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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.
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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
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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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Izmalkov SN, Semenkin OM, Bratiichuk AN. Carpal tunnel syndrome: Does preoperative disease severity influence the outcome of mini-open surgery? HAND SURGERY & REHABILITATION 2022; 41:470-476. [PMID: 35513243 DOI: 10.1016/j.hansur.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 10/18/2022]
Abstract
In the practice of carpal tunnel surgery, open decompression of the median nerve in carpal tunnel syndrome (CTS) is recognized as the therapeutic priority. However, the speed and completeness of postoperative recovery of sensitivity and function depend on the initial clinical manifestations of the disease and the severity of the electrophysiological disorder. The aim of this study was to investigate the influence of preoperative clinical and electrophysiological factors on the outcome of surgical treatment of patients with CTS of varying severity. One-hundred and eighty-nine open decompressions of the median nerve via a mini-open incision were performed in 161 patients with idiopathic CTS. Clinical observations were classified in 5 groups, according to severity. Treatment results were evaluated per group at 6 weeks and 3, 6 and 12 months after surgery. In all cases, there was improvement and positive dynamics according to clinical and electroneuromyographic data. Open decompression of the median nerve via mini-open incision can achieve significant clinical and functional improvement in the majority of patients with CTS. However, the most favorable results were mainly seen in patients with initial severity classified in the first, second and third (lower severity) groups.
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Affiliation(s)
- Sergey N Izmalkov
- Department of Traumatology, Orthopedics and Polyclinic Surgery, Samara State Medical University, 89 Chapayevskaya Str., 443099 Samara, Russian Federation
| | - Oleg M Semenkin
- Traumatological and Orthopedic Department, Mother & Child Samara Hospital ("IDK Hospital"), 70 Volzhskoe Highway, 443072 Samara, Russian Federation
| | - Aleksandr N Bratiichuk
- Department of Traumatology, Orthopedics and Polyclinic Surgery, Samara State Medical University, 89 Chapayevskaya Str., 443099 Samara, Russian Federation.
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Pattankar S, Roy R, Warade A, Desai K. Analysis of the Long-Term Outcome in Open Carpal Tunnel Release Surgeries with and without External Neurolysis of Median Nerve, Using Boston Carpal Tunnel Questionnaire (BCTQ)-Hindi Version. J Neurosci Rural Pract 2021; 12:470-477. [PMID: 34295100 PMCID: PMC8289532 DOI: 10.1055/s-0041-1723100] [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] [Indexed: 11/21/2022] Open
Abstract
Background
The effectiveness of open carpal tunnel release (OCTR) in treating carpal tunnel syndrome (CTS) is well known. However, the role of ancillary external neurolysis of the median nerve is not well-documented. The Boston carpal tunnel questionnaire (BCTQ) is a commonly used disease-specific outcome instrument for CTS, which is validated across major languages of the world. No such validated Hindi version of BCTQ exists.
Objectives
To analyze and compare the long-term outcome in patients who underwent OCTR alone and OCTR with external neurolysis of the median nerve, using BCTQ–Hindi version, while checking its validity.
Materials and Methods
A retrospective, cross-sectional study was conducted at a tertiary care institute. The BCTQ was translated into Hindi language by a language expert. Eighty-four consecutive patients who underwent either unilateral/bilateral OCTR, with or without external neurolysis of the median nerve, between 2009 and 2019 were included in the study. Outcome analysis was done using BCTQ–Hindi version and patient satisfaction scoring. BCTQ–Hindi version was examined for statistical validity. Subgroup analysis of the outcome based on surgical technique (OCTR vs. OCTR with external neurolysis) used was carried out.
Results
Response rate was 80.9%. Total hands evaluated were 108. BCTQ–Hindi version showed statistical validity. Overall symptom severity score (SSS) and functional severity score (FSS) were 1.14 ± 0.4 and 1.12 ± 0.35, respectively. Subgroup analysis of outcome revealed statistically significant results in favor of OCTR with external neurolysis of the median nerve.
Conclusions
BCTQ–Hindi version is statistically validated. OCTR with external neurolysis of the median nerve is a promising avenue in surgical management of CTS. Further prospective studies are warranted.
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Affiliation(s)
- Sanjeev Pattankar
- Department of Neurosurgery & Gamma Knife Radiosurgery, P D Hinduja Hospital & MRC, Mumbai, India
| | - Rohan Roy
- Department of Neurosurgery & Gamma Knife Radiosurgery, P D Hinduja Hospital & MRC, Mumbai, India
| | - Anshu Warade
- Department of Neurosurgery & Gamma Knife Radiosurgery, P D Hinduja Hospital & MRC, Mumbai, India
| | - Ketan Desai
- Department of Neurosurgery & Gamma Knife Radiosurgery, P D Hinduja Hospital & MRC, Mumbai, India
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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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Lu YT, Deol AK, Sears ED. The Association Between Electrodiagnostic Severity and Treatment Recommendations for Carpal Tunnel Syndrome. J Hand Surg Am 2021; 46:92-98. [PMID: 33131978 PMCID: PMC7864860 DOI: 10.1016/j.jhsa.2020.08.020] [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: 08/26/2019] [Revised: 06/27/2020] [Accepted: 08/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Our study aimed to evaluate the relationship between electrodiagnostic study (EDS) severity and utilization of treatments for carpal tunnel syndrome (CTS) as well as the duration of time between EDS and carpal tunnel release (CTR). METHODS We conducted a retrospective medical chart review at a single tertiary hand center to evaluate CTS-related care that patients received after EDS. We recorded patient age, sex, race/ethnicity, insurance type, CTS-related surgical and nonsurgical healthcare utilization after EDS testing, and number of days between EDS and CTR. RESULTS Among all patients with an eventual diagnosis of CTS who received EDS (n = 210), nearly half had normal or mild severity (23%, n = 48; and 28%, n = 58, respectively) and the other half had moderate or severe EDS findings (26%, n = 55; and 23%, n = 49, respectively). Patients with severe findings had the highest rate of receiving surgery (53%) compared with patients with mild and moderate findings (33% vs 46%, respectively). Among the patients who received CTR (n = 73), patients with severe EDS findings had the shortest time to CTR (59.5 days; interquartile range [IQR], 30-81), compared with mild severity (170 days; IQR, 87-415) and moderate severity (77 day; IQR, 42-292). Moderate and severe EDS findings were associated with significantly higher odds of receiving CTR in adjusted analyses (odds ratio, 2.48, 95% confidence interval, 1.04-5.93 and odds ratio 3.79, 95% confidence interval, 1.51-9.50, respectively) compared with patients with mild EDS findings. However, the odds of receiving steroid injection and hand therapy/orthosis were not significantly different based on severity. CONCLUSIONS Electrodiagnostic study severity had a direct relationship to the probability of receiving surgery but did not correlate with use of nonsurgical treatment. The study findings signal a need to evaluate the value of nonsurgical treatments in patients with severe EDS findings. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Yu-Ting Lu
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI,Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Amrit K. Deol
- Chicago Medical School, Rosalind Franklin University of Medicine and Science
| | - Erika D. Sears
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI,Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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Comparing open conventional carpal tunnel release with mini-incision technique in the treatment of carpal tunnel syndrome: A non-randomized clinical trial. Ann Med Surg (Lond) 2020; 55:119-123. [PMID: 32477509 PMCID: PMC7251294 DOI: 10.1016/j.amsu.2020.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
Background Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy which is the result of the compression of the median nerve in the wrist. Currently, there is no consensus about the best treatment option. The purpose of this clinical trial was to compare the clinical outcomes of patients undergoing open CT release with mini-incision CT release. Patients and methods This clinical trial included 75 patients with CTS who were divided into two groups of 45 and 30 patients to undergo open-CT release or mini incision CT release respectively. Patients were evaluated pre-operatively, days after the surgery and then five months after the operation to record outcomes. At follow-up, the visual analogue scale (VAS) scores for pain, patients' satisfaction, return to work, length of scar, paresthesia, grip and opposition strength were measured. Results A total of 75 patients (mean age: 52.13 years, 73.3% female) underwent CTS surgery. Forty-five patients (60%) had open-CT release and 30 patients (40%) had mini-incision CT release. Postoperative pain and scar length were significantly lower in the mini incision group compared to open group (p < 0.001). The mini-incision CT group returned to work earlier than open group with higher satisfaction (p < 0.001). No significant differences were observed between two groups in respect to the improvement of the opposition, grip and paresthesia (p > 0.05). Conclusion Our study demonstrated that mini-incision CT release improves pain more effectively and has better quality of life because of smaller length of scar, immediate return to work and higher overall satisfaction. Neurosensory and motor improvements were also seen in both techniques with the same clinical impact.
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Effectiveness of mini-open carpal tunnel release: An outcome study. Arch Plast Surg 2019; 46:350-358. [PMID: 31336424 PMCID: PMC6657193 DOI: 10.5999/aps.2018.00535] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 02/01/2019] [Indexed: 12/03/2022] Open
Abstract
Background Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy with a high morbidity and healthcare-related costs. Currently there is no consensus about the best treatment option. The purpose of this prospective cohort study conducted at a single institution was to evaluate the clinical outcomes and patient satisfaction following a mini-open carpal tunnel release for idiopathic CTS. Methods A total of 72 patients (53 female and 19 male patients; mean age, 57.8±15.3 years; range, 24–94 years) had a mini-open carpal tunnel release performed by a single senior surgeon between June 2015 and June 2016. The patients were evaluated preoperatively, and at 3 and 12 months post-intervention. At every follow-up, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and visual analogue scale (VAS) scores for pain and satisfaction were completed. Digital sensibility (using Semmes- Weinstein monofilaments) was assessed and pinch and grip strengths were measured. Results Statistically significant and clinically relevant improvement was found in terms of digital sensibility, grip and pinch strength (except for 2-point pinch), BCTSQ scores and pain scores. The complication rate was minimal, and no major complications occurred. Two patients experienced recurrence. The availability of follow-up records (including patient-reported outcomes, BCTSQ and VAS scores, and the complication rate) at 1-year post-intervention varied between 69% and 74% (50–53 patients) depending on which parameter was assessed. Patient satisfaction was high (mean, 80.9±26.0; range, 0–100). Conclusions This study demonstrates that mini-incision carpal tunnel release is clinically effective in the short and long term.
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Li M, Jiang J, Zhou Q, Zhang C. Sonographic follow-up after endoscopic carpal tunnel release for severe carpal tunnel syndrome: a one-year neuroanatomical prospective observational study. BMC Musculoskelet Disord 2019; 20:157. [PMID: 30967143 PMCID: PMC6456940 DOI: 10.1186/s12891-019-2548-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/28/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Endoscopic carpal tunnel release (ECTR) has been gradually adopted for the treatment of severe carpal tunnel syndrome (CTS). However, perioperative assessment of neuroanatomical parameters of median nerve, which are important determinant of median nerve recovery, has rarely been reported. This one-year prospective study aimed to investigate the natural history of the neuroanatomical morphology of the median nerve after ECTR in severe CTS patients by high-frequency ultrasonography and assess the ability of neuroanatomical measures to quantify morphological recovery of the median nerve after ECTR. METHODS This study recruited 31 patients (44 wrists) with a definitive diagnosis of severe CTS and underwent ECTR operation. The edema length (EL) of median nerve from the inlet of the carpal tunnel to the proximal wrist was detected on long axis imaging plane and the anteroposterior diameter (D) and cross-sectional area (CSA) at the inlet of the carpal tunnel on short axis imaging plane were detected by high frequency ultrasound. All these metrics were detected at 3 days before surgery and at the 2nd week, 4th week, 3rd month, 6th month and 12th month after surgery separately. RESULTS There was no significant difference of each parameter between the 2-week postoperative (1.914 ± 0.598 cm in EL, 0.258 ± 0.039 cm in D and 0.138 ± 0.015 cm2 in CSA) and 3-days preoperative time points (P-EL =0.250; P-D = 0.125; P-CSA =0.712). From the fourth week to the third month after surgery, the parameters quickly improved. The EL (0.715 ± 0.209 cm), D (0.225 ± 0.017 cm) and CSA (0.117 ± 0.012 cm2) at the 3- month postoperative time points were more reduced than at the fourth week after surgery (P-EL < 0.001; P-D = 0.038; P-CSA =0.014). Thereafter, the neurological anatomy parameters recovered slowly. By the 12-month postoperative time points, the three parameters were neuroanatomically close to normal. Compared to the control group in D (0.213 ± 0.005 cm), there was no difference at the 12-month time point (0.214 ± 0.009 cm, P = 0.939). However, the difference in EL (0.098 ± 0.030 cm vs. 0.016 ± 0.011 cm) and CSA (0.103 ± 0.008 cm2 vs. 0.073 ± 0.005 cm2) between patients and healthy volunteers at the 12-month time point still existed (P-EL < 0.001; P-CSA < 0.001). CONCLUSIONS Neuroanatomical parameters were gradually improved after ECTR surgery. The best time for US follow up is at 3-month postoperative time point for patients who do not show clinical improvement, since at this time the change is the greatest for most CTS patients. This study has been registered in Chinese Clinical Trial Registry: ChiCTR-ROC-17014068 (retrospectively registered 20-12-2017).
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Affiliation(s)
- Miao Li
- Department of Ultrasound, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710004 People’s Republic of China
| | - Jue Jiang
- Department of Ultrasound, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710004 People’s Republic of China
| | - Qi Zhou
- Department of Ultrasound, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710004 People’s Republic of China
| | - Chen Zhang
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710004 People’s Republic of China
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Alemdar M. Ring finger sensorial conduction studies in grading carpal tunnel syndrome: Part II. J Back Musculoskelet Rehabil 2018; 31:759-766. [PMID: 29614623 DOI: 10.3233/bmr-171068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Comparison of sensory conduction of median nerve (MN) with the one of ulnar nerve (UN) over writs-to-ring finger (RF) segment is useful in electrodiagnosis of carpal tunnel syndrome (CTS). However, there is not any consensus regarding the usage of this technique in grading of CTS. OBJECTIVES To determine whether the hands of CTS with elicitable MN sensory responses on index finger, but not on RF (non-respondings) compose a more severe electrophysiologic grade than the hands with elicitable responses on both fingers (respondings). MATERIAL AND METHODS The patients with bilateral moderate grade of CTS in whom one hand was responding and the contralateral hand was non-responding were included. Conduction study results of MN and UN were compared between respondings and non-respondings. RESULTS A total of 19 patients were included. Mean distal sensory onset latency (DSOL) of MN over index finger was longer (4.26 ± 0.49 msec versus 3.44 ± 0.39 msec; p< 0.001), sensory conduction velocity (SCV) was slower (33.7 ± 4.3 m/sec versus 40.2 ± 3.0 m/sec; p< 0.001), SNAP amplitude was smaller (10.3 ± 3.3 μV versus 19.1 ± 7.7 μV; p< 0.001), distal motor latency was longer (5.69 ± 0.60 msec versus 4.63 ± 0.32 msec; p< 0.001), and minimum F wave latency was longer (29.3 ± 1.7 msec versus 26.8 ± 1.4 msec; p< 0.001) in non-respondings than respondings. The nonresponding hand had a longer MN DSOL and slower SCV on index finger compared with contralateral responding hand in all of 19 patients. CONCLUSION Non-responding hands have more progressed median neuropathies, and represent a more severe electrophysiologic grade than responding hands. Further studies are warranted to determine whether the absence of MN sensory responses on ring finger is related with forthcoming NCS worsening and a preferable hallmark for deciding surgical intervention or not.
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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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Tang CQY, Lai SWH, Tay SC. Patient-reported outcomes of carpal tunnel release surgery in patients with bilateral severe carpal tunnel syndrome. J Hand Surg Eur Vol 2017; 42:932-936. [PMID: 28770645 DOI: 10.1177/1753193417721456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This retrospective study examined whether the presenting complaint of numbness is relieved post-operatively in severe carpal tunnel syndrome and also assessed any correlation between outcomes of the first and second procedures in staged bilateral carpal tunnel releases. Carpal tunnel release (60 open and 38 endoscopic) was done in 49 patients with bilateral severe carpal tunnel syndrome. There was complete resolution of numbness post-operatively in 77% ( n = 75) of hands. The median post-operative time before complete resolution of numbness was 21 days (IQR 8 to 21; range 3 to 482). The likelihood of complete resolution of symptoms after the second carpal tunnel release in patients with complete resolution of symptoms after the first carpal tunnel release was 22 (95% CI: 4 to 131) times that of the likelihood of improvement in patients with incomplete resolution of symptoms after the first carpal tunnel release. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- C Q Y Tang
- 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - S W H Lai
- 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - S C Tay
- 2 Department of Hand Surgery, Singapore General Hospital, Singapore.,3 Adjunct Associate Professor, Duke-NUS Medical School
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Tang CQY, Lai SWH, Tay SC. Long-term outcome of carpal tunnel release surgery in patients with severe carpal tunnel syndrome. Bone Joint J 2017; 99-B:1348-1353. [DOI: 10.1302/0301-620x.99b10.bjj-2016-0587.r2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 05/15/2017] [Indexed: 11/05/2022]
Abstract
Aims Few studies have examined the long-term outcome of carpal tunnel release (CTR). The aim of this study was to evaluate the patient-reported long-term outcome of CTR for electrophysiologically severe carpal tunnel syndrome (CTS). Patients and Methods We reviewed the long-term outcome of 40 patients with bilateral severe CTS who underwent 80 CTRs (46 open, 34 endoscopic) between 2002 and 2012. The outcomes studied were patient-reported outcomes of numbness resolution, the Boston Carpal Tunnel Questionnaire (BCTQ) score, and patient satisfaction. Results The mean follow-up was 9.3 years. Complete resolution of numbness was reported by 93.8% of patients, persistent numbness by 3.8%, and recurrent numbness by 2.5%. The mean BCTQ symptom score was 1.1 (sd 0.3; 1.0 to 2.55) and the mean Boston function score was 1.15 (sd 0.46; 1.0 to 3.5). 72.5% of patients were asymptomatic and had no functional impairment. Men had poorer outcomes than women and patients < 55 years had poorer outcomes than patients ≥ 55 years. All patients who had undergone endoscopic CTR reported complete resolution of numbness compared with 89.1% of those who had undergone open release (p = 0.047). There was no significant difference in outcome between dominant and non-dominant hands. Patient satisfaction rates were good. There were no adverse events. Conclusion CTR has a favourable outcome and good rates of satisfaction, even in patients with bilateral severe CTS at a mean of nine years after surgery. Endoscopic CTR has a higher rate of numbness resolution than open surgery. There were no significant differences in outcome between the dominant and non-dominant hand. Cite this article: Bone Joint J 2017;99-B:1348–53.
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Affiliation(s)
- C. Q. Y. Tang
- Yong Loo Lin School of Medicine, National
University of Singapore, 1E Kent Ridge Road, NUHS
Tower Block, 119228, Singapore
| | - S. W. H. Lai
- Yong Loo Lin School of Medicine, National
University of Singapore, 1E Kent Ridge Road, NUHS
Tower Block, 119228, Singapore
| | - S. C. Tay
- Singapore General Hospital, The
Academia, 20 College Road, 169856, Singapore
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Keser N, Dortcan N, Cikla U, Uluc K, Celikoglu E, Is M, Gurer B. Semivertical Incision: An Aesthetically and Electrophysiologically Effective Mini-Incision Technique for Carpal Tunnel Decompression. Med Sci Monit 2017. [PMID: 28627507 PMCID: PMC5486888 DOI: 10.12659/msm.902343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The purpose of this study was to present the clinical results of our retrospective series of carpal tunnel release (CTR) operations. For these operations we used a unique type of incision, for the first time, for treatment of carpal tunnel syndrome (CTS) consisting of a 1-cm semi-vertical (SV) incision made into the wrist crease for macroscopic open CTR. Material/Methods This retrospective study included 114 patients (101 females and 13 males) with CTR who were operated upon in our neurosurgery clinic between December 2010 and June 2015. Patient ages ranged from 35 to 83 years (mean 55.05±12.04 years). In total, 127 hands (73 right and 54 left) were operated upon using the SV skin incision technique. After an average follow-up of 18 months (ranging from 6 to 30 months), clinical and electrophysiological (EP) evaluations were performed. Results A review of the English language literature published since 1957, when Phalen first popularised the diagnosis and treatment of this disease, determined that no previous reports of the mini-open incision technique as described in our study have been published. In our retrospective patient case review, we found that after operations using the SV incision technique, statistically significant differences were detected in electromyography (EMG) improvements (p<0.01). In addition, patients who showed improvement in EMG studies (n=90) were satisfied with the result of their surgery. Conclusions Our study demonstrated that 1-cm skin SV incision was a cosmetically satisfying, fast, and safe approach to CTR that was not only clinically effective but also electrophysiologically effective.
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Affiliation(s)
- Nese Keser
- Department of Neurosurgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, T.R. Health Sciences University, Istanbul, Turkey
| | - Nimet Dortcan
- Department of Electrophysiology Laboratory, Istanbul Fatih Sultan Mehmet Education and Research Hospital, T.R. Health Sciences University, Istanbul, Turkey
| | - Ulas Cikla
- Department of Neurosurgery, The University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kutluay Uluc
- Department of Neurosurgery, The University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Erhan Celikoglu
- Department of Neurosurgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, T.R. Health Sciences University, Istanbul, Turkey
| | - Merih Is
- Department of Neurosurgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, T.R. Health Sciences University, Istanbul, Turkey
| | - Bora Gurer
- Department of Neurosurgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, T.R. Health Sciences University, Istanbul, Turkey
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15
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Hohenberger G, Maier M, Grechenig C, Schwarz A, Matzi V, Weiglein A. Carpal tunnel release: Safe and simple identification of the flexor retinaculum based on superficial anatomical landmarks. Clin Anat 2017; 30:512-516. [DOI: 10.1002/ca.22865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 02/23/2017] [Indexed: 12/31/2022]
Affiliation(s)
- G.M. Hohenberger
- Department of Orthopedics and Trauma Surgery; Medical University of Graz, Austria; Auenbruggerplatz 5 Graz 8036 Austria
| | - M.J. Maier
- Institute for Statistics and Mathematics, Vienna University of Economics and Business, Austria; Welthandelsplatz 1 Wien 1020 Austria
| | - C. Grechenig
- Department of Orthopedics and Trauma Surgery; Medical University of Graz, Austria; Auenbruggerplatz 5 Graz 8036 Austria
| | - A.M. Schwarz
- AUVA Trauma Hospital Graz, Austria; Göstinger Straße 24 Graz 8020 Austria
| | - V. Matzi
- State Hospital Hochsteiermark/Leoben, Austria; Vordernberger Straße 42 Leoben 8700 Austria
| | - A.H. Weiglein
- Institute of Anatomy, Medical University of Graz, Austria; Harrachgasse 21 Graz 8010 Austria
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Kronlage SC, Menendez ME. The benefit of carpal tunnel release in patients with electrophysiologically moderate and severe disease. J Hand Surg Am 2015; 40:438-44.e1. [PMID: 25708432 DOI: 10.1016/j.jhsa.2014.12.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/09/2014] [Accepted: 12/09/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare change in numbness and pain after carpal tunnel release in patients with electrophysiologically moderate and severe disease. METHODS We tested the primary null hypothesis that there is no difference in the total Carpal Tunnel Symptoms Scale score 3 months after surgery between patients with moderate and those with severe disease. Ninety-five patients (47 in the moderate cohort, and 48 in the severe cohort) who had miniopen carpal tunnel release between November 2011 and November 2013 were identified from our prospectively collected database. For each patient, the total Carpal Tunnel Symptoms Scale score, as well the numbness and pain subscale scores, at the preoperative and postoperative (2-wk, 1-mo, 2-mo, 3-mo, ≥ 1-y) visits were documented. The data were analyzed with repeated-measures analysis of variance. RESULTS Three months after surgery, patients with moderate carpal tunnel syndrome (CTS) reported, on average, no symptoms, and patients with severe disease had reduced but unresolved symptoms. Although symptoms diminished in both groups from the preoperative assessment to the 2-week postoperative assessment, patients with severe CTS had comparatively more severe symptoms at all time points with the exception of pain at 2 weeks and 1 year or longer after surgery, at which times there was no significant difference. At 1 year or longer after surgery, 1 (2%) patient with moderate CTS and 9 (19%) patients with severe CTS reported continued symptoms. Preoperative electrodiagnostic severity was the factor most predictive of symptom scores. CONCLUSIONS Patients with severe CTS experience considerable reduction in symptoms after surgery but should be informed that recovery may be more prolonged and, in some cases, incomplete 1 year after carpal tunnel release, particularly with regard to numbness. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic III.
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Affiliation(s)
- Steven C Kronlage
- The Andrews Institute, Gulf Breeze, FL; Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA.
| | - Mariano E Menendez
- The Andrews Institute, Gulf Breeze, FL; Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
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Comparative analysis between minimal access versus traditional accesses in carpal tunnel syndrome: A perspective randomised study. J Plast Reconstr Aesthet Surg 2014; 67:237-43. [DOI: 10.1016/j.bjps.2013.10.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 04/14/2013] [Accepted: 10/21/2013] [Indexed: 12/13/2022]
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Yu-Chen Ho S, Lin YT. Comparing the effectiveness of endoscopic carpal tunnel release between idiopathic and long-term hemodialysis patients. FORMOSAN JOURNAL OF SURGERY 2014. [DOI: 10.1016/j.fjs.2013.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Komurcu HF, Kilic S, Anlar O. Relationship of age, body mass index, wrist and waist circumferences to carpal tunnel syndrome severity. Neurol Med Chir (Tokyo) 2013; 54:395-400. [PMID: 24257492 PMCID: PMC4533441 DOI: 10.2176/nmc.oa2013-0028] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Carpal tunnel syndrome (CTS) has a multifactorial etiology involving systemic, anatomical, idiopathic, and ergonomic characteristics. In this study, an investigation of the relationship between the CTS degree established by electrophysiological measurements in patients with clinical CTS prediagnosis, and age, gender, body mass index (BMI), hand wrist circumference, and waist circumference measurements has been done. On 547 patients included in the study, motor and sensory conduction examinations of the median and ulnar nerve were done on one or two upper extremities thought to have CTS. In terms of CTS severity, the patients were divided into four groups (normal, mild, medium, and severe CTS). A total of 843 electrophysiological examinations were done consisting of 424 on the right hand wrist and 419 on the left hand wrist. When the age group of 18–35 years is taken as the reference group, the CTS development risk independent of BMI has been found to have increased by a factor of 1.86 for ages 36–64 years, and by 4.17 for ages 65 years and higher after adjustment for BMI. With respect to normal degree CTS group, the BMI were significantly different in groups with mild, medium, and severe CTS. The waist circumferences of groups with mild, medium, and severe CTS severity were found to be significantly higher in comparison to the normal reference group. When this value was corrected with BMI and re-examined the statistically significant differences persisted. The study identified a significant relationship between the CTS severity and age, BMI, waist circumference.
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Bolster M, Schipper C, Van Sterkenburg S, Ruettermann M, Reijnen M. Single interrupted sutures compared with Donati sutures after open carpal tunnel release: A prospective randomised trial. J Plast Surg Hand Surg 2013; 47:289-91. [DOI: 10.3109/2000656x.2012.762006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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