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Effect of ultrasound-guided versus landmark-guided local corticosteroid injection for carpal tunnel syndrome: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:545-561. [PMID: 35635576 DOI: 10.1007/s00402-022-04437-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS), the commonest neuropathy of the upper limb, can be managed with different therapeutic approaches. Local corticosteroid injection has been adopted widely in clinical practice, as it showed great efficacy in treating CTS. However, the best injection technique continues to be a subject of controversy. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ultrasound-guided (US-guided) versus landmark-guided (LM-guided) corticosteroid injection on the clinical and electrophysiological outcomes in patients with CTS. METHODS We performed a systematic literature search in Medline, Embase, and CENTRAL, from which we included randomized controlled trials (RCTs) that compared US-guided and LM-based corticosteroid injection in treating individuals with CTS. We evaluated the following outcomes: Boston carpal tunnel questionnaire functional status scale (BCTQ-FSS) and symptom severity scale (BCTQ-SSS), and adverse event rate. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcome. RESULTS A total of 8 RCTs that enrolled 500 wrists were deemed eligible. US-guided injection showed a significantly better BCTQ-FSS (SMD = -0.22, 95% CI -0.39 to -0.04), BCTQ-SSS (SMD = -0.77, 95% CI -1.22 to -0.31), and adverse event rate (RR = 0.32, 95% CI 0.21 to 0.49) compared to LM-based injection. CONCLUSION This meta-analysis showed the superiority of US-guided corticosteroid injection over LM-guided corticosteroid injection in enhancing functional status, improving symptom severity, and reducing the adverse event rate in individuals with CTS.
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Lech L, Loucas R, Leitsch S, Vater A, Mayer JM, Giunta R, Holzbach T. Is there a need for postoperative monitoring after open carpal tunnel release under WALANT? HAND SURGERY & REHABILITATION 2022; 41:638-643. [PMID: 35850181 DOI: 10.1016/j.hansur.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Open carpal tunnel release (OCTR) under wide-awake local anesthesia with no tourniquet (WALANT) is a common outpatient procedure in hand surgery worldwide. In our clinic, WALANT has replaced intravenous regional anesthesia with a tourniquet (IVRA, or 'Bier block') as standard practice in OCTR. We therefore wondered what the optimal postoperative setting after OCTR under WALANT is. In this study, we compared patient satisfaction in two postoperative settings: immediate discharge (ID) after the operation, or short postoperative monitoring (PM) period in the outpatient clinic. Our hypothesis was that older patients would prefer a brief postoperative surveillance. We retrospectively analyzed patient satisfaction with the two settings using an adjusted questionnaire based on the standard Swiss grading system. We also assessed postoperative pain, satisfaction with the perioperative preparations and the reasons for unscheduled postoperative consultations, as secondary outcomes. One hundred and nine patients (ID, n = 63; PM, n = 46) were included in this single-center retrospective observational study. Patients were highly satisfied with both postoperative settings (Mean: ID 5.1/6; PM 5.5/6; p = 0.07). Even patients aged ≥80 years reported extremely high satisfaction with both settings (ID 5.6/6; PM 6.0/6; p = 0.08). Fifteen patients (ID, n = 11 [17.5%]; PM, n = 4 [8.7%], p = 0.72) unexpectedly consulted a doctor after surgery. OCTR under WALANT as an outpatient procedure with immediate discharge was associated with high patient satisfaction. However, detailed postoperative monitoring could contribute to the patient's well-being and education on how to cope with the postoperative course, and help with any questions.
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Affiliation(s)
- L Lech
- Department of Hand and Plastic Surgery, Thurgau Hospital Group, Pfaffenholzstraße 4, 8500 Frauenfeld, Switzerland; Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080 Würzburg, Germany.
| | - R Loucas
- Department of Hand and Plastic Surgery, Thurgau Hospital Group, Pfaffenholzstraße 4, 8500 Frauenfeld, Switzerland.
| | - S Leitsch
- Department of Hand and Plastic Surgery, Thurgau Hospital Group, Pfaffenholzstraße 4, 8500 Frauenfeld, Switzerland.
| | - A Vater
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080 Würzburg, Germany.
| | - J M Mayer
- Department of Plastic and Hand Surgery, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
| | - R Giunta
- Divison of Hand-, Plastic and Aesthetic Surgery, University Hospital LMU Munich: Marchioninistraße 15, 81377 Munich, Germany.
| | - T Holzbach
- Department of Hand and Plastic Surgery, Thurgau Hospital Group, Pfaffenholzstraße 4, 8500 Frauenfeld, Switzerland.
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Papanas N, Stamatiou I, Papachristou S. Carpal Tunnel Syndrome in Diabetes Mellitus. Curr Diabetes Rev 2022; 18:e010921196025. [PMID: 34468300 DOI: 10.2174/1573399817666210901114610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022]
Abstract
The aim of the present brief review was to discuss carpal tunnel syndrome (CTS) in diabetes mellitus (DM). Generally, CTS is more common in DM, especially in subjects with coexisting diabetic polyneuropathy (DPN) and/or long DM duration. There is no agreement if it is more frequent in type 1 or type 2 DM. The precise underlying mechanisms are not entirely clear but appear to involve hyperglycaemia-induced median nerve oedema, increased sensitivity to exogenous trauma and nerve myelin ischaemia and axonal degeneration. More recently, increased vascular endothelial growth factor (VEGF) and advanced glycation endproducts (AGEs) appear to also play an important role. Median nerve conduction study remains the cornerstone of CTS diagnosis in DM, being more sensitive than clinical examination. CTS can be treated medically or surgically. The latter appears now to be equally effective in subjects with vs. without DM in terms of recurrence rates and quality of life.
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Affiliation(s)
- Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Iliana Stamatiou
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stella Papachristou
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Moradi A, Sadr A, Ebrahimzadeh MH, Hassankhani GG, Mehrad-Majd H. Does diabetes mellitus change the carpal tunnel release outcomes? Evidence from a systematic review and meta-analysis. J Hand Ther 2021; 33:394-401. [PMID: 32156577 DOI: 10.1016/j.jht.2020.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis. INTRODUCTION Carpal tunnel syndrome (CTS) is one of the most common upper extremity conditions which mostly affect women. Management of patients suffering from both CTS and diabetes mellitus (DM) is challenging, and it was suggested that DM might affect the diagnosis as well as the outcome of surgical treatment. PURPOSE OF THE STUDY This meta-analysis was aimed to compare the response with CTS surgical treatment in diabetic and nondiabetic patients. METHODS Electronic databases were searched to identify eligible studies comparing the symptomatic, functional, and neurophysiological outcomes between diabetic and nondiabetic patients with CTS. Pooled MDs with 95% CIs were applied to assess the level of outcome improvements. RESULTS Ten articles with 2869 subjects were included. The sensory conduction velocities in the wrist-palm and wrist-middle finger segments showed a significantly better improvement in nondiabetic compared with diabetic patients (MD = -4.31, 95% CI = -5.89 to -2.74, P < .001 and MD = -2.74, 95% CI = -5.32 to -0.16, P = .037, respectively). However, no significant differences were found for the improvement of symptoms severity and functional status based on the Boston Carpal Tunnel Questionnaire and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire as well as motor conduction velocities and distal motor latencies. CONCLUSION Metaresults revealed no significant difference in improvements of all various outcomes except sensory conduction velocities after CTS surgery between diabetic and nondiabetic patients. A better diabetic neuropathy care is recommended to achieve better sensory recovery after CTS surgery in diabetic patients.
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Affiliation(s)
- Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ata Sadr
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Hassan Mehrad-Majd
- Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran.
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Wolny T, Linek P. The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial. J Manipulative Physiol Ther 2018; 41:641-649. [DOI: 10.1016/j.jmpt.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/27/2018] [Accepted: 10/28/2018] [Indexed: 11/15/2022]
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Daşar U, Mutlu T. The Effect of Diabetes Mellitus on Decompression Surgery in Carpal Tunnel Syndrome. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.463198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Wahab KW, Sanya EO, Adebayo PB, Babalola MO, Ibraheem HG. Carpal Tunnel Syndrome and Other Entrapment Neuropathies. Oman Med J 2017; 32:449-454. [PMID: 29218119 DOI: 10.5001/omj.2017.87] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Entrapment neuropathy is the result of pressure on a peripheral nerve as it passes through a narrow canal that is bounded by stiff tissues. In spite of their ubiquitous nature, they are underdiagnosed, underreported, and sometimes not properly managed, especially in developing countries. Entrapment neuropathies are of various types, but the most common type is carpal tunnel syndrome. Mechanisms involved in the pathophysiology of entrapment neuropathies include mechanical compression and nerve ischemia. A clear understanding of the various types and the underlying mechanisms of entrapment neuropathies are invaluable in the decision-making process involved in the management of every patient with the condition.
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Affiliation(s)
- Kolawole Wasiu Wahab
- Department of Medicine, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel O Sanya
- Department of Medicine, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Philip B Adebayo
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Musbaudeen O Babalola
- Department of Surgery, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Hakeem G Ibraheem
- Department of Surgery, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
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Raducha JE, Gil JA, DeFroda SF, Wawrzynski J, Weiss APC. An Evidence-Based Approach to the Differentiation of Compressive Neuropathy from Polysensory Neuropathy in the Upper Extremity. JBJS Rev 2017; 5:e9. [DOI: 10.2106/jbjs.rvw.17.00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Wolny T, Linek P, Saulicz E. Overall health status in patients with mild to moderate carpal tunnel syndrome: A case-control study. J Hand Ther 2017; 30:293-298. [PMID: 28233620 DOI: 10.1016/j.jht.2016.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 09/24/2016] [Accepted: 10/12/2016] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN A case-control study. INTRODUCTION There are no reports in the literature that evaluate the overall health status (OHS) of patients with mild to moderate forms of carpal tunnel syndrome (CTS) using 36-Item Short Form Health Survey (SF-36). PURPOSE OF THE STUDY To assess OHS in patients with mild to moderate CTS, in comparison with healthy subjects. METHODS The study involved 273 healthy people and 140 people diagnosed with CTS. The CTS diagnosis was made on the basis of clinical examinations and nerve conduction studies. OHS was assessed using the SF-36. RESULTS In the assessment of physical components of OHS, in the CTS group (compared with healthy subjects), the results show significantly lower values in physical functioning, role limitations because of physical health problems, bodily pain, and general health perceptions by 7.44, 23.2, 18.9, and 4.1, respectively. Mental components were lower (in CTS group) only in relation to vitality and social functioning by 4.1 and 5.5, respectively. In the assessment of physical component summary (PCS) and mental component summary (MCS), the results show significantly lower values of PCS (by 13 in CTS group) and no significant differences in the assessment of MCS between patients with CTS and healthy subjects. DISCUSSION The perception of the OHS in CTS patients is diminished. Hence, when evaluating the effects of the therapy, not only disease-specific scales should be used, but also the OHS. This will allow an assessment of the impact of CTS on OHS and the impact of applied therapy, not only in terms of a reduction in the main symptoms of the condition. CONCLUSIONS Mild and moderate forms of CTS significantly affected the PCS of the OHS and all its subcomponents (physical functioning, role limitations because of physical health problems, bodily pain, and general health perceptions) but did not affect the MCS of OHS evaluated as a whole. There were significant differences in the mental component in the evaluation of vitality and social functioning. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Tomasz Wolny
- Department of Kinesiotherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland; Department of Physiotherapy, The Academy of Business, Dąbrowa Górnicza, Poland
| | - Pawel Linek
- Department of Kinesiotherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.
| | - Edward Saulicz
- Department of Kinesiotherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland; Department of Physiotherapy, The Academy of Business, Dąbrowa Górnicza, Poland
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Nazari G, MacDermid JC, Bain J, Levis CM, Thoma A. Estimation of health-related-quality of life depends on which utility measure is selected for patients with carpal tunnel syndrome. J Hand Ther 2016; 30:299-306. [PMID: 27988154 DOI: 10.1016/j.jht.2016.11.001] [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: 02/17/2016] [Revised: 10/25/2016] [Accepted: 11/02/2016] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Cross-sectional. INTRODUCTION Carpal tunnel syndrome (CTS) refers to the compression neuropathy of the median nerve at the wrist. PURPOSE OF THE STUDY To establish the interinstrument reliability, convergent construct validity, and the levels of agreement of health utility indexes 2 and 3 (HUI-2 and HUI-3), EuroQol 5-dimensions (EQ-5D), EuroQol-visual analog scale (EQ-VAS) and to determine the difference of these utility measures based on age and gender in patients with carpal tunnel syndrome. METHODS Seventy-four patients with a confirmed diagnosis of carpal tunnel syndrome completed the 3 questionnaires and EQ-VAS a month before surgery. Demographic characteristics were reported. Intraclass correlation coefficients were used to assess relative interinstrument reliability. Pearson correlation coefficients (r) were used to establish convergent construct validity. Bland-Altman plots and t tests were used to describe the levels of agreement between the 4 utility measures. A 2-way analysis of variance was performed to determine the effect of age and gender on the utility measures; HUI-2, HUI-3, and EQ-5D. RESULTS The intraclass correlation coefficients were 0.85 for HUI-3 vs HUI-2 and 0.80 for HUI-2 vs EQ-VAS. Pearson correlation coefficients ranged from 0.60 to 0.89; HUI-3 vs HUI-2: 0.89, and HUI-3 vs EQ-5D: 0.60. One-sample t test demonstrated significant differences between HUI-3 vs HUI-2, HUI-3 vs EQ-5D, and HUI-3 vs EQ-VAS measures, with mean differences of -0.12, -0.15, and -0.14, respectively. A 2-way analysis of variance test controlling for age and gender indicated neither as predictors of outcome scores. CONCLUSIONS The HUI-3 vs HUI-2 and HUI-2 vs EQ-VAS demonstrated excellent interinstrument relative reliability measures. The HUI-3 vs HUI-2 displayed very strong convergent construct validity measures, and strong validity measures were established between the remaining utility measures. In addition, the pair-wise utility comparisons demonstrated minimal bias between HUI-2 vs EQ-5D, HUI-2 vs EQ-VAS, and EQ-VAS vs EQ-5D measures. DISCUSSION N/A. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Goris Nazari
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
| | - Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - James Bain
- Division of Plastic Surgery, MacHANd, McMaster Medical Centre/Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Carolyn M Levis
- Division of Plastic Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, MacHANd, Hamilton, Ontario, Canada
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Rota E, Morelli N. Entrapment neuropathies in diabetes mellitus. World J Diabetes 2016; 7:342-353. [PMID: 27660694 PMCID: PMC5027001 DOI: 10.4239/wjd.v7.i17.342] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/18/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
Neuropathy is a common complication of diabetes mellitus (DM) with a wide clinical spectrum that encompasses generalized to focal and multifocal forms. Entrapment neuropathies (EN), which are focal forms, are so frequent at any stage of the diabetic disease, that they may be considered a neurophysiological hallmark of peripheral nerve involvement in DM. Indeed, EN may be the earliest neurophysiological abnormalities in DM, particularly in the upper limbs, even in the absence of a generalized polyneuropathy, or it may be superimposed on a generalized diabetic neuropathy. This remarkable frequency of EN in diabetes is underlain by a peculiar pathophysiological background. Due to the metabolic alterations consequent to abnormal glucose metabolism, the peripheral nerves show both functional impairment and structural changes, even in the preclinical stage, making them more prone to entrapment in anatomically constrained channels. This review discusses the most common and relevant EN encountered in diabetic patient in their epidemiological, pathophysiological and diagnostic features.
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Thomsen NOB, Björk J, Cederlund RI. Health-related quality of life 5 years after carpal tunnel release among patients with diabetes: a prospective study with matched controls. BMC Endocr Disord 2014; 14:85. [PMID: 25326166 PMCID: PMC4203934 DOI: 10.1186/1472-6823-14-85] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/03/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy encountered in diabetes. The short-term improvement after carpal tunnel release has previously been demonstrated not to differ between patients with and without diabetes, despite a marked impairment in health-related quality of life (HRQL) among the former. In this study, we compare HRQL 5 years after carpal tunnel release between these two groups of patients. METHODS In a prospective series, 35 patients with diabetes and CTS were matched with 31 control patients with idiopathic CTS but no diabetes. At the 5-year follow-up patients completed the Medical Outcomes Short-Form 36 (SF-36) and Antonovsky's sense of coherence (SOC) questionnaire. Differences in changes over time were compared between patients with and without diabetes using mixed model analysis. RESULTS Although patients with diabetes reported a significant decrease in physical functioning (p =0.004) as compared to patients without diabetes, postoperative improvement was maintained in the physical domains, role physical and bodily pain. A more pronounced decline in the mental health domain, social function (p =0.03), was demonstrated among patients with diabetes. There was no evidence of any difference in SOC between the patient groups. CONCLUSION Patients with diabetes retained their improvement in physical domains sensitive to changes after carpal tunnel release in the long-term, despite a decline in other domains of both physical and mental HRQL. This differed from patients without diabetes. Differences in SOC could not explain the sharper decline in these domains among patients with diabetes.
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Affiliation(s)
- Niels OB Thomsen
- />Department of Clinical Sciences Malmö - Hand Surgery, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Jonas Björk
- />Competence Centre for Clinical Research, Lund University and Skåne University Hospital, Lund, Sweden
| | - Ragnhild I Cederlund
- />Department of Health Sciences, The Vårdal Institute, Lund University, Lund, Sweden
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Symptoms During or Shortly After Isolated Carpal Tunnel Release and Problems Within 24 hours After Surgery. J Hand Microsurg 2014; 7:30-5. [PMID: 26078500 DOI: 10.1007/s12593-014-0157-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022] Open
Abstract
This study used the National Survey of Ambulatory Surgery (NSAS) database to measure the incidence of and risk factors for symptoms in the ambulatory surgery center and problems within 24 h after isolated carpal tunnel release (CTR). The NSAS contained records on 400,000 adult patients with carpal tunnel syndrome who were treated with CTR in 2006, based on ICD-9 codes. The type of anesthesia used and factors associated with symptoms and problems were sought in bivariate and multivariable statistical analyses. The mean duration of the procedure was 16 ± 8.8 min. Only 5 % were performed under local anesthesia without sedation, 45 % with IV sedation, 28 % regional anesthesia, and 19 % general anesthesia. Symptoms in the ambulatory surgery center or a problem within 24 h after discharge were recorded in 10 % of patients, all of them minor and transient, including difficulties with pain and its treatment. The strongest risk factors were male sex, age of 45 years and older, and participation of an anesthesiologist. Local anesthesia and regional anesthesia were associated with more perioperative symptoms and postoperative problems. Most CTR are performed with some sedation in the United States. CTR is a safe procedure: one in 10 patients will experience a minor issue in the perioperative or immediate postoperative period.
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Mojaddidi MA, Ahmed MS, Ali R, Jeziorska M, Al-Sunni A, Thomsen NOB, Dahlin LB, Malik RA. Molecular and pathological studies in the posterior interosseous nerve of diabetic and non-diabetic patients with carpal tunnel syndrome. Diabetologia 2014; 57:1711-9. [PMID: 24865616 DOI: 10.1007/s00125-014-3271-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/22/2014] [Indexed: 12/24/2022]
Abstract
AIMS/HYPOTHESIS We sought to establish the molecular and pathological changes predisposing diabetic and non-diabetic patients to the development of carpal tunnel syndrome (CTS). METHODS The posterior interosseous nerve (PIN) was biopsied in 25 diabetic and 19 non-diabetic patients undergoing carpal tunnel decompression for CTS. Detailed morphometric and immunohistological analyses were performed in the nerve biopsy. RESULTS In diabetic patients median nerve distal motor latency was prolonged (p < 0.05 vs non-diabetic patients), PIN myelinated fibre density (p < 0.05), fibre area (p < 0.0001) and axon area (p < 0.0001) were reduced, the percentage of unassociated Schwann cell profiles (p < 0.0001) and unmyelinated axon density (p < 0.0001) were increased and the axon diameter was reduced (p < 0.0001). Endoneurial capillary basement membrane area was increased (p < 0.0001) in diabetic patients, but endothelial cell number was increased (p < 0.01) and luminal area was reduced (p < 0.05) in non-diabetic patients with CTS. There was no difference in the expression of hypoxia-inducible factor 1α between diabetic and non-diabetic patients with CTS. However, the expression of vascular endothelial growth factor A (VEGF) (p < 0.05) and its receptors VEGFR-1 (p < 0.01) and VEGFR-2 (p < 0.05) was significantly increased in diabetic patients, particularly those with type 1 diabetes, and related to the severity of nerve fibre pathology. CONCLUSIONS/INTERPRETATION This study demonstrates increased nerve fibre and microvascular pathology in relation to enhanced expression of VEGF and its receptors in a non-compressed nerve in diabetic compared with non-diabetic patients with CTS. It therefore provides a potential molecular and pathological basis for the predisposition of diabetic patients to the development of CTS.
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Affiliation(s)
- Moaz A Mojaddidi
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, AV Hill Building, Oxford Road, Manchester, M13 9PT, UK
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Thomsen NOB, Cederlund RI, Andersson GS, Rosén I, Björk J, Dahlin LB. Carpal tunnel release in patients with diabetes: a 5-year follow-up with matched controls. J Hand Surg Am 2014; 39:713-20. [PMID: 24582843 DOI: 10.1016/j.jhsa.2014.01.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical outcomes 5 years after carpal tunnel release among patients with and without diabetes. METHODS In a prospective consecutive series, 35 patients with diabetes (median age, 54 y; 15 type 1 and 20 type 2 diabetes) with carpal tunnel syndrome were age- and sex-matched with 31 control patients without diabetes (median age, 51 y) with idiopathic carpal tunnel syndrome. Exclusion criteria were other nerve entrapment, cervical radiculopathy, inflammatory joint disease, thyroid disorder, previous wrist fracture, and long-term exposure to vibrating tools. Participants were examined independently at baseline, 1 year, and 5 years after surgery for sensory function (Semmes-Weinstein), motor function (abductor pollicis brevis muscle strength and grip strength), cold intolerance, and completion of the Boston Carpal Tunnel Questionnaire symptom severity and functional status score. RESULTS Five years after surgery, the overall attendance rate for clinical examinations and completion of the Boston Carpal Tunnel Questionnaire were 86% and 95%, respectively. Between 1 and 5 years after surgery, there was a tendency toward a decrease in sensory function but an increase in motor function, with no statistically significant difference between groups. Cold intolerance demonstrated long-term significant improvement for patients with diabetes. The improvement in symptom severity and functional status score, as well as the large effect size, were maintained at 5 years in both patient groups. CONCLUSIONS Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes. Furthermore, improvement in cold intolerance in patients with diabetes suggests the potential for the long-term regeneration of small nerve fibers. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic I.
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Affiliation(s)
- Niels O B Thomsen
- Department of Hand Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Malmö-Hand Surgery, Lund University, Lund, Sweden; Department of Health Sciences, the Vårdal Institute, Lund University, Lund, Sweden; Department of Clinical Neurophysiology and the Competence Centre for Clinical Research, Skåne University Hospital, Lund, Sweden.
| | - Ragnhild I Cederlund
- Department of Hand Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Malmö-Hand Surgery, Lund University, Lund, Sweden; Department of Health Sciences, the Vårdal Institute, Lund University, Lund, Sweden; Department of Clinical Neurophysiology and the Competence Centre for Clinical Research, Skåne University Hospital, Lund, Sweden
| | - Gert S Andersson
- Department of Hand Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Malmö-Hand Surgery, Lund University, Lund, Sweden; Department of Health Sciences, the Vårdal Institute, Lund University, Lund, Sweden; Department of Clinical Neurophysiology and the Competence Centre for Clinical Research, Skåne University Hospital, Lund, Sweden
| | - Ingmar Rosén
- Department of Hand Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Malmö-Hand Surgery, Lund University, Lund, Sweden; Department of Health Sciences, the Vårdal Institute, Lund University, Lund, Sweden; Department of Clinical Neurophysiology and the Competence Centre for Clinical Research, Skåne University Hospital, Lund, Sweden
| | - Jonas Björk
- Department of Hand Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Malmö-Hand Surgery, Lund University, Lund, Sweden; Department of Health Sciences, the Vårdal Institute, Lund University, Lund, Sweden; Department of Clinical Neurophysiology and the Competence Centre for Clinical Research, Skåne University Hospital, Lund, Sweden
| | - Lars B Dahlin
- Department of Hand Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Malmö-Hand Surgery, Lund University, Lund, Sweden; Department of Health Sciences, the Vårdal Institute, Lund University, Lund, Sweden; Department of Clinical Neurophysiology and the Competence Centre for Clinical Research, Skåne University Hospital, Lund, Sweden
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Carpal tunnel release surgery and venous hypertension in early hemodialysis patients without amyloid deposits. ScientificWorldJournal 2013; 2013:481348. [PMID: 24307871 PMCID: PMC3836390 DOI: 10.1155/2013/481348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 09/25/2013] [Indexed: 11/17/2022] Open
Abstract
AIM Carpal tunnel syndrome (CTS) is one of the frequent problems of the patients who underwent hemodialysis (HD). The role of venous hypertension due to arteriovenous fistula (AVF) has not been clarified completely; therefore, we aimed to investigate the role of venous hypertension due to AVF in hemodialysis patients who had CTS. PATIENTS AND METHODS We included 12 patients who had been receiving HD treatment for less than 8 years and the newly diagnosed CTS patients with the same arm of AVF. All patients were diagnosed clinically and the results were confirmed by both nerve conduction studies and electromyography. Open carpal tunnel release surgery was performed on all of them. Venous pressure was measured in all patients before and after two weeks of surgery. RESULTS There were significant differences before and after the surgery with regard to pressures (P > 0.05). After the surgery, all carpal ligament specimens of the patients were not stained with Congo red for the presence of amyloid deposition. CONCLUSION Increased venous pressure on the same arm with AVF could be responsible for CTS in hemodialysis patients. Carpal tunnel release surgery is the main treatment of this disease by reducing the compression on the nerve.
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Jenkins PJ, Duckworth AD, Watts AC, McEachan JE. The outcome of carpal tunnel decompression in patients with diabetes mellitus. ACTA ACUST UNITED AC 2012; 94:811-4. [PMID: 22628597 DOI: 10.1302/0301-620x.94b6.29174] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Diabetes mellitus is recognised as a risk factor for carpal tunnel syndrome. The response to treatment is unclear, and may be poorer than in non-diabetic patients. Previous randomised studies of interventions for carpal tunnel syndrome have specifically excluded diabetic patients. The aim of this study was to investigate the epidemiology of carpal tunnel syndrome in diabetic patients, and compare the outcome of carpal tunnel decompression with non-diabetic patients. The primary endpoint was improvement in the QuickDASH score. The prevalence of diabetes mellitus was 11.3% (176 of 1564). Diabetic patients were more likely to have severe neurophysiological findings at presentation. Patients with diabetes had poorer QuickDASH scores at one year post-operatively (p = 0.028), although the mean difference was lower than the minimal clinically important difference for this score. After controlling for underlying differences in age and gender, there was no difference between groups in the magnitude of improvement after decompression (p = 0.481). Patients with diabetes mellitus can therefore be expected to enjoy a similar improvement in function.
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Affiliation(s)
- P J Jenkins
- Queen Margaret Hospital, Whitefield Road, Dunfermline KY12 0SU, UK.
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Redmond CL, Bain GI, Laslett LL, McNeil JD. Deteriorating tactile sensation in patients with hand syndromes associated with diabetes: a two-year observational study. J Diabetes Complications 2012; 26:313-8. [PMID: 22658410 DOI: 10.1016/j.jdiacomp.2012.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/23/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
Abstract
AIMS To observe the natural history of hand function during a two-year period in participants with hand syndromes associated with diabetes and to determine factors related to changing function. METHODS Hand function was measured over three annual visits using Disability of the Arm, Shoulder and Hand (DASH) and SF-36v2 questionnaires, grip strength, light touch and 9-hole peg tests. Light touch was tested with WEST monofilaments at 7 sites on the hand (score 35 to 0). Data were analyzed using repeated-measures ANOVA, Spearman's correlation, and Wilcoxon signed-rank tests. RESULTS Participants (n=60) were aged 61 ± 10.5 years, 57% female, diagnosed with diabetes and at least one of four associated hand disorders. Presentations of carpal tunnel syndrome, or past release (n=27, 45%) and trigger finger (n=24, 40%) were common. Tactile sensation was reduced during the two-year period (median, range; 30 months, 25-40 months). Initial median (inter-quartile range) scores for the dominant hand of 25.5 (22-28.5) were reduced to 23 (21.5-27). This sensory loss was weakly associated with HbA1c (r=0.30, p=0.05) and occurred predominantly in participants with trigger finger (p=0.05). CONCLUSIONS Light touch perception was reduced in longstanding diabetic hand syndromes. Tactile abnormalities that were detected by clinical examination progressed during a two year period and were related to metabolic control and musculoskeletal diagnosis.
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Affiliation(s)
- Christine L Redmond
- University of Adelaide, Discipline of Medicine, Modbury Hospital, Smart Road, Modbury, 5092, Australia.
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Abstract
AIM To evaluate vibration perception thresholds of patients with and without diabetes, before and after surgical carpal tunnel release. METHODS In a prospective study, 35 consecutive patients with diabetes and carpal tunnel syndrome were age and gender matched with 31 patients without diabetes having idiopathic carpal tunnel syndrome. Preoperatively, 6, 12 and 52 weeks after surgery, the vibration perception threshold of the index and little finger (median and ulnar nerve, respectively) was measured at seven different frequencies (8, 16, 32, 64, 125, 250 and 500 Hz). RESULTS At several frequencies, patients with diabetes and carpal tunnel syndrome demonstrated significantly impaired vibration perception thresholds of both the index and the little finger, before as well as after carpal tunnel release, compared with patients without diabetes with idiopathic carpal tunnel syndrome. After surgery, the overall sensibility index improved for the index finger [patients with diabetes and carpal tunnel syndrome (0.79 to 0.91, P < 0.001), patients without diabetes with idiopathic carpal tunnel syndrome (0.91 to 0.96, P > 0.05)] as well as for the little finger [patients with diabetes and carpal tunnel syndrome (0.82 to 0.90, P < 0.008), patients without diabetes with idiopathic carpal tunnel syndrome (0.95 to 0.99, P < 0.05)]. For the index finger, the sensibility index improved to a significantly higher degree for patients with diabetes and carpal tunnel syndrome not having signs of peripheral neuropathy (0.83 to 0.95, P < 0.001) compared with those with neuropathy (0.74 to 0.84, P < 0.02). Vibration perception threshold correlates with age of both patients with diabetes and carpal tunnel syndrome and patients without diabetes with idiopathic carpal tunnel syndrome, while no relationship was found based on duration of diabetes. CONCLUSIONS Vibrotactile sense is significantly impaired in patients with diabetes before and after carpal tunnel release compared with patients without diabetes. However, patients with diabetes obtained significant recovery of vibration perception threshold, particularly those without peripheral neuropathy.
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Affiliation(s)
- N O B Thomsen
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
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Cederlund RI, Ramel E, Rosberg HE, Dahlin LB. Outcome and clinical changes in patients 3, 6, 12 months after a severe or major hand injury--can sense of coherence be an indicator for rehabilitation focus? BMC Musculoskelet Disord 2010; 11:286. [PMID: 21176232 PMCID: PMC3022903 DOI: 10.1186/1471-2474-11-286] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 12/22/2010] [Indexed: 11/14/2022] Open
Abstract
Background Our objective was to explore outcome and clinical changes in hand function, satisfaction in daily occupations, sleep disturbances, health and quality of life in consecutive patients after a severe or major hand injury. Our objective was also to investigate possible differences between groups according to severity of injury, presence of peripheral nerve injury and the patients' sense of coherence. Methods A postal questionnaire, including demographic data, disabilities of the arm, shoulder and hand (DASH), QoL (SF-36), EuroQol (EQ-5D VAS), hand function (VAS), satisfaction in daily occupation (SDO), was sent out 3, 6 and 12 months after injury to 45 consecutive patients with a severe or major hand injury. Sense of coherence (SOC) was evaluated at 6 months. For the descriptive study, non-parametric tests were used since almost all results were measured with ordinal scales, the study sample was small, and most variables not normally distributed. Results Almost all self-assessed aspects of hand function, satisfaction in daily occupations, health (DASH), and physical QoL (SF-36) improved statistically for the whole group over time. Large clinical improvement was seen for physical QoL and health, while a low or no improvement was observed for mental QoL, and cold sensitivity. Few differences were found between participants with a severe or major of hand injury or with or without a major nerve injury. No significant differences in demographic data were observed between participants with high or low SOC, but participants with low SOC showed significantly lower satisfaction in daily occupations, higher DASH scores, lower mental QoL, more sleep disturbances, and bodily pain. Correlation was found between SOC, and QoL, health and satisfaction in daily occupations. Conclusions SOC had a significant influence on patients with a severe or major traumatic hand injury. Patients with lower SOC would probably benefit from extra support and help to master their daily life, indicating that sense of coherence is an indicator for future rehabilitation focus.
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Affiliation(s)
- Ragnhild I Cederlund
- Division of Occupational Therapy and Gerontology, Department of Health Sciences, Lund University, Lund, Sweden.
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