of moderate CTS patients with or without risk factors underwent surgery after 1 year of follow-up. Although almost all patients with severe CTS, with and without risk factors, showed complete recovery or changed to mild CTS at 1 year postoperatively, the result was statistically significant for cases without risk factors (P value = 0.002). CONCLUSION Conservative treatment for moderate CTS would be a good option, and the final result may be seen 1 year later; however, its positive effect is quicker and better for moderate CTS cases without risk factors. Surgical release of the carpal tunnel may be the best choice not only for severe CTS cases with risk factors but also for cases without risk factors. For obtaining consistent rapid result, it is recommended to do surgical release for all cases of moderate or severe CTS without considering risk factors, but more clinical researches are needed. LEVEL OF EVIDENCE II.
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Affiliation(s)
- M Pourmokhtari
- Department of Orthopedic Surgery, Jahrom University of Medical Sciences, Jahrom, Iran
| | - M Mazrooyi
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
| | - A R Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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18
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Revision Carpal Tunnel Release: Risk Factors and Rate of Secondary Surgery. Plast Reconstr Surg 2020; 145:1204-1214. [DOI: 10.1097/prs.0000000000006742] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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19
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Zhang D, Collins J, Blazar P, Earp BE. Factors Associated With Advanced Presentation for Carpal Tunnel Release. J Hand Surg Am 2020; 45:111-116. [PMID: 31668408 DOI: 10.1016/j.jhsa.2019.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/30/2019] [Accepted: 08/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to determine factors associated with presentation of carpal tunnel syndrome for carpal tunnel release (CTR) in the advanced electrodiagnostic stages. METHODS We identified 920 patients with preoperative electrodiagnostic studies (EDSs) who underwent CTR at a tertiary-care referral center from July 2008 to June 2013. Patients were divided into 2 groups: those in the advanced electrodiagnostic stage, defined as those with unrecordable nerve potentials on preoperative EDSs (group 1), and those with recordable nerve potentials on preoperative EDSs (group 2). Logistic regression was used to determine factors that were associated with presentation in the advanced stages of the disease. RESULTS Multivariable regression analysis showed older age (odds ratio [OR] 1.05; 95% confidence interval [95% CI], 1.04-1.07), diabetes mellitus (OR, 1.72; 95% CI, 1.13-2.62), and hypertension (OR, 1.88; 95% CI, 1.25-2.84) to be associated with advanced presentation for CTR. CONCLUSIONS A 10-year increase in age results in a 1.6-times increase in the odds of advanced presentation. Diabetes mellitus or hypertension independently doubles the odds of advanced presentation. A subset of symptomatic patients with carpal tunnel syndrome may benefit from earlier referral for hand surgery evaluation and earlier CTR. Older patients with diabetes mellitus and hypertension are at increased risk for advanced presentation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Jamie Collins
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Brandon E Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Abstract
Background: Increasing severity of carpal tunnel syndrome (CTS), as graded by nerve conduction studies (NCS), has been demonstrated to predict the speed and completeness of recovery after carpal tunnel release (CTR). The purpose of this study is to compare the cross-sectional area (CSA) of the median nerve in patients with severe and nonsevere CTS as defined by NCS. Methods: Ultrasound CSA measurements were taken at the carpal tunnel inlet at the level of the pisiform bone by a hand fellowship-trained orthopedic surgeon. Severe CTS on NCS was defined as no response for the distal motor latency (DML) and/or distal sensory latency (DSL). Results: A total of 274 wrists were enrolled in the study. The median age was 51 years (range: 18-90 years), and 72.6% of wrists were from female patients. CSA of median nerve and age were comparatively the best predictors of severity using a linear regression model and receiver operator curves. Using cutoff of 12 mm2 for severe CTS, the sensitivity and specificity are 37.5% and 81.9%, respectively. Conclusions: Ultrasound can be used to grade severity in younger patients (<65 years) with a CTS-6 score of >12.
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Affiliation(s)
| | | | | | - John R. Fowler
- University of Pittsburgh Medical Center,
PA, USA,John R. Fowler, Department of Orthopaedics,
University of Pittsburgh Medical Center, Suite 1010, Kaufmann Building, 3471
Fifth Avenue, Pittsburgh, PA 15213, USA.
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21
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Smith WR, Hirsch DC, Osei-Hwedieh DO, Goitz RJ, Fowler J. A Comparison of Changes in Median Nerve Cross-sectional Area Between Endoscopic and Mini-Open Carpal Tunnel Release. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019; 2:80-83. [PMID: 35415483 PMCID: PMC8991522 DOI: 10.1016/j.jhsg.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/18/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to determine whether there is a difference in the change in cross-sectional area (CSA) of the median nerve in patients undergoing carpal tunnel release (CTR) based on surgical technique and whether this change is associated with changes in patient-reported outcomes evaluated using the Carpal Tunnel Syndrome Assessment Questionnaire. Methods Individuals with carpal tunnel syndrome were evaluated with ultrasound and the CTSAQ before and 6 weeks after surgery. Patients were eligible for inclusion if they underwent either a mini-open CTR (MOCTR) or endoscopic CTR (ECTR). A single surgeon performed all surgeries. Changes in median nerve CSA, Carpal Tunnel Syndrome Assessment Questionnaire scores, and their associated surgical technique (MOCTR vs ECTR) were analyzed. Results A total of 77 patients were enrolled, 13 of whom were lost to follow-up, which left 64 for analysis. Of those, 42 patients underwent ECTR and 22 MOCTR. Mean age was 55 years; there were 52 women and 12 men. Mean changes in CSA for endoscopic and mini-open techniques from before to 6 weeks after surgery were –1.9 mm2 (95% confidence interval [CI], –1.1 to –2.7) and +0.6 mm2 (95% CI, –1.6 to 0.4), respectively. Mean Symptom Severity Scores improved after endoscopic and mini-open release by 1.7 (95% CI, 1.4–2.1) and 1.5 (95% CI, 1.2–1.9), respectively. Mean Functional Status Scores improved after endoscopic and mini-open release by 1.2 (95% CI, 0.9–1.9) and 0.7 (95% CI, 0.03–1.3), respectively. Conclusions Patients undergoing ECTR demonstrated decreased median nerve CSA, whereas those undergoing MOCTR demonstrated increased median nerve CSA at 6 weeks. All patients undergoing surgical intervention demonstrated improvement in both Symptom Severity Scores and Functional Status Scores after surgery. Whereas both techniques successfully improve patient outcome scores, an increase in CSA after MOCTR may be seen in the initial postoperative period, potentially contributing to a slower short-term improvement in outcome in functional scores compared with ECTR. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- William R Smith
- Department of Orthopedics, University of Pittsburgh Medical Center, Bethel Park, PA
| | - David C Hirsch
- Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David O Osei-Hwedieh
- Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Robert J Goitz
- Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John Fowler
- Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA
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22
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Sears ED, Meerwijk EL, Schmidt EM, Kerr EA, Chung KC, Kamal RN, Harris AHS. Variation in Nonsurgical Services for Carpal Tunnel Syndrome Across a Large Integrated Health Care System. J Hand Surg Am 2019; 44:85-92.e1. [PMID: 30579690 PMCID: PMC6400455 DOI: 10.1016/j.jhsa.2018.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 09/19/2018] [Accepted: 11/02/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate facility-level variation in the use of services for patients with carpal tunnel syndrome (CTS) receiving care in the Veterans Health Administration (VHA). METHODS A national cohort of VHA patients diagnosed with CTS during fiscal year 2013 was divided into nonsurgical and operative treatment groups for comparison. We assessed the use of 5 types of CTS-related services (electrodiagnostic studies [EDS], imaging, steroid injection, oral steroids, and therapeutic modalities) in the prediagnosis and postdiagnosis periods before any operative intervention at the patient and facility levels. RESULTS Among 72,599 patients newly diagnosed with CTS, 5,666 (7.8%) received carpal tunnel release within 12 months. The remaining 66,933 (92.2%) were in the nonsurgical group. Therapeutic modalities and EDS were the most commonly employed services after the index diagnosis and had large facility-level variation in use. At the facility level, the use of therapeutic modalities ranged from 0% to 93% in the operative group (mean, 32%) compared with 1% to 67% (mean, 30%) in the nonsurgical group. The use of EDS in the postdiagnosis period ranged from 0% to 100% (mean, 59%) in the operative treatment group and 0% to 55% (mean, 26%) in the nonsurgical group at the facility level. CONCLUSIONS There is wide facility variation in the use of services for CTS among patients receiving operative and nonsurgical treatment. Care delivered by facilities with the highest and lowest rates of service use may suggest overuse and underuse, respectively, of nonsurgical CTS services and a lack of consideration of individual patient factors in making health care decisions regarding use. CLINICAL RELEVANCE Surgeons must understand the degree of treatment variability for CTS, comprehend the ramifications of large variation in reimbursement and waste in the health care system, and become involved in devising strategies to optimize hand care across all phases of care.
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Affiliation(s)
- Erika D. Sears
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI,Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Esther L. Meerwijk
- Veterans Affairs Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA
| | - Eric M. Schmidt
- Veterans Affairs Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA
| | - Eve A. Kerr
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI,Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Kevin C. Chung
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | | | - Alex H. S. Harris
- Veterans Affairs Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA,Department of Surgery, Stanford University, Palo Alto, CA
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Abstract
BACKGROUND Hand conditions are common in elderly persons. PURPOSE To assess the prevalence of common hand conditions in elderly persons in a community setting, specifically osteoarthritis of the hand, trigger finger, and carpal tunnel syndrome. METHODS The elderly persons were recruited from community groups for elderly persons. Data collection included participants' demographic and clinical data; quick disability, arm, shoulder, and hand (QuickDASH) questionnaire; and presence of hand conditions. RESULTS Of the 55 elderly persons recruited, almost a third of them presented with a hand condition (n = 17, 30.8%). Hand conditions were more common in females (39% in females, 7% in males; χ = 4.97, p = .04). Quick-DASH scores were higher in those with hand conditions, indicating lower levels of function (greater disability) (t =-4.61, p = .002). CONCLUSIONS Most elderly persons did not seek medical attention for their hand condition until the late stages. Nurses can play an important role in providing community hand assessment, education on hand symptoms, information about available treatment, and adaptive approaches to maximize functioning.
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Panagopoulos GN, Wu T, Fowler JR. Correlation of ultrasound cross-sectional area of the median nerve, nerve conduction studies and 2-point discrimination. Muscle Nerve 2018; 59:236-239. [PMID: 30390396 DOI: 10.1002/mus.26374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 09/16/2018] [Accepted: 10/30/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The purpose of this study was to determine the correlation between a measure of physical performance, a measure of physiology and a measure of anatomy in the setting of carpal tunnel syndrome (CTS). METHODS A retrospective review of 215 consecutive patients with suspected CTS was conducted. All patients were evaluated with static 2-point discrimination (2PD), ultrasound (US) measurement of the median nerve cross-sectional area (CSA), and nerve conduction studies (NCS). Correlations between 2PD and US and NCS parameters were calculated. The ability of US/NCS to predict 2PD was evaluated. RESULTS Analysis failed to prove a statistically significant correlation between 2PD and median nerve CSA. A weak correlation was detected between 2PD and NCS parameters. When 2PD was used as a reference standard, NCS parameters combined had the greatest sensitivity, followed by US. CONCLUSIONS Currently used diagnostic tests (NCS and US) correlate poorly with 2PD. Muscle Nerve 000: 000-000, 2018 Muscle Nerve 59:236-239, 2019.
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Affiliation(s)
- Georgios N Panagopoulos
- Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, Pennsylvania, 15213, USA
| | - Tiffany Wu
- Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, Pennsylvania, 15213, USA
| | - John R Fowler
- Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, Pennsylvania, 15213, USA
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26
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Magnussen MJ, Morren J. Electrodiagnostic Testing in the Diagnosis and Management of Carpal Tunnel Syndrome. Orthopedics 2017; 40:263. [PMID: 29039869 DOI: 10.3928/01477447-20170920-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Neral M, Imbriglia JE, Carlson L, Wollstein R. Motor Examination in the Diagnosis of Carpal Tunnel Syndrome. J Hand Microsurg 2017; 9:67-73. [PMID: 28867905 DOI: 10.1055/s-0037-1603346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022] Open
Abstract
The relative importance and use of motor evaluation to diagnose carpal tunnel syndrome (CTS) is not clear. Because the ulnar nerve is not affected in CTS, we evaluated comparing the strength of the median-nerve innervated muscles to the ulnar innervated muscles in the same patient, through manual muscle testing (MMT) and a handheld dynamometer. Our purpose was to evaluate whether this method, which takes into account patient-dependent factors that would affect both groups of muscles equally, can provide better assessment of CTS. A retrospective case-control review of MMT and dynamometer-measured strength for CTS was performed. The study was performed retrospectively but prior to surgery or other treatment. There were 28 cases (CTS) and 14 controls (without CTS). Positive nerve conduction tests defined cases. MMT of the thenar musculature was found to be unreliable as a test for CTS. Comparisons to ulnar nerve innervated muscle strength did not improve sensitivity or specificity of the MMT examination. Use of the dynamometer improved sensitivity and specificity of motor testing in CTS over MMT. Motor evaluation is important for the diagnosis of CTS, but further study is warranted, specifically to define the method of motor evaluation and delineate the subgroup of patients (predominantly thenar motor presentation) that would benefit most from motor testing and motor-focused treatment.
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Affiliation(s)
- Mithun Neral
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, United States.,Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Joseph E Imbriglia
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Lois Carlson
- The Hand Center, University of Connecticut School of Medicine, Glastonbury, Connecticut, United States
| | - Ronit Wollstein
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, United States.,Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Technion School of Medicine, Haifa, Israel
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28
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Kho JY, Gaspar MP, Kane PM, Jacoby SM, Shin EK. Prognostic Variables for Patient Return-to-Work Interval Following Carpal Tunnel Release in a Workers' Compensation Population. Hand (N Y) 2017; 12:246-251. [PMID: 28453350 PMCID: PMC5480659 DOI: 10.1177/1558944716661991] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We hypothesize that depressive and anxiety disorders, chronic pain conditions, and work-related factors are significant determinants of the time interval for return to work (RTW) in the workers' compensation (WC) population following carpal tunnel release (CTR) surgery. METHODS We retrospectively reviewed records of all WC patients who underwent open CTR surgery over a 5-year period by 1 of 3 fellowship-trained hand surgeons. One hundred fifty-two wrists in 108 patients (64 unilateral, 44 bilateral) met the inclusion criteria. Demographic, medical, and surgical data were obtained from patient records. Bivariate and multivariate analyses were performed to assess predictors of RTW. RESULTS Eighty-nine percent of all patients returned to work full-duty. Average RTW duration in all wrists was 12.5 ± 11.3 weeks. Predictors of delayed RTW in bivariate and multivariate analyses were depression with or without anxiety, chronic pain disorders including fibromyalgia, preoperative opioid use, and modified preoperative work status. Job type, motor nerve conduction velocity, and bilateral surgery were not predictive of delayed RTW interval. CONCLUSIONS WC patients with depression, anxiety, or fibromyalgia and other chronic pain disorders were significantly more likely to have delayed RTW following CTR than were WC patients without these conditions. In addition, those who use opioid medications preoperatively and those with preoperative work restrictions were also found to have a significantly delayed RTW after CTR. Knowledge of these risk factors may help care providers and employers identify those WC patients who are most likely to have a protracted postoperative recovery period.
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Affiliation(s)
- Jenniefer Y. Kho
- Sutter Gould Medical Foundation, Modesto, CA, USA,The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael P. Gaspar
- The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA,Michael P. Gaspar, The Philadelphia Hand Center, P.C., The Franklin Building, Suite G114, 834 Chestnut Street, Philadelphia, PA 19107, USA.
| | - Patrick M. Kane
- The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA
| | - Sidney M. Jacoby
- The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA
| | - Eon K. Shin
- The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA
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Watchmaker JD, Watchmaker GP. Independent Variables Affecting Outcome of Carpal Tunnel Release Surgery. Hand (N Y) 2017; 13:1558944717703739. [PMID: 28443704 PMCID: PMC5987970 DOI: 10.1177/1558944717703739] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In making the decision to undergo carpal tunnel release (CTR), patients may consider probability of symptom resolution. Prior studies have examined potential preoperative variables that might influence the postoperative outcome. Few studies, however, contain the sample size, prospective design, and high participant completion rate to provide solid data from which to counsel patients. The purpose of this study was to prospectively evaluate factors that have been implicated or dismissed in past studies as sources of outcome variation following CTR surgery and provide patient-relatable facts that the surgeon might use in preoperative patient counseling. METHODS One thousand thirty-one consecutive patients undergoing open CTR were prospectively enrolled. Preoperative frequency of daytime numbness, nighttime awakening, and duration of symptoms were recorded in addition to physical exam, height, weight, gender, history of diabetes, history of thyroid disease, and severity of electrodiagnostic findings. After surgery, patients reported percent resolution of numbness at defined intervals. RESULTS Age and gender are the only independent factors that predict the degree of resolution of numbness 6 months following surgery. All other studied variables are not independent factors nor are any paired combinations of factors. Below the age of 50, the average reported resolution of daytime numbness by 6 months is 97.3% (men 91.8% and women 99.4%). After age 50, there is a linear 0.77% decline in average resolution of daytime numbness per year. CONCLUSIONS Age and gender but no other studied factors predict resolution of daytime numbness in a multivariate model of patients undergoing CTR.
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Correlating Median Nerve Cross-sectional Area With Nerve Conduction Studies. J Hand Surg Am 2016; 41:958-962. [PMID: 27702467 DOI: 10.1016/j.jhsa.2016.08.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/21/2016] [Accepted: 08/25/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether there is a correlation between the cross-sectional area (CSA) of the median nerve, as measured using ultrasound, and the distal motor and/or sensory latencies as measured on nerve conduction studies. METHODS Patients with clinical signs and symptoms of carpal tunnel syndrome were prospectively enrolled in this study. Subjects underwent ultrasound measurement of the CSA of the median nerve at the carpal tunnel inlet by a fellowship-trained hand surgeon, followed by nerve conduction studies (NCS) by a certified electrodiagnostic technician who was blinded to the results of the ultrasound examination. Pearson correlations were performed to compare CSA and NCS. RESULTS Pearson correlation was r = 0.57 between CSA and distal motor latency and r = 0.47 between CSA and distal sensory latency. Correlation was r = 0.81 between distal motor latency and distal sensory latency. CONCLUSIONS There is a correlation between CSA of the median nerve and NCS. Further research is necessary to determine which test correlates better with patient symptoms and function. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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