1
|
Endoscopic Release Superficial Rather Than Deep to the Transverse Carpal Ligament for Carpal Tunnel Syndrome Improves Immediate Postoperative Transient Symptomatic Exacerbation With Fewer Absences From Work. Arthroscopy 2023; 39:963-970.e2. [PMID: 36208712 DOI: 10.1016/j.arthro.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/11/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To determine the endoscopic release superficially rather than deep to the transverse carpal ligament to reduce the incidence of transient symptomatic exacerbation and postoperative absence from work in patients with carpal tunnel syndrome. METHODS From January 2012 to January 2018, patients with idiopathic carpal tunnel syndrome who underwent one-portal endoscopic release superficial to the transverse carpal ligament (ERSTCL) were analyzed. For comparison, a cohort treated with the conventional Chow endoscopic release between February 2008 and October 2013 were included. Transient worsening of symptoms, discrimination sensation, and days off work were assessed. The minimal clinically important difference was calculated for discrimination sensation. Severity of symptom and functional status also were assessed using the Levine-Katz Questionnaire. Significance was set at P < .05. RESULTS There was a significant difference between the ERSTCL group and the control group regarding the incidence of symptomatic exacerbation 1 week after surgery (2% vs 9%; P = .003) but no difference in other time intervals within the initial 3 months. There was a significant difference in 2-point discrimination 1 week (mean change = -0.13, 95% confidence interval [CI] -0.30 to 0.04, P = .01) and 2 weeks after surgery (mean change = -0.18, 95% CI -0.36 to -0.01, P = .033). Postoperative 1 and 2 weeks, 28% and 35% patients in ERSTCL group achieved a minimal clinically important difference, respectively. Compared with control group, the difference in frequencies was statistically significant (28% vs 45%; P = .027; 35% vs 57%; P = .015). The difference between the 2 groups in postoperative absence from work was statistically significant (95% CI 1.083-4.724; P = .002), with an average reduction in sick leave of 3 days in ERSTCL group. At a mean follow-up of 3 years, no significant difference was found between the groups regarding symptom and function statuses. CONCLUSIONS Endoscopic release superficial rather than deep to transverse carpal ligament for carpal tunnel syndrome improves immediate postoperative transient symptomatic exacerbation, which allows the patients to return to work earlier. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
|
2
|
Alkhuzai A. Prospective Comparative Analysis Study of Minimally Invasive Surgical Decompressions versus Traditional Surgical Decompression of Carpal Tunnel Syndrome. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Carpal tunnel syndrome (CTS) occurs when there is compression on the median nerve within the carpal tunnel in the wrist joint. It commonly affects those who make frequent, repetitive hand movements, with women being more affected than men. The present study was aimed at comparing minimally invasive and classical surgical decompression techniques for carpal tunnel syndrome. Materials and Methods: One hundred and four patients with CTS who were scheduled for carpal tunnel decompression were chosen at random. The patients were divided into two groups. Group A had standard classical long incision decompression, whereas Group B had minimally invasive decompression. The patients were evaluated with the Boston Functional Score Scale. Between the two groups, a comparison of visit reports was made at 3, 6, and 12 months after surgery. Results: There was no significant difference in patient age (Group A was 38 years old and Group B was 36 years old) and availability of bilateral CTS status (A was 34 and B was 31). The female-male ratios in groups A and B were 3.6 to 0.2 and 3.1 to 0.3, respectively, with a p-value of p<0.05 indicating significant difference. Comparing both groups, the minimally invasive decompression technique showed a high rate of functional hand grip and a low rate of complications including early wound healing, rapid resumption of palmar strength grip, and rapid return to daily activities. Conclusion: The findings indicate that patients who underwent the minimally invasive surgical decompression one-stitch technique showed significant improvement over the traditional method.
Collapse
|
3
|
Lee SH, Gong HS. Grip Strength Measurement for Outcome Assessment in Common Hand Surgeries. Clin Orthop Surg 2022; 14:1-12. [PMID: 35251535 PMCID: PMC8858903 DOI: 10.4055/cios21090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022] Open
Abstract
Grip strength has been used to evaluate the upper extremity functional status and clinical outcomes following upper extremity trauma or surgery. Understanding general recovery patterns of grip strengthening can be helpful in assessing the patients’ recovery status and in assisting in preoperative consultations regarding expectations for recovery. We summarize related studies on grip strength measurement and recovery patterns in common hand conditions, including carpal tunnel syndrome, cubital tunnel syndrome, triangular fibrocartilage complex injury, and distal radius fractures.
Collapse
Affiliation(s)
- Seung Hoo Lee
- Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|
4
|
Li G, Kong L, Kou N, Wang Y, Yu K, Bai J, Tian D. The comparison of limited-incision versus standard-incision in treatment of carpal tunnel syndrome: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e15372. [PMID: 31045782 PMCID: PMC6504321 DOI: 10.1097/md.0000000000015372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Carpal tunnel syndrome is a common compressive neuropathy of the median nerve. Compared with standard release, the efficacy, safety, and postoperative complications of limited carpal tunnel release remain controversial. The purpose of this study was to compare the effects of the 2 treatments. METHODS The English-language literature was searched using MEDLINE, Web of Science, and Embase. Randomized controlled trials that compared standard and limited incision for carpal tunnel release were included in the meta-analysis. Strength, interval to return to activities, the rate of adverse events, effectiveness, and operative time were compared. RESULTS Thirteen randomized controlled trials (RCTs) containing 1020 patients were included. Limited incision treated patients showed better early recovery of grip strength (mean difference [MD], 4.25 [0.86-7.65]; P = .01) and pinch strength (MD, 1.37 [0.24-2.51]; P = .02) but no advantage after more than 6 months. Patients treated with limited incision showed an earlier return to activities (MD,-8.80 [-9.21 to -8.39]; P < .01) and reduced operative time (standardized mean difference [SMD], -1.68 [-3.24 to-0.12]; P = .04). The rate of adverse event was significantly higher in standard group compared with that in limited group (risk ratio [RR] 0.61, 95% CI 0.38-0.96, P = .03). CONCLUSIONS Limited incision release allows us to return to activities early, reduces operative time, decreases rate of adverse events, and improves strength during the early postoperative period. Results at 6 months or longer are similar according to current data. However, the results of this meta-analysis should be interpreted with caution due to heterogeneity amongst the included studies.
Collapse
Affiliation(s)
- Gaocen Li
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang
| | - Lingde Kong
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang
| | | | - Yanxue Wang
- Department of Pharmacy, Ningjin County Hospital of Hebei Province, Xingtai, Hebei, PR China
| | - Kunlun Yu
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang
| | - Jiangbo Bai
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang
| | - Dehu Tian
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang
| |
Collapse
|
5
|
Quality of Randomized Controlled Trials for Surgical Treatment of Carpal Tunnel Syndrome: A Systematic Review. Plast Reconstr Surg 2019; 143:791-799. [PMID: 30822284 DOI: 10.1097/prs.0000000000005366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Randomized controlled trials are considered the gold standard in evidence-based medicine. The authors conducted a systematic review to evaluate the quantity, quality, and trends of randomized controlled trials that assess surgical treatment of carpal tunnel syndrome. METHODS The authors identified randomized controlled trials comparing two or more surgical interventions for carpal tunnel syndrome in PubMed, Cochrane, Scopus, Google Scholar, and Clinicaltrials.gov. Two independent reviewers evaluated articles for inclusion, extracted data, and assessed randomized controlled trial quality using the Jadad score. RESULTS Of 2253 identified studies, 58 met full inclusion criteria. They were published between 1985 and 2015, with a significant increase over time (p = 0.003). They were most frequently published in Journal of Hand Surgery (European Volume) [n = 15 (25.9 percent)]. Most randomized controlled trials were single-center studies [n = 54 (93.1 percent)] conducted in the United Kingdom [n = 13 (22.4 percent)] or the United States [n = 10 (17.2 percent)], with a mean study size of 80.1 ± 55.5 patients. Funding source was unknown in 62.1 percent (n = 36). Three-quarters [n = 44 (75.9 percent)] of randomized controlled trials did not define the primary outcome measure(s). Less than 30 percent (n = 17) of randomized controlled trials conducted a power analysis. Only four studies with patients reported lost to follow-up provided an explanation for each patient. Six randomized controlled trials (10.3 percent) conducted intention-to-treat analysis. The mean Jadad score was 2.14 ± 1.26, with no significant improvement over time (p = 0.245). CONCLUSIONS Despite the significant increase in the number of randomized controlled trials published studying surgical treatment of carpal tunnel syndrome over time, a mean Jadad score of 2.14 with no change over time indicates a need for improvement in quality. Proper study design is key to avoiding introduction of bias and ensuring the validity of conclusions drawn.
Collapse
|
6
|
Chen Y, Ji W, Li T, Cong X, Chen Z. The mini-incision technique for carpal tunnel release using nasal instruments in Chinese patients. Medicine (Baltimore) 2017; 96:e7677. [PMID: 28767593 PMCID: PMC5626147 DOI: 10.1097/md.0000000000007677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Treatment of carpal tunnel syndrome (CTS) remains a challenge for hand surgeons. Carpal tunnel release (CTR) using nasal instruments has the advantages of both endoscopy and open surgery. In this study we aimed to explore the effectiveness of CTR using nasal instruments in Chinese patients.We present a case series of 49 cases of idiopathic CTS treated with the mini-incision technique using nasal instruments. The average recovery days before return to normal work and complications were recorded. The mean grip strength, pinch strength, and sensation were evaluated. Subjective results were evaluated using the visual analogue scale (VAS), Levine Carpal Tunnel Syndrome Questionnaire (LCTSQ), Disabilities of the Arm, Shoulder, and Hand (DASH), and Medical Outcomes Study (MOS) 36-item short-form health survey (SF-36).The mean follow-up was 13 months. No return of symptoms or blood vessel injury occurred. The incidence of scar tenderness was only 8.1%, later pillar pain (after 4 weeks) was 18.4%, and average recovery time to return to normal work was 23.7 days. The mean grip strength, pinch strength, and sensation were significantly improved (P < .001). The VAS, LCTSQ, and DASH survey postoperative mean scores were lower than the preoperative scores (P < .001). SF-36 scores were significantly increased following surgery (P < .001).We conclude that the mini-incision technique for CTR using nasal instruments in Chinese patients is safe, effective, and low cost. It is worthwhile for the technique to be promoted and used.
Collapse
|
7
|
Huisstede BM, van den Brink J, Randsdorp MS, Geelen SJ, Koes BW. Effectiveness of Surgical and Postsurgical Interventions for Carpal Tunnel Syndrome-A Systematic Review. Arch Phys Med Rehabil 2017; 99:1660-1680.e21. [PMID: 28577858 DOI: 10.1016/j.apmr.2017.04.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 04/17/2017] [Accepted: 04/27/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions for carpal tunnel syndrome (CTS). DATA SOURCES The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016. STUDY SELECTION Two reviewers independently applied the inclusion criteria to select potential studies. DATA EXTRACTION Two reviewers independently extracted the data and assessed the methodologic quality. DATA SYNTHESIS A best-evidence synthesis was performed to summarize the results. Four systematic reviews and 33 RCTs were included. Surgery versus nonsurgical interventions, timing of surgery, and various surgical techniques and postoperative interventions were studied. Corticosteroid injection was more effective than surgery (strong evidence, short-term). Surgery was more effective than splinting or anti-inflammatory drugs plus hand therapy (moderate evidence, midterm and long-term). Manual therapy was more effective than surgical treatment (moderate evidence, short-term and midterm). Within surgery, corticosteroid irrigation of the median nerve before skin closure as additive to CTS release or the direct vision plus tunneling technique was more effective than standard open CTS release (moderate evidence, short-term). Furthermore, short was more effective than long bulky dressings, and a sensory retraining program was more effective than no program after surgery (moderate evidence, short-term). For all other interventions only conflicting, limited, or no evidence was found. CONCLUSIONS Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the short-term, midterm, and/or long-term to treat CTS. However there is strong evidence that a local corticosteroid injection is more effective than surgery in the short-term, and moderate evidence that manual therapy is more effective than surgery in the short-term and midterm. There is no unequivocal evidence that suggests one surgical treatment is more effective than the other. Postsurgical, a short- (2-3 days) favored a long-duration (9-14 days) bulky dressing and a sensory retraining program seems to be more effective than no program in short-term. More research regarding the optimal timing of surgery for CTS is needed.
Collapse
Affiliation(s)
- Bionka M Huisstede
- University Medical Center Utrecht, Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Physical Therapy Science & Sports, Utrecht, The Netherlands; Erasmus MC, Department of General Practice, Rotterdam, The Netherlands.
| | - Janneke van den Brink
- University Medical Center Utrecht, Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Physical Therapy Science & Sports, Utrecht, The Netherlands
| | - Manon S Randsdorp
- Erasmus MC, Department of General Practice, Rotterdam, The Netherlands
| | - Sven J Geelen
- University Medical Center Utrecht, Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Physical Therapy Science & Sports, Utrecht, The Netherlands
| | - Bart W Koes
- Erasmus MC, Department of General Practice, Rotterdam, The Netherlands
| |
Collapse
|
8
|
A Randomized Comparison of Double Small, Standard, and Endoscopic Approaches for Carpal Tunnel Release. Plast Reconstr Surg 2017; 138:641-647. [PMID: 27152579 DOI: 10.1097/prs.0000000000002511] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The purpose of this study was to introduce a new surgical technique of carpal tunnel release through double small incisions, and to compare the technique with the standard open release and endoscopic release. METHODS Two hundred and seven patients were allocated randomly into group A (n = 73), B (n = 65), or C (n = 69). Patients in group A were treated with carpal tunnel release by means of double small incisions. Patients in group B were treated by means of the standard incision. Patients in group C had endoscopic release. RESULTS Preoperatively, the mean severity of symptoms of groups A, B, and C was 3.7 ± 0.58, 3.8 ± 0.62, and 3.7 ± 0.52, respectively; and the mean functional status was 3.2 ± 0.71, 3.2 ± 0.71, and 3.5 ± 0.64, respectively. At the final follow-up of 3 years, the mean severity of symptoms of the groups was 1.2 ± 0.45, 1.2 ± 0.31, and 1.5 ± 0.36, respectively; and the mean functional status was 1.2 ± 0.38, 1.2 ± 0.41, and 1.5 ± 0.42, respectively. Patient satisfaction was 95 ± 4.2, 90 ± 5.8, and 93 ± 4.4, respectively. There were no significant differences between groups regarding symptom severity or function status (p > 0.05). For scar appearance, there were significant differences between groups A and B and between B and C, but not between A and C; for patient satisfaction, there were significant differences in all comparisons. CONCLUSIONS Carpal tunnel release by means of double small incisions is a minimally invasive and less technically challenging procedure with good nerve visualization, resulting in good appearance of scars. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
Collapse
|
9
|
Zumsteg JW, Crump MJ, Logan GD, Weikert DR, Lee DH. The Effect of Carpal Tunnel Release on Typing Performance. J Hand Surg Am 2017; 42:16-23.e2. [PMID: 27863829 PMCID: PMC5364521 DOI: 10.1016/j.jhsa.2016.10.005] [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: 01/12/2016] [Revised: 07/28/2016] [Accepted: 10/03/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the effect of carpal tunnel release (CTR) on typing performance. METHODS We prospectively studied 27 patients undergoing open CTR. Patient demographics and clinical characteristics including nerve conduction studies, electromyography results, and duration of symptoms were collected. Before surgery and at 8 time points after surgery, ranging from 1 to 12 weeks, typing performance for an approximately 500-character paragraph was assessed via an on-line platform. The Michigan Hand Questionnaire (MHQ) and the Boston Carpal Tunnel Questionnaire functional component (BCTQ-F) and symptom severity component (BCTQ-S) component were completed before surgery and at 1, 3, 6, and 12 weeks after surgery. We used repeated-measures analyses of variance and follow-up dependent-samples t tests to analyze change in typing performance across sessions, and linear regressions to assess relationships between typing performance and demographic and outcome measures. We compared typing speed with the MHQ, BCTQ-F, and BCTQ-S using the Pearson correlation test. RESULTS Average typing speed decreased significantly from 49.7 ± 2.7 words per minute (wpm) before surgery to 45.2 ± 3.1 wpm at 8 to 10 days after surgery. Mean typing speed for the group exceeded the preoperative value between weeks 2 and 3, with continued improvement to 53.5 ± 3.5 wpm at 12 weeks after surgery. No clinical or demographic variables were associated with the rate of recovery or the magnitude of improvement after CTR. The MHQ, BCTQ-F, and BCTQ-S each demonstrated significant improvement from preoperative values over the 12-week period. The MHQ and BCTQ-F scores correlated well with typing speed. CONCLUSIONS On average, typing speed returned to preoperative levels between 2 and 3 weeks after CTR and typing speed showed improvement beyond preoperative levels after surgery. The MHQ and BCTQ-F correlate well with typing speed after CTR. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
Affiliation(s)
- Justin W. Zumsteg
- Vanderbilt University Medical Center, Department of Orthopedics, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232, Phone: 615.343.2524
| | - Matthew J. Crump
- Brooklyn College of CUNY, Department of Psychology, 2900 Bedford Avenue, Brooklyn, NY 11210, Phone: 718.951.5000 x6068
| | - Gordon D. Logan
- Vanderbilt University, Department of Psychology, 506 Wilson Hall, 111 21st Avenue South, Nashville, TN 37232, Phone: 615.322.2529
| | - Douglas R. Weikert
- Vanderbilt University Medical Center, Department of Orthopedics, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232, Phone: 615.343.2524
| | - Donald H. Lee
- Vanderbilt University Medical Center, Department of Orthopedics, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232, Phone: 615.343.2524
| |
Collapse
|