1
|
Westenberg RF, DiGiovanni PL, Schep NWL, Eberlin KR, Chen NC, Coert JH. Does Revision Carpal Tunnel Release Result in Long-Term Outcomes Equivalent to Single Carpal Tunnel Release? A Matched Case-Control Analysis. Plast Reconstr Surg 2024; 153:746e-757e. [PMID: 37189245 DOI: 10.1097/prs.0000000000010682] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND The aims of this study were to evaluate long-term patient-reported outcomes after revision carpal tunnel release (CTR); compare these outcomes with those of patients who had a single CTR and a comparable age, sex, race, type of initial surgery, and follow-up time; and assess which factors are associated with worse patient-reported outcomes after revision CTR. METHODS The authors retrospectively identified 7351 patients who had a single CTR and 113 patients who had a revision CTR for carpal tunnel syndrome between January of 2002 and December of 2015 at five academic urban hospitals. Of these 113 revision CTR cases, 37 patients completed a follow-up questionnaire including the Boston Carpal Tunnel Questionnaire (BCTQ), the Numerical Rating Scale for Pain Intensity, and satisfaction score. Those who completed the follow-up questionnaire were randomly matched to five controls (patients who had a single CTR) based on age, sex, race, type of initial surgery, and follow-up time. Of these 185 matched controls, 65 completed the follow-up questionnaire. RESULTS A linear mixed effects model using matched sets as a random effect showed that patients who had a revision CTR had a higher total BCTQ score, Numerical Rating Scale for Pain Intensity score, and a lower satisfaction score at time of follow-up than patients who had a single CTR. Multivariable linear regression showed that thenar muscle atrophy before the revision surgery was independently associated with more pain after revision surgery. CONCLUSION Patients improve after revision CTR, but generally have more pain, have a higher BCTQ score, and are less satisfied at long-term follow-up compared with patients who had a single CTR.
Collapse
Affiliation(s)
- Ritsaart F Westenberg
- From the Massachusetts General Hospital
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht
| | | | | | | | | | - J Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht
| |
Collapse
|
2
|
Saggar SK, Thaman RG, Mohan G, Kumar D. Mapping Neurophysiological Patterns in Carpal Tunnel Syndrome: Correlations With Tinel's and Phalen's Signs. Cureus 2024; 16:e58168. [PMID: 38741883 PMCID: PMC11089430 DOI: 10.7759/cureus.58168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/16/2024] Open
Abstract
Background This study aimed to observe the neurophysiological severity grading of carpel tunnel syndrome (CTS) using nerve conduction studies (NCSs) and the correlation between Tinel's and Phalen's signs. Methodology In this cross-sectional study, 240 patients of CTS were enrolled. NCSs were conducted in 480 hands. Various variables such as distal latency, amplitude, and nerve conduction velocity in both sensory and motor median nerves were recorded. The provocative tests capable of reproducing patients' symptoms such as Phalen's test and Tinel's test were performed on all 480 hands studied. Results Neurophysiological variables were affected in 449 out of 480 hands. Tinel's sign was observed in 59% of cases (265 hands) while Phalen's sign was positive in 37.2% (167 hands) of cases. Severity grading of CTS based on neurophysiological variables resulted in Grade I (mild) in 202 hands, Grade II (mild to moderate) in 56 hands, Grade III (moderate) in 39 hands, and Grade IV (severe) in 152 hands. Provocative tests (Tinel's and Phalen's) used for the diagnosis of CTS were positive in 68 hands (36.66%) and 26 hands (12.8%), respectively, in mild Grade I. However, as the CTS severity grade increased, the provocative test success rate also increased simultaneously. In severe Grade IV CTS, Tinel's and Phalen's tests were positive in 134 (88.1%) hands and 94 (61.8%) hands, respectively. Conclusions This study underscores the unreliability of Tinel's and Phalen's signs as screening methods for CTS severity. With moderate sensitivity and specificity, NCSs are deemed essential for confirming CTS diagnosis and assessing severity, especially in mild cases that might be mistakenly perceived as normal hands by consultants.
Collapse
Affiliation(s)
- Sanjeev K Saggar
- Physiology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Richa G Thaman
- Physiology, Medical Education, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Gurinder Mohan
- General Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Dinesh Kumar
- Neurology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| |
Collapse
|
3
|
Mahmoud W, El-Naby MMH, Awad AA. Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00147-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Carpal tunnel syndrome (CTS) is known as one of the most common neurological extra-articular manifestations in rheumatoid arthritis (RA) patients. Studies on CTS in RA depend mostly on electrophysiological assessment. Few studies have used ultrasonography for evaluation of the local causes with much focus on wrist arthritis and tenosynovitis as the main cause of entrapment neuropathy of the median nerve in RA. The aim of our study is to assess the local causes of carpal tunnel syndrome in rheumatoid arthritis patients by ultrasonography and whether inflammatory or anomalous variations could affect decision-making and patient management.
Results
Carpal tunnel syndrome was diagnosed in 71 out of 74 examined RA wrists by nerve conduction studies (NCSs) and was categorized from minimal to severe according to Padua et al.’s (Ital J Neurol Sci 18:145–50, 1997) grading criteria. Median nerve CSA at the level of the carpal tunnel inlet and flattening ratio showed statistically significant relation with CTS severity. Bifid MN was found in 20 wrists (10 mild CTS wrists and 10 moderate CTS wrists), a persistent median artery was found in 4 wrists with moderate CTS, and an accessory muscle bundle was present in 3 wrists (2 mild CTS and 1 moderate CTS). The majority of the examined hands (85.1%) showed flexor tendon tenosynovitis at the wrist level and radio-carpal joint synovitis. The US7-joint score using GSUS7 & PDUS7 for synovitis, tenosynovitis and erosions showed significant relation with patients’ disease activity by DAS28 score. Significant relations between CTS severity and the following nerve conduction studies’ parameters, median nerve distal motor latency (DML), motor/sensory NCV, peak sensory latency, amplitude of SNAP, and median-radial latency difference test, were observed.
Conclusion
Synovial inflammation and local causes of median nerve compression such as bifid median nerve, persistent median artery, and accessory muscle bundle are collectively contributing factors in the etiology of carpal tunnel syndrome in rheumatoid arthritis patients. Ultrasonographic visualization of these inflammatory and anomalous variations enables early detection of CTS and highlights the possibility of non-arthritic-related causes. Using the 7-joint ultrasound (US7) score for assessment of synovitis, tenosynovitis, and erosions in rheumatoid arthritis patients is of valuable role in reflecting inflammation and its relation to the development of CTS in RA patients.
Collapse
|
4
|
Ratasvuori M, Sormaala M, Kinnunen A, Lindfors N. Ultrasonography for the diagnosis of carpal tunnel syndrome: correlation of clinical symptoms, cross-sectional areas and electroneuromyography. J Hand Surg Eur Vol 2022; 47:369-374. [PMID: 34812067 DOI: 10.1177/17531934211059808] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study evaluates the usefulness of ultrasonography in diagnosing carpal tunnel syndrome (CTS). The cross-sectional area of the median nerve was measured at the forearm and its entry into the carpal tunnel and compared with clinical symptoms and electroneuromyography. A total of 124 patients were examined, 77 patients with clinically confirmed CTS and 47 controls. A significant correlation was found between the ultrasonography cross-sectional area values at entry points into the carpal tunnel and electroneuromyography. The highest sensitivity (87%) and specificity (91%) for different cut-off values (8.5-12.5 mm2) of the cross-sectional area was for 11.5 mm2. The use of ultrasonography may provide a quick and reliable differential diagnostic tool for the primary diagnosis of CTS in patients with classical symptoms.Level of evidence: II.
Collapse
Affiliation(s)
- Maire Ratasvuori
- Department of Musculoskeletal and Plastic Surgery, Töölö Hospital, Helsinki, Finland
| | - Markus Sormaala
- Department of Radiology, HUS Helsinki Medical Imaging Center, Helsinki, Finland
| | | | - Nina Lindfors
- Department of Musculoskeletal and Plastic Surgery, Töölö Hospital, Helsinki, Finland
| |
Collapse
|
5
|
Hamzeh H, Madi M, Alghwiri AA, Hawamdeh Z. The long-term effect of neurodynamics vs exercise therapy on pain and function in people with carpal tunnel syndrome: A randomized parallel-group clinical trial. J Hand Ther 2021; 34:521-530. [PMID: 32893098 DOI: 10.1016/j.jht.2020.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/03/2020] [Accepted: 07/22/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Carpal tunnel syndrome (CTS) is a common disorder that limits function and quality of life. Little evidence is available on the long-term effect of neurodynamics and exercise therapy. PURPOSE OF THE STUDY This study aimed to examine the long-term effect of neurodynamic techniques vs exercise therapy in managing patients with CTS. STUDY DESIGN Parallel group randomized clinical trial. METHODS Of 57 patients screened, 51 were randomly assigned to either receiving four sessions of neurodynamics and exercise or home exercise therapy alone as a control. Blinded assessment was performed before treatment allocation, at treatment completion, and 6 months posttreatment. Outcome measures included Symptom Severity Scale (SSS), Functional Status Scale (FSS), Shortened version of the Disabilities of the Arm, Shoulder, and Hand (DASH), Numerical Pain Rating Scale, grip strength and range of motion. RESULTS Data from 41 individuals (52 hands) were analyzed. The neurodynamics group demonstrated significant improvement in all outcome measures at 1 and 6 months (P < .05). Mean difference in SSS was 1.4 (95% CI= 0.9-1.4) at 1 month and 1.6 (95% CI = 0.9-2.2) at 6 months. Mean difference in FSS was 0.9 (95% CI = 0.4-1.4) at 1 month and 1.4 (95% CI = 0.7-2.0) at 6 months. Significant between-group differences were found in pain score at 1 month (-1.93) and in FSS (-0.5) and Shortened version of DASH (-12.6) at 6 months (P < .05). No patient needed surgery 1 year after treatment. CONCLUSIONS Although both treatments led to positive outcomes, neurodynamics therapy was superior in improving function and strength and in decreasing pain.
Collapse
Affiliation(s)
- Hayat Hamzeh
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan.
| | - Mohammad Madi
- Department of Physiotherapy and Occupational Therapy, The Hashemite University, Zarqa, Jordan
| | - Alia A Alghwiri
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Ziad Hawamdeh
- Department of Special Surgery, Orthopaedic and Rehabilitation Medicine Section, School of Medicine, The University of Jordan, Amman, Jordan
| |
Collapse
|
6
|
Küçük EB, Taşkıran ÖÖ. Evaluation of Duruöz Hand Index in diagnosis and staging of Carpal tunnel syndrome. J Clin Neurosci 2020; 82:111-114. [PMID: 33317717 DOI: 10.1016/j.jocn.2020.10.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/27/2020] [Accepted: 10/18/2020] [Indexed: 11/30/2022]
Abstract
Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the upper limb. In this cross-sectional study our aim is to investigate the value of Duruöz Hand Index (DHI) in diagnosis and staging of CTS patients and comparing it with Boston Carpal Tunnel Questionnaire (BQ) and provocative tests. Among 423 patients who were referred to the EMG laboratory at the physical medicine and rehabilitation unit with the symptoms of CTS, 294 patients were included in the study. Patients' demographic data, weight, height, body mass index (BMI) measurements, physical examinations, Tinel and Phalen provocative test results, visual analog scale for pain, DHI and BQ scores were recorded. Electrophysiological examinations were also performed. The mean age was 45.1 ± 11.6 years and 254 (86.4%) patients were women. Based on the results of EMG, 120 (40.8%) patients were found negative for CTS, 57 (19.4%) patients had mild CTS, 89 (30.3%) patients had moderate CTS and 28 (9.5%) patients had severe CTS. Among the parameters evaluated, DHI scores were found to be significantly higher in the severe CTS group. DHI (r: 0.306, p < 0.001) and Boston functional status scale (FSS) (r: 0.257p = 0.001) were found to be correlated with CTS severity. Tinel positivity (OR: 2.36, p: 0.01), Phalen positivity (OR: 2.22, p: 0.02), Boston symptom severity scale (SSS) scores (OR: 1.76, p: 0.024), increasing age (OR: 1.06, p < 0.001) and increased BMI (OR: 1.07, p: 0.03) were found to be associated with increased likelihood of CTS diagnosis. In conclusion, DHI was found to be correlated with CTS severity similar to Boston FSS.
Collapse
Affiliation(s)
- Esin Benli Küçük
- Physical Theraphy and Rehabilitation Department, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey.
| | - Özden Özyemişçi Taşkıran
- Physical Theraphy and Rehabilitation Department, Koç University School of Medicine, İstanbul, Turkey
| |
Collapse
|
7
|
Sartorio F, Dal Negro F, Bravini E, Ferriero G, Corna S, Invernizzi M, Vercelli S. Relationship between nerve conduction studies and the Functional Dexterity Test in workers with carpal tunnel syndrome. BMC Musculoskelet Disord 2020; 21:679. [PMID: 33054739 PMCID: PMC7558696 DOI: 10.1186/s12891-020-03651-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background Dexterity impairments caused by carpal tunnel syndrome (CTS) make working and daily activities challenging. We aimed to investigate: i) the relationship between dexterity and nerve conduction studies (NCS) in workers with classic symptoms presentation; ii) the ability of the Functional Dexterity Test (FDT) to discriminate different levels of CTS severity as classified by NCS; iii) the diagnostic accuracy of a clinical battery composed of the FDT, Phalen’s test and Tinel’s sign. Methods In a convenience sample of individuals diagnosed with CTS, we correlated FDT net scores with the NCS-based classification by means of Spearman’s (rho) test. Discriminative ability of the FDT was assessed by ANOVA, and a ROC curve determined cutoff thresholds. Sensitivity, specificity, and likelihood ratios (LRs) were used to investigate the diagnostic accuracy of the clinical battery. Results Data from 180 hands were collected. The FDT was significantly correlated (rho = 0.25, p < 0.001) with NCS. The FDT was able to discriminate subjects with severe/extreme NCS findings, and two thresholds (0.29–0.36) were identified. Adding the FDT to the provocative tests improved the overall diagnostic accuracy (specificity: 0.97, CI95% 0.83–0.99; LR+: 14.49, CI95% 2.09–100.53). Conclusions Sensorimotor impairments related to CTS can affect hand dexterity. The FDT discriminated patients with severe NCS involvement. Positive results on the clinical battery (Phalen, Tinel, and FDT) could help to confirm the CTS diagnosis, showing a very high specificity and LR+. On the contrary, the low sensitivity is not able to rule out CTS in individuals with negative results.
Collapse
Affiliation(s)
- Francesco Sartorio
- Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Gattico-Veruno (NO), Italy
| | - Francesca Dal Negro
- Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Gattico-Veruno (NO), Italy
| | | | - Giorgio Ferriero
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Tradate (VA), Via Maugeri 4, I-27100, Pavia, Italy.
| | - Stefano Corna
- Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Gattico-Veruno (NO), Italy
| | - Marco Invernizzi
- Physical and Rehabilitation Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Stefano Vercelli
- Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Gattico-Veruno (NO), Italy
| |
Collapse
|
8
|
Affiliation(s)
- Inge Petter Kleggetveit
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital-Rikshospitalet, P.b. 4950 Nydalen, 0424 Oslo, Norway
| | - Ellen Jørum
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| |
Collapse
|