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Kennedy DL, Chism-Balangue T, Furniss D. Reporting of scar outcomes in the hand and wrist; a state-of-the-art literature review. BMC Musculoskelet Disord 2023; 24:249. [PMID: 37004025 PMCID: PMC10064537 DOI: 10.1186/s12891-023-06296-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVES The aim of this literature review was to synthesise and report current practice in evaluation and reporting of scar outcomes in hand and wrist clinical research. METHODS A systematic search from inception to 2022 was conducted using three electronic databases. English language randomized controlled trials and observational cohort studies reporting standardised scar outcome measures and/or scar symptoms, appearance, impairment, function, or mental health outcomes in patients with hand and wrist scars were included. Two independent reviewers determined study eligibility and performed data extraction of a priori identified scar outcome domains. Data analysis included descriptive statistics and identification of discordance in taxonomy. RESULTS Fifty-nine studies were included. Elective surgery cohorts were the most frequently included clinical population (n = 28; 47%) followed by burns (n = 16; 27%). Six different standardised scar outcome measures were reported by 25% of studies however only 7% of studies utilised a patient-reported measure. Scar symptoms were the most frequently reported outcome domain (81%); but taxonomy was incongruous, constructs lacked working definitions required for generalisability and outcome measurement was variable and unreported. Nineteen different measures of scar appearance and structure were reported by 30 (51%) of studies however only nine (23%) were patient-reported. Seven different hand function PROMs were reported by 25 (43%) studies. Person-centred domains including scar acceptability (12%), mental health impact (5%), and social participation (4%) were rarely reported. CONCLUSIONS This review highlights that evaluation and reporting of hand and wrist scar outcomes is not standardised, assessment methods and measures are under-reported and there is discordance in taxonomy. Evaluation is not person-centred, rather it is dependent on clinician assessment. Domains including scar acceptability, mental health, and social participation are rarely addressed. A stakeholder consensus derived hand and wrist scar core outcome measurement set will promote standardisation and underpin improvements in clinical research quality, transparency, and rigour.
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Affiliation(s)
- Donna L Kennedy
- Therapy Department, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK.
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK.
| | | | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Science, University of Oxford, Botnar Research Centre, Oxford, UK
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Mujadzic T, Friedman HI, Atwez A, Botonjic H, Mujadzic MM, Chen E, Gilstrap JN, Mujadzic MM. Palmar Creases and Their Implication on Carpal Tunnel Surgery. Ann Plast Surg 2022; 88:S495-S497. [PMID: 35690945 DOI: 10.1097/sap.0000000000003123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND A thorough knowledge of normal and variant anatomy of the wrist and hand is fundamental to avoiding complications during carpal tunnel release. The purpose of this study was to document variations of the surface anatomy of the hand to identify a safe zone in which the initial carpal tunnel incision could be placed. The safe zone was identified as the distance between the radial side of hook of hamate and the ulnar edge of the origin of the motor branch of the median nerve (MBMN). METHODS Kaplan's cardinal line and other superficial markers were used to estimate the size of the safe zone, in accordance to prior published anatomical studies. The presence of a longitudinal palmar crease (thenar, median, or ulnar creases) within the safe zone was recorded. RESULTS Of the 150 participants (75 male, 75 female) examined, the average safe zone widths were 10.85 (right) and 10.28 (left) mm. In all the hands examined, 86.33% of the safe zones (259 of 300) contained a longitudinal palmar crease. In the White population (n = 50), the average safe zone widths were 11.49 (right) and 10.01 (left) mm; in the African American population (n = 50), the average safe zone widths were 12.27 (right) and 12.01 (left) mm; and in the Asian population (n = 50), the average safe zone widths were 8.79 (right) and 8.82 (left) mm. On overage, males had a larger safe zone width than females by 4.55 mm. CONCLUSIONS Although there seems to be variability between race and sex with regard to safe zone width, finding 86.33% of longitudinal palmar creases within the safe zone suggests that, for most patients, the initial carpal tunnel surgery incision may be hidden within the palmar crease while minimizing the risk of motor branch of the median nerve injury. Overall, the safe zone width is on average up to 10.5 mm measured from the hook of the hamate along Kaplan's cardinal line.
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Affiliation(s)
- Tarik Mujadzic
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
| | - Harold I Friedman
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
| | - Abdelaziz Atwez
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
| | - Hata Botonjic
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
| | | | - Elliott Chen
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
| | - Jarom N Gilstrap
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
| | - Mirsad M Mujadzic
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
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Acute Pain Predictors of Remote Postoperative Pain Resolution After Hand Surgery. Pain Ther 2021; 10:1105-1119. [PMID: 33870479 PMCID: PMC8586397 DOI: 10.1007/s40122-021-00263-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Chronic postsurgical pain (CPSP) is a global issue with high prevalence. This study compared acute pain descriptors among patients undergoing carpal tunnel release (CTR) or trigger finger release (TFR). We hypothesized worst pain intensity on postoperative day (POD) 10 would be best to predict the time to pain resolution. METHODS In this secondary analysis of a negative, randomized, double-blind placebo-controlled trial, adult veterans undergoing CTR or TFR were enrolled January 2012-January 2014, with data analysis February 2020-October 2020. Participants were randomized to receive minocycline 200 mg or placebo 2 h prior to the operation, then minocycline 100 mg or placebo twice daily for 5 days. The Brief Pain Inventory, assessed daily, captured three pain scores: average and worst pain over the past 24 h, and current pain intensity. Fifteen acute pain descriptors based on the pain scores (clusters, mean, median, pain scores on POD 10, and linear slopes) were compared as predictors of time to pain resolution. RESULTS Of 131 randomized participants, 114 (83 CTR, 31 TFR) were included. Average pain over the last 24 h reported on POD 10 best predicted time to pain cessation. Every one-point increase in the average pain score was associated with a 36.0% reduced rate of pain cessation (HR, 0.64, 95% CI 0.55-0.74, p < 0.001). Average pain on POD 10 was significantly associated with the development of CPSP at 90 days (OR 1.74, 95% CI 1.30-2.33, p value < 0.001). The optimal cutoff score for the high-risk group was determined as average pain on POD 10 ≥ 3. CONCLUSIONS This study validates prior work and demonstrates the importance of assessing pain severity on POD 10 to identify patients at high risk for CPSP who are most likely to benefit from early pain intervention. Future research in diverse surgical cohorts is needed to further validate pain assessment on POD 10 as a significant predictor of CPSP.
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Núñez-Cortés R, Cruz-Montecinos C, Torres-Castro R, Tapia C, Püschel TA, Pérez-Alenda S. Effects of Cognitive and Mental Health Factors on the Outcomes Following Carpal Tunnel Release: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 103:1615-1627. [PMID: 34861234 DOI: 10.1016/j.apmr.2021.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/10/2021] [Accepted: 10/18/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the effects of the cognitive and mental health factors on the outcomes after carpal tunnel release (CTR). DATA SOURCES Embase, PubMed/MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health, and Cochrane Central Register of Controlled Trials databases from inception to August 14, 2021. STUDY SELECTION Randomized controlled trials and observational studies of patients with CTR were included. The included studies aimed to determine the effect of the cognitive (catastrophic thinking, kinesiophobia, self-efficacy) or mental health factors (symptoms of anxiety and depression) on the outcomes at least 3 months post CTR. DATA EXTRACTION Two independent reviewers performed data extraction and assessed the risk of bias. Data were extracted using a standardized protocol and reporting forms. The risk of bias of the included studies was assessed using the Quality in Prognosis Studies risk-of-bias tool. Random-effects models were used for meta-analysis. DATA SYNTHESIS A total of 15 studies involving 2599 patients were included in this systematic review. The majority of studies indicate a significant association between the cognitive or mental health factors and outcomes after CTR. Quantitative analysis showed a moderate association of symptoms of depression on symptom severity (n=531; r=0.347; 95% CI, 0.205-0.475; P≤.0001), function (n=386; r=0.307; 95% CI, 0.132-0.464; P=.0008), and pain (n=344; r=0.431; 95% CI, 0.286-0.558; P≤.0001). In general, the risk of bias in the included studies was low. CONCLUSIONS This systematic review and meta-analysis showed that symptoms of depression have a moderate association with symptom severity, function, and pain after CTR. Symptoms of anxiety, catastrophic thinking, and self-efficacy are also important indicators of poor postsurgery outcomes. Physicians, physical therapists, and occupational therapists should consider evaluating these variables in patients undergoing CTR.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Division of Research, Devolvement and Innovation in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Claudio Tapia
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Thomas A Püschel
- Ecology and Evolutionary Biology Division, School of Biological Sciences, University of Reading, Reading, United Kingdom; Primate Models for Behavioural Evolution Lab, Institute of Cognitive and Evolutionary Anthropology, School of Anthropology, University of Oxford, Oxford, United Kingdom
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain.
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Draghi F, Ferrozzi G, Bortolotto C, Ballerini D, Fiorina I, Preda L. Sonography before and after carpal tunnel release: video article. J Ultrasound 2020; 23:363-364. [PMID: 32378166 DOI: 10.1007/s40477-020-00465-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 11/25/2022] Open
Abstract
Carpal tunnel release for compression of the median nerve at the wrist is a common procedure, often resulting in good clinical outcomes. There are, however, many anatomical variations in and around the carpal tunnel and it is important to be aware of these during carpal tunnel release. After surgery, recurrent carpal tunnel syndrome is uncommon, but difficult to diagnose and treat. Ultrasonography is often necessary for the evaluation of the anatomical variations before carpal tunnel release and to evaluate the most common complications after carpal tunnel release.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Guia Ferrozzi
- Diagnostic Imaging Department, Centro Medico Inacqua, Piacenza, Italy
- Diagnostic Imaging Department, Centro Medico Riabilitativo Rocca, Piacenza, Italy
| | - Chandra Bortolotto
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Daniela Ballerini
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy.
| | - Ilaria Fiorina
- Unit of Interventional Radiology-Radiology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Preda
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
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Ingram J, Mauck BM, Thompson NB, Calandruccio JH. Cost, Value, and Patient Satisfaction in Carpal Tunnel Surgery. Orthop Clin North Am 2018; 49:503-507. [PMID: 30224011 DOI: 10.1016/j.ocl.2018.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The cost of carpal tunnel release (CTR) surgery can be decreased and patient satisfaction increased by a few relatively simple changes. Although cost estimates vary in the literature, most investigators agree that open CTR costs less than endoscopic CTR, and the clinic procedure room or ambulatory surgery center is cheaper than the ambulatory surgery center, which is less than the hospital. Patient satisfaction can be increased by making office visits more patient-centered and improving the quality of dialogue between the surgeon and patient.
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Affiliation(s)
- Joseph Ingram
- Campbell Clinic-University of Tennessee, Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
| | - Benjamin M Mauck
- Campbell Clinic-University of Tennessee, Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - Norfleet B Thompson
- Campbell Clinic-University of Tennessee, Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - James H Calandruccio
- Campbell Clinic-University of Tennessee, Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
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Bae JY, Kim JK, Yoon JO, Kim JH, Ho BC. Preoperative predictors of patient satisfaction after carpal tunnel release. Orthop Traumatol Surg Res 2018; 104:907-909. [PMID: 29709655 DOI: 10.1016/j.otsr.2018.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/12/2018] [Accepted: 04/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND We investigated preoperative factors among demographic and clinical characteristics, as well as psychological factors that influence postoperative patient satisfaction, with the goal of assisting preoperative patient consultation for CTR. MATERIALS AND METHODS We included 92 hands from 60 patients diagnosed with idiopathic carpal tunnel syndrome. We selected the following factors as possible preoperative predictors for patient satisfaction: age, sex, duration of symptoms, static two-point discrimination, the Semmes-Weinstein monofilament test, grip strength, electrophysiological category and scores for the Boston Carpal Tunnel Questionnaire, the Pain Anxiety Symptoms scale and the Center for the Epidemiological Study of Depression scale. We used a cumulative logit model with generalized estimation equations to identify the predictors of patient satisfaction after CTR. RESULTS Univariate analyses demonstrated significant correlations of patient satisfaction with age, preoperative grip power and preoperative CES-D. Multivariate analyses showed that age and preoperative CES-D scores were significantly correlated with patient satisfaction. CONCLUSION Age and depression level were preoperative predictors influencing satisfaction after CTR. LEVELS OF EVIDENCE IV.
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Affiliation(s)
- Joo-Yul Bae
- Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, South Korea
| | - Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Joon O Yoon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Hee Kim
- Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, South Korea
| | - Byeong Cheol Ho
- Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, South Korea
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Datema M, Tannemaat MR, Hoitsma E, van Zwet EW, Smits F, van Dijk JG, Malessy MJA. Outcome of Carpal Tunnel Release and the Relation With Depression. J Hand Surg Am 2018; 43:16-23. [PMID: 28951099 DOI: 10.1016/j.jhsa.2017.08.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/15/2017] [Accepted: 08/22/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the relation between depressive symptoms and outcome of carpal tunnel release (CTR). METHODS Prospective study in a general hospital with data collection at baseline and 3 and 12 months after CTR. We quantified depressive symptoms using the Center for Epidemiologic Studies Depression (CES-D) scale and performed multivariable analyses on 2 outcome measures: (1) carpal tunnel syndrome (CTS) symptoms (Boston Carpal Tunnel Questionnaire [BCTQ]) and (2) palmar pain, focusing on preoperative CES-D and BCTQ score, sex, age, alcohol use, diabetes, and severity of nerve conduction abnormalities. RESULTS We included 227 patients. Before surgery, patients with depression had a higher BCTQ score than patients without depression. After 1 year, depressed patients had a higher BCTQ score and more palmar pain. The CES-D decreased by a median of 2 points from baseline to 1 year. This correlated with the decrease in BCTQ score. Multivariable analyses showed that preoperative depression had a small but statistically significant influence on palmar pain, but not on postoperative BCTQ score. CONCLUSIONS Depression is not an independent predictor of residual CTS symptoms 1 year after CTR. Depressive symptoms in patients with CTS decrease after CTR, along with a decrease in CTS symptoms. The nature of this relationship is unknown. Patients with CTS and depression may expect a somewhat higher degree of palmar pain after CTR, the clinical relevance of which is small. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Mirjam Datema
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Martijn R Tannemaat
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Elske Hoitsma
- Department of Neurology, Alrijne Hospital, Leiden, The Netherlands
| | - E W van Zwet
- Department of Statistics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Febe Smits
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J Gert van Dijk
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martijn J A Malessy
- Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands
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Patient-reported outcomes after open carpal tunnel release using a standard protocol with 1 hand therapy visit. J Hand Ther 2017; 30:58-64. [PMID: 27469537 DOI: 10.1016/j.jht.2016.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN Retrospective case series. INTRODUCTION Open carpal tunnel release (OCTR) is a common treatment for carpal tunnel syndrome, but there is no consensus on the number of hand therapy visits needed to achieve optimal patient outcomes. PURPOSE OF THE STUDY The purpose is to examine changes in patient-reported symptoms and function over a 12-week period after OCTR with 1 postoperative hand therapy visit. METHODS Eligible subjects were consecutive patients treated with a standard OCTR protocol by a fellowship trained hand surgeon that included 1 hand therapy visit at 10-14 days postoperatively. Patients were excluded from participation if they had additional surgery at the time of OCTR, had another upper extremity diagnosis that required therapeutic intervention, or received more or less than 1 visit of hand therapy. Responses on the Boston Carpal Tunnel Questionnaire (BCTQ) were collected at preoperative and 3 postoperative time points: at the hand therapy visit, 6 weeks, and 12 weeks. Change over time in the BCTQ Symptom Severity Scale and Functional Status Scale was assessed. RESULTS A total of 134 patients who were treated with the standard protocol had a complete BCTQ data set. Both BCTQ scales showed significant improvement over time. The Symptom Severity Scale showed significant improvement by the hand therapy visit at 10-14 days postoperatively, whereas significant improvement on the Functional Status Scale did not occur until 6 weeks postoperatively. The magnitude of change from preoperative to 12 weeks postoperative was 1.51 points on the Symptom Severity Scale and 0.91 points on the Functional Status Scale. Complication rates were low with an incidence of 13% for pillar pain and palm pain combined. CONCLUSIONS Patient-reported symptoms and function improved significantly up to 12 weeks after OCTR. Moreover, there was a low incidence of pillar and palm pain. In a retrospective review of patients with a favorable prognosis based on having no need for extra surgical procedures or additional therapy visits, one therapy visit associated with improvements in symptoms and function, a low incidence of pillar/palm pain and favorable 12-weeks outcomes. There appears to be a subset of less complicated patients for whom one visit can allow for favorable outcomes. LEVEL OF EVIDENCE 2B.
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Park JW, Gong HS, Rhee SH, Kim J, Lee YH, Baek GH. The Effect of Psychological Factors on the Outcomes of Carpal Tunnel Release: A Systematic Review. J Hand Surg Asian Pac Vol 2017; 22:131-137. [DOI: 10.1142/s0218810417300029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Several studies report that psychological factors are associated with outcomes of carpal tunnel release. However, interpretation of the association is difficult as there are diverse outcome parameters and patient expectations are different. We performed a systematic review to assess the relationships between psychological factors and the various outcome parameters. Methods: We identified 611 papers and selected 8 papers that fit the inclusion criteria. Psychological factors assessed were anxiety, depression, pain catastrophizing, coping, and mental health status. Outcomes of interest included satisfaction and measures of perceived level of function, pain, and physical measures of recovery. Results: For satisfaction and perceived level of function as the outcome, three studies reported a significant association, one study found an association approaching a value of significance, and one study reported no association. For pain as the outcome, two studies reported a significant association. For physical measures, one study reported no association. Conclusions: This systematic review found that depression correlates with postoperative pain, but that the association is less clear between psychological factors and outcomes such as satisfaction, perceived level of symptom and function, and physical measures of recovery. As pain may not be a primary symptom or outcome of CTS, we consider that the current literature does not strongly support the association between psychological factors and outcomes of CTR. This review could be of benefit during preoperative counseling in patients with psychological disturbances.
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Affiliation(s)
- Jin Woo Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Hwan Rhee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jihyeung Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Ho Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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11
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Egloff N, Wegmann B, Juon B, Stauber S, von Känel R, Vögelin E. The impact of anxiety and depressive symptoms on chronic pain in conservatively and operatively treated hand surgery patients. J Pain Res 2017; 10:259-263. [PMID: 28203103 PMCID: PMC5293357 DOI: 10.2147/jpr.s116674] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The aim of this prospective study was to examine to what extent anxiety and depressive symptoms predict the level of pain at 4-month follow-up in hand surgery patients. A total of 132 consecutive patients (mean age: 51.5±17.1 years, 51.9% female) of a tertiary center for hand surgery participated in this study. The patients underwent conservative or operative treatment, depending on the nature of their hand problem. The initial pain assessment included psychometric testing with the hospital anxiety and depression scale. Ninety-nine patients underwent operative treatment and 33 patients were conservatively treated. At 4-month follow-up, the amount of pain was measured with a visual analog scale (0–10). After controlling for age, sex, and pre-surgical pain intensity, depressive symptoms were a significant predictor for increased pain levels at follow-up in conservatively treated patients. In operatively treated patients, anxiety symptoms showed a trend for being a predictor of pain level at follow-up. The findings support the assumption that psychological factors may have an impact on pain outcome in patients presenting to hand surgery clinics.
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Affiliation(s)
- Niklaus Egloff
- Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital Bern University Hospital; Department of Clinical Research, University of Bern
| | - Barbara Wegmann
- Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital Bern University Hospital
| | - Bettina Juon
- Department of Plastic and Hand Surgery, Inselspital Bern University Hospital, Bern
| | - Stefanie Stauber
- Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital Bern University Hospital
| | - Roland von Känel
- Department of Clinical Research, University of Bern; Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - Esther Vögelin
- Department of Plastic and Hand Surgery, Inselspital Bern University Hospital, Bern
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Abstract
Carpal tunnel release for compression of the median nerve at the wrist is one of the most common and successful procedures in hand surgery. Complications, though rare, are potentially devastating and may include intraoperative technical errors, postoperative infection and pain, and persistent or recurrent symptoms. Patients with continued complaints after carpal tunnel release should be carefully evaluated with detailed history and physical examination in addition to electrodiagnostic testing. For those with persistent or recurrent symptoms, a course of nonoperative management including splinting, injections, occupational therapy, and desensitization should be considered prior to revision surgery.
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Affiliation(s)
- John W Karl
- Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-1130, New York, NY 10032, USA
| | - Stephanie M Gancarczyk
- Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-1130, New York, NY 10032, USA
| | - Robert J Strauch
- Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-1130, New York, NY 10032, USA.
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13
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Cho YJ, Lee JH, Shin DJ, Park KH. Comparison of short wrist transverse open and limited open techniques for carpal tunnel release: a randomized controlled trial of two incisions. J Hand Surg Eur Vol 2016; 41:143-7. [PMID: 26353946 DOI: 10.1177/1753193415603968] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 07/10/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this randomized controlled trial was to compare outcomes of limited open and short wrist transverse techniques in patients with carpal tunnel syndrome. In a single centre randomized controlled trial, 84 patients with idiopathic carpal tunnel syndrome were randomized before surgery to limited open or short wrist transverse open carpal tunnel release. The patients were evaluated at 6 weeks, 3 months, 6 months, and 1 and 2 years after surgery. At every follow-up, the Brigham and Women's Carpal Tunnel Questionnaire scores, scar discomfort, and subjective patient satisfaction were evaluated. Two years after surgery, five patients were lost to follow-up. The groups had similar Brigham and Women's Carpal Tunnel Questionnaire Symptom Severity and Functional Status scores and subjective satisfaction scores. The incidence of scar discomfort was not significantly different between the two groups on serial postoperative follow-up. Short wrist transverse open release surgery showed similar early postoperative symptoms and subjective and functional outcomes to limited open release. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Y J Cho
- Department of Orthopedic Surgery, Kyung Hee University, Seoul, Korea
| | - J H Lee
- Department of Orthopedic Surgery, Kyung Hee University, Seoul, Korea
| | - D J Shin
- Department of Orthopedic Surgery, Kyung Hee University, Seoul, Korea
| | - K H Park
- Department of Orthopedic Surgery, Kyung Hee University, Seoul, Korea
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Associations between Distal Upper Extremity Job Physical Factors and Psychosocial Measures in a Pooled Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:643192. [PMID: 26557686 PMCID: PMC4628736 DOI: 10.1155/2015/643192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/10/2015] [Indexed: 11/24/2022]
Abstract
Introduction. There is an increasing body of literature relating musculoskeletal diseases to both job physical exposures and psychosocial outcomes. Relationships between job physical exposure measures and psychosocial factors have not been well examined or quantified. These exploratory analyses evaluate relationships between quantified exposures and psychosocial outcomes. Methods. Individualized quantification of duration, repetition, and force and composite scores of the Strain Index (SI) and the Threshold Limit Value for Hand Activity Level (TLV for HAL) were compared to 10 psychosocial measures. Relationships and predicted probabilities were assessed using ordered logistic regression. Analyses were adjusted for age, BMI, and gender. Results and Discussion. Among 1834 study participants there were multiple statistically significant relationships. In general, as duration, repetition, and force increased, psychosocial factors worsened. However, general health and mental exhaustion improved with increasing job exposures. Depression was most strongly associated with increased repetition, while physical exhaustion was most strongly associated with increased force. SI and TLV for HAL were significantly related to multiple psychosocial factors. These relationships persisted after adjustment for strong confounders. Conclusion. This study quantified multiple associations between job physical exposures and occupational and nonoccupational psychosocial factors. Further research is needed to quantify the impacts on occupational health outcomes.
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Abstract
Compressive neuropathies of the upper extremity are common and can result in profound disability if left untreated. Nerve releases are frequently performed, but can be complicated by both iatrogenic events and progression of neuropathy. In this review, we examine the management of postoperative complications after 2 common nerve compression release procedures: carpal tunnel release and cubital tunnel release.
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Affiliation(s)
- Katherine B. Santosa
- House Officer, Section of Plastic Surgery, Department of Surgery,
University of Michigan Health System
| | - Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Department of
Surgery, University of Michigan Health System
| | - Jennifer F. Waljee
- Assistant Professor, Section of Plastic Surgery, Department of
Surgery, University of Michigan Health System
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16
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Kim JK, Lim HM. The Korean version of the Carpal Tunnel Questionnaire. Cross cultural adaptation, reliability, validity and responsiveness. J Hand Surg Eur Vol 2015; 40:200-5. [PMID: 25005562 DOI: 10.1177/1753193414540083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to translate and culturally adapt the Carpal Tunnel Questionnaire to produce an equivalent Korean version. A total of 53 patients completed the Korean version of the Carpal Tunnel Questionnaire pre-operatively and 3 months after open carpal tunnel release. All 53 also completed the Korean version of the Disabilities of Arm, Shoulder, and Hand questionnaire pre-operatively and 3 months post-operatively. Reliability was measured by determining the test-retest reliability and internal consistency. Test-retest reliability was assessed using intraclass correlation coefficients and paired t-tests, and internal consistency using Cronbach's alpha coefficients. Pearson correlation analysis was carried out on the Korean version of the Carpal Tunnel Questionnaire scores and the Korean version of the Disabilities of Arm, Shoulder, and Hand scores to assess construct validity. Responsiveness was evaluated using effect sizes and standardized response means. The reliability of the Korean version of the Carpal Tunnel Questionnaire was good. The scores in the Korean version of the Disabilities of Arm, Shoulder, and Hand strongly correlated with the scores in the Korean version of the Carpal Tunnel Questionnaire. Standardized response mean and effect size were both large for the Korean version of the Carpal Tunnel Questionnaire. The study shows that the Korean version of the Carpal Tunnel Questionnaire is a reliable, valid and responsive instrument for measuring outcomes in carpal tunnel syndrome.
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Affiliation(s)
- J K Kim
- Department of Orthopedic Surgery, Ewha Womans University School of Medicine, Seoul, South Korea
| | - H M Lim
- Department of Orthopedic Surgery, Ewha Womans University School of Medicine, Seoul, South Korea
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17
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Using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement to assess reporting of observational trials in hand surgery. J Hand Surg Am 2013; 38:1584-9.e2. [PMID: 23845586 PMCID: PMC3989883 DOI: 10.1016/j.jhsa.2013.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/07/2013] [Accepted: 05/07/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To use the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist to critically evaluate the change in quality of observational trial reporting in the Journal of Hand Surgery American between 2005 and 2011. METHODS A cross-sectional analysis of observational studies published in the Journal of Hand Surgery American was designed to sample 2 6-month periods of publication (March 2005 to August 2005 and June 2011 to November 2011). Fifty-one items were extracted from the STROBE statement for evaluation. Overall STROBE compliance rates for articles and specific checklist items were determined. Final compliance percentages from each period were compared by Student t-testing. Changes in item compliance over time were quantified. RESULTS Overall compliance with the STROBE statement was 38% (range, 10%-54%) in 2005 and 58% (range, 39%-85%) for 2011 manuscripts representing a significant improvement. Seventy-five percent or greater of articles (2005/2011) provided the explicit reporting of background (100%/97%), follow-up time (85%/94%), overall interpretation of data (100%/94%), and results of similar studies (95%/89%). Twenty-five percent or less of articles provided the study design in the abstract (10%/20%), a clear description of the study's setting (10%/23%), the handling of missing data (0%/6%), the potential directions of bias (5%/11%), and the use of a power analysis (0%/17%). Eighty-six percent (44/51) of items were more frequently satisfied in 2011 articles than in 2005 publications. Absolute increases in compliance rates of 40% or greater were noted in 10 items (20%) with no worsening in compliance for an individual item over 6%. CONCLUSIONS The overall quality of the reporting of observational trials in the Journal of Hand Surgery American improved from 2005 to 2011. Current observational trials in hand surgery could still benefit from increased reporting of methodological details including the use of power analyses, the handling of missing data, and consideration of potential bias. LEVEL OF EVIDENCE Diagnostic III.
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Abstract
Evaluation of outcomes after peripheral nerve surgeries include several assessment methods that reflect different aspects of recovery, including reinnervation, tactile gnosis, integrated sensory and motor function, pain and discomfort, and neurophysiologic and patient-reported outcomes. This review lists measurements addressing these aspects as well as the advantages and disadvantages of each tool. Because of complexities of neurophysiology, assessment remains a difficult process, which requires researchers to focus on measurements best relevant to specific conditions and research questions.
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Affiliation(s)
- Yirong Wang
- Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing
| | - Malay Sunitha
- Clinical Research Coordinator, Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System; Ann Arbor, MI
| | - Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, The University of Michigan Medical School
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Endoscopic carpal tunnel release is preferred over mini-open despite similar outcome: a randomized trial. Clin Orthop Relat Res 2013; 471:1548-54. [PMID: 23100191 PMCID: PMC3613542 DOI: 10.1007/s11999-012-2666-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 10/15/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND The decision to perform endoscopic versus the mini-open carpal tunnel release technique is most likely left to surgeons rather than patients with idiopathic carpal tunnel syndrome. QUESTIONS/PURPOSES We hypothesized that (1) at 3 months after surgery, the subjective outcomes of endoscopic release, performed on one hand, and mini-incision release, performed on the other, would not differ in patients with bilateral carpal tunnel syndrome; however, (2) each patient would likely prefer one technique over the other for specific reasons. METHODS Fifty-two patients with bilateral carpal tunnel syndrome had one hand randomized to undergo endoscopic release and the other to undergo mini-incision release. Each patient was assessed with the Boston Carpal Tunnel Questionnaire (BCTQ) and DASH preoperatively and at each followup. Three months after surgery, the patients commented on which technique they preferred and completed a questionnaire regarding the reasons for not preferring the other technique. RESULTS The mean BCTQ symptom/function score and DASH improved similarly in the endoscopic release group and the mini-incision release group. Thirty-four patients preferred endoscopic release and 13 preferred the mini-incision technique. Scar or pillar pain was the most commonly cited factor in not preferring either technique followed by postoperative pain for the open technique and transient worsening of symptoms for the endoscopic technique. CONCLUSIONS Despite similar improvements in BCTQ and DASH scores after endoscopic and open techniques at 3 months postoperatively, the majority of our patients preferred the endoscopic technique. The most concerning reason for not preferring the other technique was scar or pillar pain.
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Lamacraft G. The link between acute postoperative pain and chronic pain syndromes. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2012. [DOI: 10.1080/22201173.2012.10872823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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