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Davids FA, Ramtin S, Razi A, Ring D, Teunis T, Reichel LM. Variation in Interpretation of Provocative Tests for Carpal Tunnel Syndrome. J Hand Surg Am 2024:S0363-5023(24)00308-3. [PMID: 39140920 DOI: 10.1016/j.jhsa.2024.07.004] [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: 02/29/2024] [Revised: 06/22/2024] [Accepted: 07/10/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE We studied variation in interpretation of specific symptoms during clinical tests for carpal tunnel syndrome to estimate the degree to which surgeons consider pain without paresthesia characteristic of median neuropathy. METHODS We invited all upper-extremity surgeon members of the Science of Variation Group to complete a scenario-based experiment. Surgeons read 5-10 clinical vignettes of patients with variation in patient demographics and random variation in symptoms and signs as follows: primary symptoms (nighttime numbness and tingling, constant numbness and loss of sensibility, pain with activity), symptoms elicited by a provocative test (Phalen, Durkan, or Tinel) (tingling, pain), and location of symptoms elicited by the provocative test (index and middle fingers, thumb and index fingers, little and ring fingers, entire hand). RESULTS Patient factors associated with surgeon interpretation of provocative tests as negative included pain rather than paresthesia during the Phalen, Durkan, or Tinel test and location of symptoms in the entire hand rather than the median nerve distribution. CONCLUSIONS Specialists do not consider pain without paresthesia or a noncharacteristic symptom distribution as characteristic of carpal tunnel syndrome. CLINICAL RELEVANCE Awareness that elicitation of pain with Phalen, Durkan, and Tinel tests is regarded by specialists as relatively uncharacteristic of median neuropathy can help limit the potential for both overdiagnosis and overtreatment of median neuropathy as well as underdiagnosis and undertreatment of mental and social health contributions to illness (notable correlates of the intensity and distribution of pain).
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Affiliation(s)
- Floor A Davids
- Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Sina Ramtin
- Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Amin Razi
- Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - David Ring
- Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, TX.
| | - Teun Teunis
- Department of Plastic Surgery, University Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Lee M Reichel
- Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, TX
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2
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Rezaee M, Roshandel H, Rahimibarghani S, Rihani TSS, Mohammadyahya E. Predictors of pain intensity in carpal tunnel syndrome: Development and validation of a model. Clin Neurol Neurosurg 2024; 243:108395. [PMID: 38936177 DOI: 10.1016/j.clineuro.2024.108395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Pain often accompanies carpal tunnel syndrome and affects patients' health-related quality of life. The aim was to develop and validate a predictive model for the pain intensity of carpal tunnel syndrome using demographic, clinical, electrophysiological, and ultrasound findings. METHODS We conducted a secondary analysis of data from a large sample of patients (May 2017 to December 2022) with carpal tunnel syndrome. A total of 520 (53.0 %) mild, 276 (28.1 %) moderate, and 186 (18.9 %) severe syndromes were included in the complete data set of 982 hands (61.1 % female). The mean age was 57.8 (10.7) years and the median duration [interquartile range] of the symptoms was 4 [2,10] months. A regression model was developed and validated to predict pain intensity on a numerical rating scale using a tree-based machine learning algorithm. RESULTS The validation of the regression model showed good performance with a root mean squared error, R-squared, and mean absolute error of 1.35, 0.42, and 1.05, respectively. Overall, the top significant predictors of pain intensity were compound motor nerve action potential latency, nocturnal pain, and thenar weakness. These were followed by the cross-sectional area of the median nerve, sensory nerve action potential, bowing of the flexor retinaculum, disease duration, and body mass index. We did not find strong associations between the median nerve transcarpal latency, age, sex, and diabetes with the pain intensity of carpal tunnel syndrome. CONCLUSION Our model showed good performance in predicting the subjective pain intensity of carpal tunnel syndrome, even in the context of non-linear relations.
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Affiliation(s)
- Mehdi Rezaee
- Department of Anesthesiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Islamic Republic of Iran
| | - Hamid Roshandel
- Department of Orthopedics, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Sarvenaz Rahimibarghani
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Tayebeh Sadat Salehi Rihani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Elham Mohammadyahya
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
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3
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Self-reported cannabis use is not associated with greater opioid use in elective hand surgery patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY 2022:10.1007/s00590-022-03321-z. [PMID: 35986814 PMCID: PMC9392061 DOI: 10.1007/s00590-022-03321-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 10/26/2022]
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4
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Forcelini CM, Chichelero ER, de Oliveira AT, Tres da Silva F, Durigan PHB, Ramos NO, Bianchini L, Battistel BLI, Borghetti V. Boston Carpal Tunnel Questionnaire and Severity of Carpal Tunnel Syndrome. J Clin Neuromuscul Dis 2022; 23:183-188. [PMID: 35608641 DOI: 10.1097/cnd.0000000000000409] [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: 06/15/2023]
Abstract
OBJECTIVES Carpal tunnel syndrome (CTS) is a common compressive neuropathy linked to disability in severe cases. Tools capable of distinguishing the severity spectrum median nerve entrapment in clinical practice are desirable. METHODS This cross-sectional study included 58 CTS patients assisted in a Brazilian neurologic clinic. Participants were naive of surgical interventions and answered to Boston Carpal Tunnel Questionnaire (BCTQ). CTS was classified as mild, moderate, and severe according to electrodiagnostic testing. RESULTS There was no significant difference in BCTQ scores across the severity spectrum of median nerve entrapment, not even comparing mild cases with the group moderate/severe. Mild cases were younger (mean ± SD: 46.5 ± 9.2 years) than severe ones (60.0 ± 13.5, P = 0.04) and the group moderate/severe (55.5 ± 14.5, P = 0.01). CONCLUSIONS Results suggest that BCTQ is not adequate to assess the interpatient severity of median nerve entrapment on clinical practice.
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Affiliation(s)
| | | | | | | | | | - Nathália Orso Ramos
- Faculdade de Medicina, Universidade de Passo Fundo, Passo Fundo, Brazil; and
| | - Larissa Bianchini
- Faculdade de Medicina, Universidade de Passo Fundo, Passo Fundo, Brazil; and
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5
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Chu MM, Chan J, Chan CC. Predicting outcomes of conservative treatment for patients with carpal tunnel syndrome: Group- and individual-based rehabilitation. Hong Kong J Occup Ther 2021; 34:39-49. [PMID: 34408558 PMCID: PMC8366207 DOI: 10.1177/1569186121997937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/06/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To identify predicting factors of treatment outcomes of a two stage group-based and then individual-based intervention programme for patients with carpal tunnel syndrome (CTS). Methods A prospective cohort study where patients diagnosed with CTS were recruited from an out-patient occupational therapy clinic to join the two-stage CTS programme. The Stage-One programme consisted of splinting and educational talks in a group format, while the Stage-Two programme consisted of four weekly individual sessions providing psychosocial support, reinforcing correct ergonomics and mobilization. Baseline assessment on six potential predicting factors and four outcome measures was done for all patients. Patients were re-assessed at the end of the Stage-One and the Stage-Two programme. Analysis was done by binary logistic regression adjusted for baseline covariates. Results One hundred and sixty-six patients completed the Stage-One programme and 46 patients also completed the Stage-Two programme. Results showed that the Chinese Symptom Severity Scale (SSS) baseline score was the only significant predictor for the Stage-One programme outcomes (AUC for ROC was 0.708) with an optimum cut-off score of 23.5. On the other hand, the Chinese QuickDASH baseline score was the only significant predictor for the Stage-Two programme outcomes (AUC for ROC was 0.801) with an optimum cut-off score of 27.4. Conclusions The significant predictor for the Stage One Programme was the Chinese SSS baseline score and that for the Stage Two Programme was the Chinese QuickDASH baseline score. The optimum cut-off scores identified may be applied clinically to guide client-centered treatment planning.
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Smuck M, Schneider BJ, Ehsanian R, Martin E, Kao MCJ. Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain. PAIN MEDICINE 2021; 21:1759-1768. [PMID: 31578562 DOI: 10.1093/pm/pnz224] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Examine the interrelationship between smoking and pain in the US population. DESIGN A cross-sectional population-based study. SETTING Nationwide survey. METHODS Comprehensive pain reports categorically defined as head, spine, trunk, and limb pain; smoking history; demographics; medical history from a total of 2,307 subjects from the 2003-2004 National Health and Nutrition Examination Survey obtained from the Centers for Disease Control were analyzed. Unpaired t tests were used to analyze independent continuous variables, and chi-square tests were used to analyze categorical variables between smoker and nonsmoker groups. Weighted multivariate logistic regression analyses determined the association of current smoking with the presence of pain in various body regions. RESULTS Smoking is most strongly associated with spine pain (odds ratio [OR] = 2.89, 95% confidence interval [CI] = 2.21-3.77), followed by headache (OR = 2.47, 95% CI = 1.73-3.53), trunk pain (OR = 2.17, 95% CI = 1.45-2.74), and limb pain (OR = 1.99, 95% CI = 1.45-2.73). CONCLUSIONS Current smoking is associated with pain in every region of the body. This association is strongest for spine and head pain. Given that pain is a strong motivator and that current smoking was associated with pain in all body regions, we recommend that these results be used to further raise public awareness about the potential harms of smoking.
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Affiliation(s)
- Matthew Smuck
- Physical Medicine and Rehabilitation, Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Byron J Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee.,Vanderbilt University Medical Center, Center for Musculoskeletal Research
| | - Reza Ehsanian
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee.,Department of Neurosurgery, Stanford University, Palo Alto, California.,Division of Physical Medicine and Rehabilitation, Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Elizabeth Martin
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee.,Division of Physical Medicine and Rehabilitation, Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Ming-Chih J Kao
- Physical Medicine and Rehabilitation, Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Stanford, California
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7
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The rate and associated risk factors for acute carpal tunnel syndrome complicating a fracture of the distal radius. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:981-987. [PMID: 33891155 PMCID: PMC8233234 DOI: 10.1007/s00590-021-02975-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/12/2021] [Indexed: 12/03/2022]
Abstract
Background Acute carpal tunnel syndrome (ACTS) is a known complication of distal radius fractures. This study aimed to document the demographics, range of presenting symptoms and risk factors of patients who develop ACTS following a fracture of the distal radius.
Methods A retrospective review of 1189 patients with an acute distal radius fracture treated in the study centre over a one-year period were identified. Demographic and clinical variables were collected and compared between controls (did not develop ACTS) and those patients who did develop ACTS to identify factors associated with developing ACS.
Results There were 51 (4.3%) distal radius fractures complicated by ACTS. The mean age of patients who developed ACTS was 56 years (range, 16–89) and 73% were female. The median time of onset post-injury was one week (range, 1–12). There was no association between patient background and comorbidities with the development of ACTS. AO-OTA Type C fractures had significantly increased rates of developing ACTS.
Conclusion Four percent of distal radius fractures were complicated by ACTS. There was no association between patient background and comorbidities with the development of ACTS. AO-OTA type C complete articular fractures had a significantly higher rate of ACTS. A suggested treatment algorithm for patients presenting with ACTS has been presented.
Level of evidence: III.
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Meirelles LM, Fernandes CH, Ejnisman B, Cohen M, dos Santos JBG, Faloppa F. Mudando os conceitos para o diagnóstico da Síndrome do Túnel do Carpo em atletas do halterofilismo do esporte adaptado. Rev Bras Ortop 2020; 55:755-758. [PMID: 33364655 PMCID: PMC7748937 DOI: 10.1055/s-0040-1709737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
Objective
To examine the prevalence of carpal tunnel syndrome in powerlifting athletes with disabilities.
Methods
The present study evaluated the presence and intensity of pain (numerical scale), nocturnal paresthesia (self-report), and nerve compression (Tinel and Phalen signs) in wheelchair- and non-wheelchair-bound powerlifting athletes with disabilities. The clinical diagnosis of carpal tunnel syndrome was confirmed by the presence of two or more signs/symptoms.
Results
In total, 29 powerlifting athletes with disabilities were evaluated. None of the athletes reported the presence of pain or nocturnal paresthesia. The Tinel sign was present in 1 (3.45%) wheelchair-bound athlete. A positive Phalen test was present in 3 (10.35%) athletes (1 wheelchair-bound and 2 non-wheelchair-bound). Concurrent positive Tinel sign and Phalen sign tests were found in 2 (6.89%) athletes (1 wheelchair-bound and 1 non-wheelchair-bound).
Conclusion
Carpal tunnel syndrome was clinically diagnosed in 2 (6.89%) out of 29 powerlifting athletes with disabilities.
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Affiliation(s)
- Lia Miyamoto Meirelles
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Carlos Henrique Fernandes
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Benno Ejnisman
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Moises Cohen
- 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
| | - Flavio Faloppa
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Mosegaard SB, Stilling M, Hansen TB. Risk factors for limited improvement after total trapeziometacarpal joint arthroplasty. Health Qual Life Outcomes 2020; 18:90. [PMID: 32228611 PMCID: PMC7106898 DOI: 10.1186/s12955-020-01333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background Trapeziometacarpal (TMC) osteoarthritis can be painful and cause disability for patients. Total joint replacement of the TMC joint provides a pseudo arthrosis with good restoration of the thumb motion and pain relief in most patients. But there is also a risk of no improvement following the operation. The purpose of this study was to identify patients at risk of no clinically important improvement following operative treatment of osteoarthritis of the TMC joint. Methods We included 287 consecutive patients (225 women, 62 men) treated with total joint replacement of the TMC joint due to osteoarthritis with a mean age of 58.9 years (range 41–80) in a prospective cohort study. We collected information preoperatively and 12 months postoperatively on disabilities of the arm, shoulder and hand score (DASH), grip strength and pain at rest and activity on a visual analogue scale (VAS).Results: We found a statistically significant improvement in DASH from 42.0 to 15.9 (p < 0.001), VAS at rest from 3.5 to 0.6 (p < 0.001), VAS at activity from 7.9 to 2.5 (p < 0.001) and grip strength from 21.6 kg to 27.6 kg (p < 0.001) 12 months after the operation, when analysed as a group. There was an increased risk of no clinically important improvement in hand function for patients with preoperative high preoperative grip strength. Also, we found an increased risk of no clinically important improvement in female patients when using VAS as outcome. Conclusion However, we were unable to detect one isolated preoperative predictor as indicator of successful result after operative treatment of TMC osteoarthritis, and as so it was not possible to establish a clinical valid tool for patient selection before surgery. Informed consent was obtained from all patients for being included in the study. The study needed no approval from The Regional Committee of Biomedical Research Ethics as the data was collected, as part of our normal pre- and postoperative clinical pathway, but the study is part of an outcome study of the results after total joint arthroplasty (TJA) of the TMC joint registered in Clinicaltrials.gov (NCT01554748). Trial registration Clinicaltrials.gov (NCT01554748). Registered 15 March 2012.
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Affiliation(s)
- Sebastian Breddam Mosegaard
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Lægårdvej 12, 7500, Holstebro, Denmark. .,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark.
| | - Maiken Stilling
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Lægårdvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark
| | - Torben Bæk Hansen
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Lægårdvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark
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10
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Stirling PHC, Yeoman TFM, Duckworth AD, Clement ND, Jenkins PJ, McEachan JE. Decompression for recurrent carpal tunnel syndrome provides significant functional improvement and patient satisfaction. J Hand Surg Eur Vol 2020; 45:250-254. [PMID: 31554451 DOI: 10.1177/1753193419875945] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This prospective single-centre study describes the functional outcomes, satisfaction and health-related quality of life after open revision carpal tunnel decompression for recurrent carpal tunnel syndrome. The QuickDASH, patient satisfaction and EuroQol-5 dimensions questionnaires were collected preoperatively and postoperatively over a 5-year period (2013-2018). The median time to revision was 13.3 years (range 3.9-35.4 years; interquartile range 7.2-15.9 years). Outcomes were available for 14 hands in 13 patients at a mean of 20 months after revision surgery. The mean preoperative and postoperative QuickDASH scores were 55 and 29, respectively, and the mean improvement in QuickDASH was 26. The mean improvement in EuroQol-5 dimensions score was 0.1, and 13 of the 14 patients were satisfied. The net promoter score was 85. This study confirms that patients undergoing revision open carpal tunnel decompression for recurrent carpal tunnel syndrome experience a significant improvement in function and health-related quality of life. Level of evidence: IV.
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11
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Mosegaard SB, Stilling M, Hansen TB. Higher preoperative pain catastrophizing increases the risk of low patient reported satisfaction after carpal tunnel release: a prospective study. BMC Musculoskelet Disord 2020; 21:42. [PMID: 31954407 PMCID: PMC6969973 DOI: 10.1186/s12891-020-3058-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/10/2020] [Indexed: 12/28/2022] Open
Abstract
Background Carpal tunnel syndrome is a common upper-limb nerve compression disease. Carpal tunnel syndrome can lead to several symptoms such as tingling or numbness, pain in the hand or wrist, and reduced grip strength. Based on demographic characteristics, patient reported outcome measures, and with special attention to pain catastrophizing, the purpose of this study was to identify risk factors for low patient-reported satisfaction following surgical treatment of idiopathic carpal tunnel syndrome. Methods A total of 417 hands from 417 patients (64. 5% females) with a mean age of 58. 0 years were included in this 1-year prospective follow-up study. We collected preoperative data on disability using the Disability of the Arm, Shoulder and Hand questionnaire (DASH), quality of life using the EuroQol-5D (EQ-5D), pain catastrophizing using the Pain Catastrophizing Scale (PCS) and distal motor latency. Data on DASH score, EQ-5D, and patient satisfaction was collected 12 months postoperatively. Wilcoxon matched-pairs signed-rank test was used to test for difference in preoperative and postoperative DASH and EQ-5D score. Risk factors for low postoperative patient reported satisfaction was examined using stepwise multiple logistic regression analysis. Results We found a general improvement in patients’ DASH scores (12.29 [95% CI: 10.65–13.90], p < 0.001) and EQ-5D (0.14 [95% CI: 0.13–0.16], p < 0.001) from preoperative to 12 months postoperative. In the fully adjusted multiple regression analysis we found a statistically significant effect of preoperative PCS on patient reported satisfaction with OR = 1.05 (p = 0.022), for a one unit increase in preoperative PCS. There was no statistically significant predictive effect of preoperative EQ-5D (p = 0.869), DASH (p = 0.076), distal motor latency (p = 0.067), age (p = 0.505) or gender (p = 0.222). Conclusions Patients improved in both DASH and EQ-5D from preoperative to 12 months postoperative. Higher preoperative PCS seems to have a negative effect on postoperative patient reported satisfaction after carpal tunnel release.
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Affiliation(s)
- Sebastian Breddam Mosegaard
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Lægårdvej 12, 7500, Holstebro, Denmark. .,Department of Clinical Medicine, Aarhus University, 8000, Aarhus, Denmark.
| | - Maiken Stilling
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Lægårdvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, 8000, Aarhus, Denmark
| | - Torben Bæk Hansen
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Lægårdvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, 8000, Aarhus, Denmark
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12
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Diagnosis and Treatment of Carpal Tunnel Syndrome in Low-prevalence Circumstances. J Am Acad Orthop Surg 2018; 26:573-575. [PMID: 29952784 DOI: 10.5435/jaaos-d-17-00575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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13
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Burton CL, Chesterton LS, Chen Y, van der Windt DA. Predicting surgical intervention in patients presenting with carpal tunnel syndrome in primary care. Clin Epidemiol 2018; 10:739-748. [PMID: 29988741 PMCID: PMC6029610 DOI: 10.2147/clep.s154409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose Carpal tunnel syndrome (CTS) is a symptomatic compression neuropathy of the median nerve. This study investigated the value of candidate prognostic factors (PFs) in predicting carpal tunnel release surgery. Patients and methods This is a retrospective cohort study set in the Clinical Practice Research Datalink. Patients ≥18 years presenting with an incident episode of CTS were identified between 1989 and 2013. Candidate PF’s defined in coded electronic patient records were identified following literature review and consultation with clinicians. Time to first carpal tunnel release surgery was the primary end point. A manual backward stepwise selection procedure was used to obtain an optimal prediction model, which included all the significant PFs. Results In total, 91,412 patients were included in the cohort. The following PFs were included in an optimal model (C-statistic: 0.588 [95% CI 0.584–0.592]) for predicting surgical intervention: geographical region; deprivation status; age hazard ratio (HR 1.02 per year, 95% CI 1.01–1.02); obesity (HR 1.23, 95% CI 1.19–1.27); alcohol drinker (HR 1.05, 95% CI 1.00–1.10); smoker (HR 1.06, 95% 1.03–1.10); inflammatory condition (HR 1.13, 95% CI 0.98–1.29); neck condition (HR 1.13, 95% CI 1.03–1.23); and multisite pain (HR 1.10, 95% CI 1.05–1.15). Although not included in the multivariable model, pregnancy (if gender female) within 1 year of the index consultation, reduced the risk of surgery (HR 0.24, 95% CI 0.21–0.28). Conclusion This study shows that patients who are older and who have comorbidities including other pain conditions are more likely to have surgery, whereas patients presenting with CTS during or within a year of pregnancy are less likely to have surgery. This information can help to inform clinicians and patients about the likely outcome of treatment and to be aware of which patients may be less responsive to primary care interventions.
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Affiliation(s)
- Claire L Burton
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK,
| | - Linda S Chesterton
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK,
| | - Ying Chen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK,
| | - Danielle A van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK,
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Jerosch-Herold C, Houghton J, Blake J, Shaikh A, Wilson ECF, Shepstone L. Association of psychological distress, quality of life and costs with carpal tunnel syndrome severity: a cross-sectional analysis of the PALMS cohort. BMJ Open 2017; 7:e017732. [PMID: 29102992 PMCID: PMC5722090 DOI: 10.1136/bmjopen-2017-017732] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The Prediciting factors for response to treatment in carpal tunnel syndrome (PALMS) study is designed to identify prognostic factors for outcome from corticosteroid injection and surgical decompression for carpal tunnel syndrome (CTS) and predictors of cost over 2 years. The aim of this paper is to explore the cross-sectional association of baseline patient-reported and clinical severity with anxiety, depression, health-related quality of life and costs of CTS in patients referred to secondary care. METHODS Prospective, multicentre cohort study initiated in 2013. We collected baseline data on patient-reported symptom severity (CTS-6), psychological status (Hospital Anxiety and Depression Scale), hand function (Michigan Hand Questionnaire) comorbidities, EQ-5D-3L (3-level version of EuroQol-5 dimension) and sociodemographic variables. Nerve conduction tests classified patients into five severity grades (mild to very severe). Data were analysed using a general linear model. RESULTS 753 patients with CTS provided complete baseline data. Multivariable linear regression adjusting for age, sex, ethnicity, duration of CTS, smoking status, alcohol consumption, employment status, body mass index and comorbidities showed a highly statistically significant relationship between CTS-6 and anxiety, depression and the EQ-5D (p<0.0001 in each case). Likewise, a significant relationship was observed between electrodiagnostic severity and anxiety (p=0.027) but not with depression (p=0.986) or the EQ-5D (p=0.257). National Health Service (NHS) and societal costs in the 3 months prior to enrolment were significantly associated with self-reported severity (p<0.0001) but not with electrodiagnostic severity. CONCLUSIONS Patient-reported symptom severity in CTS is significantly and positively associated with anxiety, depression, health-related quality of life, and NHS and societal costs even when adjusting for age, gender, body mass index, comorbidities, smoking, drinking and occupational status. In contrast, there is little or no evidence of any relationship with objectively derived CTS severity. Future research is needed to understand the impact of approaches and treatments that address psychosocial stressors as well as biomedical factors on relief of symptoms from carpal tunnel syndrome.
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Affiliation(s)
- Christina Jerosch-Herold
- Faculty of Medicine and Health Sciences, School of Health, Sciences, University of East Anglia, Norwich, UK
| | - Julie Houghton
- Faculty of Medicine and Health Sciences, School of Health, Sciences, University of East Anglia, Norwich, UK
| | - Julian Blake
- Department of Clinical Neurophysiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Clinical Neurophysiology, MRC Centre for Neuromuscular Diseases, London, UK
| | - Anum Shaikh
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Edward CF Wilson
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Lee Shepstone
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
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Truntzer J, Comer G, Kendra M, Johnson J, Behal R, Kamal RN. Perioperative Smoking Cessation and Clinical Care Pathway for Orthopaedic Surgery. JBJS Rev 2017; 5:e11. [DOI: 10.2106/jbjs.rvw.16.00122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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16
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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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17
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Clement ND, Duckworth AD, Jenkins PJ, McEachan JE. Interpretation of the QuickDASH score after open carpal tunnel decompression: threshold values associated with patient satisfaction. J Hand Surg Eur Vol 2016; 41:624-31. [PMID: 26744508 DOI: 10.1177/1753193415622341] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/16/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED We studied the correlation between change in the QuickDASH score and the absolute post-operative QuickDASH score with patient satisfaction after open carpal tunnel decompression. Threshold values in the QuickDASH score, the point at which the sensitivity and specificity are maximal in predicting patient satisfaction, were identified. During the study period, outcome data were compiled for 937 carpal tunnel decompressions, which included 219 (23%) male and 718 (77%) female patients with a mean age of 58 years (standard deviation (SD) 14). There was a significant improvement (mean difference 32, 95% confidence interval (CI) 30 to 34) in the QuickDASH from a mean of 54 (SD 20) to 22 (SD 23) at 1 year after surgery. There were 808 (86%) patients who defined their outcome as satisfactory at 1 year. The identified threshold values for the post-operative QuickDASH score (⩽34 points) and the change (⩾20 points) in the score were highly predictive of patient satisfaction. However, these threshold values varied significantly according to the baseline pre-operative score. The threshold values identified in the QuickDASH can be used to interpret the score. However, the influence of the pre-operative baseline score should be taken into account when comparing different cohorts of patients or using the values to power future studies. LEVEL OF EVIDENCE IV Prognosis, observational cohort study.
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Affiliation(s)
- N D Clement
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Dunfermline, UK
| | - A D Duckworth
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Dunfermline, UK
| | - P J Jenkins
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Dunfermline, UK
| | - J E McEachan
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Dunfermline, UK
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18
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Burton CL, Chesterton LS, Chen Y, van der Windt DA. Clinical Course and Prognostic Factors in Conservatively Managed Carpal Tunnel Syndrome: A Systematic Review. Arch Phys Med Rehabil 2016; 97:836-852.e1. [DOI: 10.1016/j.apmr.2015.09.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 12/21/2022]
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Gonzalez-Suarez C, NathleenDizon J, Cua R, Cabungcal-Fidel B, Dones V, Lesniewski P, Thomas JC. Determination of the longitudinal median nerve mobility in different neurodynamic techniques. HAND THERAPY 2016. [DOI: 10.1177/1758998315617784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Neurodynamic techniques which include tensioning and gliding techniques are being employed in the treatment of carpal tunnel syndrome. There are few in vivo studies that have assessed the longitudinal mobility of the nerve using these techniques. The objective of this study was to determine the longitudinal excursion of the median nerve at the level of the wrist and distal arm by having the cervical spine lateral flexion or the wrist extension as terminal movement. Method Twenty healthy participants were included in the study. Techniques 1 and 2 had wrist extension as its terminal movement while techniques 3 and 4 had ipsilateral and contralateral neck lateral flexion as its terminal motion. Median nerve longitudinal excursion was determined using dynamic ultrasound and was measured by a motion tracking analysis program employing a fast template tracking method. Results Regardless of neurodynamic techniques, longitudinal mobility is highest at the wrist and arm level if the terminal movement is wrist extension. Median nerve excursion at the wrist and arm levels is 15.53 ± 7.04 mm and 6.82 ± 2.97 mm for technique 1 and 13.43 ± 5.64 and 5.33 ± 2.37 mm for technique 2, respectively. There was a significant decrease in median nerve excursion at the wrist level when the terminal movement was at the cervical spine. Conclusion The largest median nerve excursion in the arm and wrist occurred when wrist extension is the terminal movement. Contralateral cervical lateral flexion with a prepositioned extended wrist produced the least motion of the median nerve at both sites.
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Affiliation(s)
- Consuelo Gonzalez-Suarez
- Center for Health Research and Movement Science, University of Santo Tomas, Manila, Philippines
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
- A Mabini Rehabilitation Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Jan NathleenDizon
- A Mabini Rehabilitation Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Ronald Cua
- A Mabini Rehabilitation Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Belinda Cabungcal-Fidel
- Center for Health Research and Movement Science, University of Santo Tomas, Manila, Philippines
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
- A Mabini Rehabilitation Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Valentin Dones
- Center for Health Research and Movement Science, University of Santo Tomas, Manila, Philippines
| | - Peter Lesniewski
- School of Engineering, University of South Australia, South Australia, Australia
| | - John C Thomas
- Group Scientific Pty Ltd, Innovation House, South Australia, Australia
- School of Electrical and Electronic Engineering, Shandong University of Technology, Zibo, China
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20
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Duckworth AD, Jenkins PJ, McEachan JE. Diagnosing carpal tunnel syndrome. J Hand Surg Am 2014; 39:1403-7. [PMID: 24818965 DOI: 10.1016/j.jhsa.2014.03.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/30/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Andrew D Duckworth
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Fife, United Kingdom; Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Paul J Jenkins
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Fife, United Kingdom; Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Jane E McEachan
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Fife, United Kingdom; Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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