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Dagtas MZ, Unal OK. Long-Term Outcome of Electrodiagnostic Values and Symptom Improvement After Carpal Tunnel Release: A Retrospective Cohort Study. J Hand Surg Am 2022; 47:727-735. [PMID: 35717419 DOI: 10.1016/j.jhsa.2022.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 03/04/2022] [Accepted: 04/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to evaluate electrodiagnostic studies and clinical outcomes after carpal tunnel release surgery in moderate and severe cases of carpal tunnel syndrome (CTS). METHODS Seventy-two patients with moderate or severe CTS who underwent carpal tunnel release surgery (46 unilateral; 26 bilateral; total, 98 surgeries) between 2009 and 2014 were included in the study. The cases were divided into 2 groups according to electrodiagnostic results: those with moderate CTS and those with severe CTS. Michigan Hand Outcomes Questionnaire scores and electrodiagnostic data (sensory nerve action potentials and compound muscle action potentials) were recorded before surgery and in postoperative follow-up studies obtained at 3 months, 1 year, and 5 years. RESULTS There were 56 surgeries in the moderate CTS group and 42 surgeries in the severe CTS group. Sensory nerve action potentials and compound muscle action potentials were significantly lower in the severe CTS group when compared to the moderate CTS group at all follow-up times. There was a significant difference in Michigan Hand Outcomes Questionnaire scores between the groups before surgery, but no significant differences at the final follow-up. It was found that the values of all parameters (sensory nerve action potentials, compound muscle action potentials, and Michigan Hand Outcomes Questionnaire score) demonstrated significant improvements with time in both the severe and the moderate CTS groups. CONCLUSIONS Carpal tunnel release surgery improves symptoms, regardless of the preoperative severity. Postoperative electrodiagnostic study results of patients with moderate CTS improve to a greater degree than those of patients with severe CTS, but all remain abnormal. TYPE OF STUDY/LEVEL OF EVIDENCE Prognosis IIb.
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Affiliation(s)
- Mirza Zafer Dagtas
- Department of Orthopedics and Traumatology, Maltepe University, Istanbul, Turkey.
| | - Omer Kays Unal
- Department of Orthopedics and Traumatology, Maltepe University, Istanbul, Turkey
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Ly-Pen D, Andreu JL, de Blas G, Sánchez-Olaso A, Millán I. Response to local corticosteroid injections in carpal tunnel syndrome with normal conduction studies. REUMATOLOGIA CLINICA 2022; 18:393-398. [PMID: 35940672 DOI: 10.1016/j.reumae.2021.04.012] [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: 02/18/2021] [Accepted: 04/19/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Nerve conduction studies (NCS) have been considered as the gold standard in carpal tunnel syndrome (CTS) diagnosis, despite correlation between clinical symptomatology and NCS severity has shown to be poor. In fact, clinical symptoms precede NCS changes in months or years. Few papers have been published about the clinical response to treatment of clinically typical CTS, but with normal NCS (NNCS). OBJECTIVE To compare the clinical response to local corticosteroid injections (LCI) in clinically typical CTS, with NNCS and abnormal NCS (ANCS). METHOD We included patients older than 18, with typical CTS symptoms (ongoing daily nocturnal pain/paresthesias in hand, at least during 3 months). Follow-up was done at 3, 6 and 12 months. Primary outcome was the visual analog scale for pain (p-VAS), comparing NNCS CTS wrists with ANCS CTS wrists. Statistic signification was established by the Student's t test, Mann-Whitney's "U", χ2 test and Yates' correction. RESULTS We included 44 wrists in the NNCS group, and 83 in the ANCS group. There was no statistical significance between data in both groups, except in the 12-month follow-up, where the NNCS group achieved better results than the ANCS group in the 20% response (p=0.006). There was a trend toward a better 50% response in the 12-month follow-up. CONCLUSIONS Our data suggest that LCI are similarly effective in both CTS with NNCS and ANCS. Nonetheless, there is a mild better effect in NNCS than in ANCS at 12-month follow-up.
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Affiliation(s)
- Domingo Ly-Pen
- Abbey House Medical Centre, Navan, Co Meath C15 D290, Ireland.
| | - José-Luis Andreu
- Rheumatology Department, University Hospital Puerta de Hierro Majadahonda, Madrid 28222, Spain
| | - Gema de Blas
- Neurophysiology Department, University Hospital Ramón y Cajal, Madrid 28034, Spain
| | | | - Isabel Millán
- Biostatistics Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid 28222, Spain
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Zimmerman M, Gottsäter A, Dahlin LB. Carpal Tunnel Syndrome and Diabetes—A Comprehensive Review. J Clin Med 2022; 11:jcm11061674. [PMID: 35329999 PMCID: PMC8952414 DOI: 10.3390/jcm11061674] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is the most common compression neuropathy in the general population and is frequently encountered among individuals with type 1 and 2 diabetes. The reason(s) why a peripheral nerve trunk in individuals with diabetes is more susceptible to nerve compression is still not completely clarified, but both biochemical and structural changes in the peripheral nerve are probably implicated. In particular, individuals with neuropathy, irrespective of aetiology, have a higher risk of peripheral nerve compression disorders, as reflected among individuals with diabetic neuropathy. Diagnosis of CTS in individuals with diabetes should be carefully evaluated; detailed case history, thorough clinical examination, and electrophysiological examination is recommended. Individuals with diabetes and CTS benefit from surgery to the same extent as otherwise healthy individuals with CTS. In the present review, we describe pathophysiological aspects of the nerve compression disorder CTS in relation to diabetes, current data contributing to the explanation of the increased risk for CTS in individuals with diabetes, as well as diagnostic methods, treatment options, and prognosis of CTS in diabetes.
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Affiliation(s)
- Malin Zimmerman
- Department of Hand Surgery, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden;
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden
- Department of Orthopaedic Surgery, Helsingborg Hospital, 251 87 Helsingborg, Sweden
- Correspondence:
| | - Anders Gottsäter
- Department of Medicine, Skåne University Hospital, 205 02 Malmö, Sweden;
- Department of Clinical Sciences Malmö, Lund University, 205 02 Malmö, Sweden
| | - Lars B. Dahlin
- Department of Hand Surgery, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden;
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
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Shen YP, Li TY, Chou YC, Chen LC, Wu YT. Outcome predictors of platelet-rich plasma injection for moderate carpal tunnel syndrome. Int J Clin Pract 2021; 75:e14482. [PMID: 34107143 DOI: 10.1111/ijcp.14482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/28/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Platelet-rich plasma (PRP) injection is effective for mild-to-moderate carpal tunnel syndrome (CTS), and physicians have been using PRP injections to treat CTS. However, the predictive factors of PRP injections have not been evaluated. This retrospective study sought to identify the predictive factors of PRP injections in patients with moderate CTS. METHODS Seventy-one patients with moderate CTS receiving single PRP injections were enrolled. The outcomes at the third- and sixth-month postinjection visits were categorised into good and poor groups according to the following: (1) good outcome, with visual analogue scale (VAS) score decrease ≧50% and (2) poor outcome, with VAS score decrease <50% of preinjection scores. Significant variables between groups were entered into a binary logistic regression to determine the predictive factors. RESULTS The baseline body weight (BW), distal motor latency (DML), sensory nerve conduction velocity (SNCV), and cross-sectional area (CSA) of the median nerve were significantly different between the groups in the third month. The odds ratios (ORs) of all features were significant, except for SNCV (BW, OR: 0.911; P = .016; DML, OR: 0.383; P = .028; CSA, OR: 0.694; P = .003), and they remained significant in the sixth month (BW, OR: 0.909; P = .004; DML, OR: 0.530; P = .011; CSA, OR: 0.828; P = .032). CONCLUSION Lower BW, DML, and CSA values of the median nerve predict better outcomes after perineural injection of PRP for moderate CTS at the 3- and 6-month follow-ups.
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Affiliation(s)
- Yu-Ping Shen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Osiak K, Mazurek A, Pękala P, Koziej M, Walocha JA, Pasternak A. Electrodiagnostic Studies in the Surgical Treatment of Carpal Tunnel Syndrome-A Systematic Review. J Clin Med 2021; 10:jcm10122691. [PMID: 34207345 PMCID: PMC8235020 DOI: 10.3390/jcm10122691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 01/11/2023] Open
Abstract
The aim of our paper was to provide comprehensive data on the role of electrodiagnostic (EDX) studies in the surgical treatment of carpal tunnel syndrome (CTS). An extensive search was conducted through the major electronic database to identify eligible articles. Data extracted included grade of CTS based on neurophysiological testing, preoperative data of EDX studies, time of complete or partial resolution after surgery, postoperative Boston carpal tunnel questionnaire (CTQ) scores, age, sex, intraoperative and postoperative data of EDX studies, time to complete or partial resolution of symptoms, and number of patients without postsurgical improvement. Our main findings revealed that that electrodiagnostic testing is still a powerful tool for diagnosis of CTS. Moreover, it can also detect other pathologies. EDX testing provides a quantitative measure of the physiological function of the median nerve, which may be used to guide surgical treatment. Thirdly, when the outcome of surgery is unsatisfactory, NCS can assist in determining the reason for failure.
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Affiliation(s)
- Katarzyna Osiak
- Medical Centre for Postgraduate Education, Department of Plastic Surgery, Professor W. Orlowski Memorial Hospital, 231st Czerniakowska Street, 00-416 Warsaw, Poland;
| | - Agata Mazurek
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
| | - Przemysław Pękala
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
| | - Jerzy A. Walocha
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
| | - Artur Pasternak
- Medical Centre for Postgraduate Education, Department of Plastic Surgery, Professor W. Orlowski Memorial Hospital, 231st Czerniakowska Street, 00-416 Warsaw, Poland;
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
- Correspondence: ; Tel./Fax: +48-12-422-95-11
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Ly-Pen D, Andreu JL, de Blas G, Sánchez-Olaso A, Millán I. Response to Local Corticosteroid Injections in Carpal Tunnel Syndrome With Normal Conduction Studies. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00134-0. [PMID: 34147354 DOI: 10.1016/j.reuma.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/02/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Nerve conduction studies (NCS) have been considered as the gold standard in carpal tunnel syndrome (CTS) diagnosis, despite correlation between clinical symptomatology and NCS severity has shown to be poor. In fact, clinical symptoms precede NCS changes in months or years. Few papers have been published about the clinical response to treatment of clinically typical CTS, but with normal NCS (NNCS). OBJECTIVE To compare the clinical response to local corticosteroid injections (LCI) in clinically typical CTS, with NNCS and abnormal NCS (ANCS). METHOD We included patients older than 18, with typical CTS symptoms (ongoing daily nocturnal pain/paresthesias in hand, at least during 3 months). Follow-up was done at 3, 6 and 12 months. Primary outcome was the visual analog scale for pain (p-VAS), comparing NNCS CTS wrists with ANCS CTS wrists. Statistic signification was established by the Student's t test, Mann-Whitney's "U", χ2 test and Yates' correction. RESULTS We included 44 wrists in the NNCS group, and 83 in the ANCS group. There was no statistical significance between data in both groups, except in the 12-month follow-up, where the NNCS group achieved better results than the ANCS group in the 20% response (p=0.006). There was a trend toward a better 50% response in the 12-month follow-up. CONCLUSIONS Our data suggest that LCI are similarly effective in both CTS with NNCS and ANCS. Nonetheless, there is a mild better effect in NNCS than in ANCS at 12-month follow-up.
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Affiliation(s)
- Domingo Ly-Pen
- Abbey House Medical Centre, Navan, Co Meath C15 D290, Ireland.
| | - José-Luis Andreu
- Rheumatology Department, University Hospital Puerta de Hierro Majadahonda, Madrid 28222, Spain
| | - Gema de Blas
- Neurophysiology Department, University Hospital Ramón y Cajal, Madrid 28034, Spain
| | | | - Isabel Millán
- Biostatistics Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid 28222, Spain
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Afshar A, Tabrizi A, Tajbakhsh M, Navaeifar N. Subjective Outcomes of Carpal Tunnel Release in Patients with Diabetes and Patients without Diabetes. J Hand Microsurg 2020; 12:183-188. [PMID: 33408444 PMCID: PMC7773498 DOI: 10.1055/s-0039-1697059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction This study aims to compare the subjective outcomes of carpal tunnel surgery in the patients with diabetes and patients without diabetes, and it tries to determine the difference between insulin-dependent and noninsulin-dependent patients. Materials and Methods This retrospective cohort study compares subjective outcomes of 35 patients with type 2 diabetes and 35 patients without diabetes who had a unilateral carpal tunnel release. None of the patients with diabetes had neuropathy. All the patients had surgery by a single surgeon with miniopen incision under local anesthesia. The patients were evaluated before surgery and 6 months after surgery using two Brigham and Women's Carpal Tunnel Questionnaires Results Carpal tunnel release was improved based on symptom severity scale (SSS) and functional status scale scores in patients with diabetes and nondiabetic patients. However, the mean SSS scores were higher in patients without diabetes 6 months after the surgery. Comparison between the mean SSS scores of the patients with diabetes showed higher scores in noninsulin-dependent patients. In patients with diabetes, SSS scores were positively correlated with carpal tunnel syndrome and diabetes durations. Conclusion The outcomes of carpal tunnel release were improved in both patients with diabetes and patients without diabetes suffering from median nerve compression at the wrist. However, the duration of diabetes and its treatment can be related to the severity of the disease symptoms after the carpal tunnel releasing surgeries. In some diabetic patients, the severity of the symptoms was persistent. Level of Evidence This is a prognostic level IV study.
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Affiliation(s)
- Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Tabrizi
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Mojtaba Tajbakhsh
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Nasrin Navaeifar
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
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Zimmerman M, Eeg-Olofsson K, Svensson AM, Åström M, Arner M, Dahlin L. Open carpal tunnel release and diabetes: a retrospective study using PROMs and national quality registries. BMJ Open 2019; 9:e030179. [PMID: 31488486 PMCID: PMC6731852 DOI: 10.1136/bmjopen-2019-030179] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/31/2019] [Accepted: 08/16/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To study patient-reported outcome after open carpal tunnel release (OCTR) for carpal tunnel syndrome (CTS) in patients with or without diabetes using national healthcare quality registries. DESIGN Retrospective cohort study. SETTING Data from the Swedish National Quality Registry for Hand Surgery (HAKIR; www.hakir.se) were linked to data from the Swedish National Diabetes Register (NDR; www.ndr.nu). PARTICIPANTS We identified 9049 patients (10 770 hands) operated for CTS during the inclusion period (2010-2016). PRIMARY OUTCOME MEASURES Patient-reported outcome measures were analysed before surgery and at 3 and 12 months postoperatively using the QuickDASH as well as the HAKIR questionnaire with eight questions on hand symptoms and disability. RESULTS Patients with diabetes (n=1508; 14%) scored higher in the QuickDASH both preoperatively and postoperatively than patients without diabetes, but the total score change between preoperative and postoperative QuickDASH was equal between patients with and without diabetes. The results did not differ between patients with type 1 or type 2 diabetes. Patients with diabetic retinopathy scored higher in QuickDASH at 3 months postoperatively than patients with diabetes without retinopathy. In the regression analysis, diabetes was associated with more residual symptoms at 3 and 12 months postoperatively. CONCLUSIONS Patients with diabetes experience more symptoms both before and after OCTR, but can expect the same relative improvement from surgery as patients without diabetes . Patients with retinopathy, as a proxy for neuropathy, may need longer time for symptoms to resolve after OCTR. Smoking, older age, higher HbA1c levels and receiving a diabetes diagnosis after surgery were associated with more residual symptoms following OCTR.
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Affiliation(s)
- Malin Zimmerman
- Department of Translational Medicine - Hand Surgery, Lund University, Lund, Sweden
- Department of Hand Surgery, Skånes universitetssjukhus Malmö, Malmo, Sweden
| | - Katarina Eeg-Olofsson
- Department of Medicine, University of Gothenburg, Göteborg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Ann-Marie Svensson
- National Diabetes Register, Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - Mikael Åström
- Department of Data Analytics and Register Centre, Region Skåne Hälso- och sjukvård, Lund, Sweden
| | - Marianne Arner
- HAKIR, National Registry for Hand Surgery, Stockholm South General Hospital, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Lars Dahlin
- Department of Translational Medicine - Hand Surgery, Lund University, Lund, Sweden
- Department of Hand Surgery, Skånes universitetssjukhus Malmö, Malmo, Sweden
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Better Patient-Reported Experiences with Health Care Are Associated with Improved Clinical Outcome after Carpal Tunnel Release Surgery. Plast Reconstr Surg 2019; 143:1677-1684. [DOI: 10.1097/prs.0000000000005516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Bowman A, Rudolfer S, Weller P, Bland JDP. A prognostic model for the patient-reported outcome of surgical treatment of carpal tunnel syndrome. Muscle Nerve 2018; 58:784-789. [PMID: 29981160 DOI: 10.1002/mus.26297] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Many prognostic factors have been studied in carpal tunnel decompression, but most studies consider only a subset of variables. METHODS Three thousand three hundred thirty-two operations were used to develop prognostic models, and 885 operations were used for validation. Outcome recorded on a Likert scale was dichotomized into success or failure. Modeling was performed with both logistic regression and artificial neural networks using 87 candidate variables. RESULTS Both approaches produced predictive multivariate models for outcome with areas under a receiver operating characteristic curve of 0.7 in the validation data set. Patients with moderately severe nerve conduction abnormalities, night waking, a family history of carpal tunnel syndrome, a good response to corticosteroid injection, and women have better outcomes. Greater functional impairment, diabetes, hypertension, and surgery on the dominant hand are associated with poorer outcomes. DISCUSSION A multivariate model partially predicts the outcome of carpal tunnel surgery, aids decision making, and helps to manage patient expectations. Muscle Nerve 58:784-789, 2018.
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Affiliation(s)
- Angela Bowman
- Department of Health Informatics, Norfolk and Suffolk NHS Foundation Trust, Ipswich, Suffolk, United Kingdom
| | - Stephan Rudolfer
- Centre for Biostatistics, School of Health Sciences, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Peter Weller
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Jeremy D P Bland
- Department of Clinical Neurophysiology, East Kent Hospitals University NHS Foundation Trust, Ethelbert Road, Canterbury, Kent, United Kingdom, CT1 3NG
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Sonoo M, Menkes DL, Bland JD, Burke D. Nerve conduction studies and EMG in carpal tunnel syndrome: Do they add value? Clin Neurophysiol Pract 2018; 3:78-88. [PMID: 30215013 PMCID: PMC6133914 DOI: 10.1016/j.cnp.2018.02.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/28/2018] [Accepted: 02/03/2018] [Indexed: 12/31/2022] Open
Abstract
This paper summarises the views of four experts on the place of neurophysiological testing (EDX) in patients presenting with possible carpal tunnel syndrome, in guiding their treatment, and in reevaluations. This is not meant to be a position paper or a literature review, and heterogeneous viewpoints are presented. Nerve conduction studies should be performed in patients presenting with possible carpal tunnel syndrome to assist diagnosis, and may need to be repeated at intervals in those managed conservatively. There is evidence that local corticosteroid injection is safe and effective for many patients, thereby avoiding or deferring surgical decompression. All patients should undergo EDX studies before any invasive procedure for CTS (injection or surgery). Needle EMG studies are not obligatory, but may be needed in those with severe disease and those in whom an alternate or concomitant diagnosis is suspected.
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Affiliation(s)
- Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo 1738605, Japan
| | - Daniel L. Menkes
- Department of Neurology, Beaumont Health, Beaumont Neuroscience Building, Royal Oak, MI 48073, United States
| | - Jeremy D.P. Bland
- East Kent Hospitals University NHS Foundation Trust, Ethelbert Road, Canterbury, Kent, UK
| | - David Burke
- Department of Neurology, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
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