Association of Sleep and Hand Function in People With Carpal Tunnel Syndrome

Long-term patient-centered outcomes following carpal tunnel release surgery: a 10-year follow-up

INTRODUCTION

Carpal Tunnel Syndrome (CTS) is a painful orthopedic hand condition caused by compression of the median nerve at the wrist. Diagnosis is typically clinical, relying on patient's symptoms and physical examination findings, but confirmation often requires electrodiagnostic studies. Previous research on CTS has explored the relationship between median nerve compression severity and various outcomes. However, these studies have been limited by short follow-up durations, small to modest patient cohorts, and a narrow focus on patient-reported outcomes. The objective of this study was to provide a long-term, 10-year follow-up with a relatively large patient cohort, focusing on new patient-reported outcomes and their association with the severity of nerve compression.

METHODS

A retrospective cohort study was conducted on a total of 581 patients who underwent open carpal tunnel release surgery between 2013 and 2023 at a major teaching hospital in Jordan. Severity was categorized based on nerve conduction study results into three groups: mild, moderate, and severe and Six distinct outcomes of interest were examined.

RESULTS

No significant differences in age, health profiles, comorbidities, or disease presentation were observed among the severity groups. However, significant variations were found across the six outcomes. Patients with severe disease had longer recovery times (p < 0.01), less pain relief (p = 0.03), reduced satisfaction (p = 0.04), diminished functional improvement (p < 0.01), lower ADL improvement (p < 0.01), yet experienced better sleep quality improvement (p < 0.01).

CONCLUSION

Long-term follow-up post-open carpal tunnel release surgery revealed that severe cases experienced longer recovery times, less pain relief, reduced satisfaction, diminished functionality improvement, and lower ADL improvement, but better sleep quality.

LEVEL OF EVIDENCE

Level III, Retrospective cohort study.

Understanding the Mechanosensitivity of the Median Nerve in Pre-Surgical Carpal Tunnel Syndrome Patients: A Correlational Study

(1) Background: Neurodynamic tests are recommended for the diagnosis of entrapment neuropathies such as carpal tunnel syndrome (CTS). However, their association with clinical variables in severe patients or patients with associated comorbidities is poorly documented. This study aims to analyze the association between the mechanosensitivity of the median nerve and symptoms, function and psycho-social variables in moderate and severe carpal tunnel syndrome patients with comorbidities; (2) Methods: Correlational study. In total, 42 pre-surgical patients (24 females; 59.1 ± 12.7 years) included in the Spanish Public Healthcare System with an electrodiagnostic of CTS were selected. Sociodemographic variables and clinical features (symptoms, function, sensitivity and quality of life evaluated with the 36-item Short Form Survey (SF-36) and the Medical Outcomes Study Sleep Scale (MOS-sleep) were recorded. Upper Limb Neurodynamic Test 1 was used to evaluate neural mechanosensitivity; (3) Results: The 81% had a severe CTS and 78.6% had some comorbidity. The average time from the first medical visit to the surgeon's visit was 365.5 days. Median nerve mechanosensitivity correlated weakly with the SF-36 subscale, General Health, (Spearman's rho = 0.367) and MOS sleep scale, Awaken Short of Breath or with headache dimension (Spearman's rho = -0.353) and moderately with SF-36 subscale, Social Functioning (Spearman's rho = 0.553); (4) Conclusions: No associations were observed for median nerve mechanosensitivity, except for quality of life and sleep. Both social determinants and clinical variables should be considered when examining and treating these patients.

The impact of shoulder pathology on individuals with distal radius fracture

BACKGROUND

Shoulder pathology can occur concurrently with a distal radius fracture (DRF) but few studies have examined this population.

PURPOSE

The purpose of this study was to expand the understanding of the impact of shoulder pathology on individuals with DRF.

STUDY DESIGN

Mixed Methods Design.

METHODS

A total of 45 participants with a DRF were categorized into a DRF only (n = 29) and shoulder pathology concurrent with DRF (SPCDRF) (n = 16) groups. Quantitative data gathered included demographics, Quick Disabilities of the Arm, Shoulder, and Hand, Tampa Scale of Kinesiophobia-11, Visual Analog Scale, and Compensatory Mechanism Checklist. Qualitative interviews were performed with 7 participants in the SPCDRF group. Within group correlations were analyzed via the Spearman Rank. The Mann Whitney U test was used to compare the two groups. Qualitative analysis was performed to describe the experience of participants in the SPCDRF group. A mixed methods analysis compared quantitative and qualitative data.

RESULTS

Sixteen participants (35.6%) in the sample presented with shoulder pathology; 6 participants (37.5%) presented at initial evaluation due to the fall; 10 participants (62.5%) developed shoulder pathology due to compensation or disuse. Average number of days to develop shoulder pathology after the DRF was 43 days. SPCDRF participants had significantly greater pain levels (p = .02) and more activity avoidance (p = .03) than the DRF only group. Four qualitative themes emerged: It's difficult to perform occupations and changes had to be made; There is fear and uncertainty; The impact of pain; Tried to be normal but could not Mixed methods analysis found that qualitative data further illuminated quantitative findings.

CONCLUSIONS

Individuals with shoulder pathology concurrent with a DRF may present with higher pain levels and avoid activity more. In addition, they may describe fearfulness in using their injured upper extremity especially if they have high levels of pain.

STUDY DESIGN

Mixed Methods Design.