Postoperative Functional Recovery After Carpal Tunnel Release: A Narrative Review on Exercise-Based Rehabilitation

BackgroundPoor oral health status can lead to a deteriorated level of general health and is common among patients undergoing cardiovascular surgery. However, the effect of oral health status on postoperative outcomes in cardiovascular surgery patients remains unclear. Thus, we investigated the effect of preoperative oral health status on postoperative complications and functional recovery after cardiovascular surgery. MethodsThis single-centre retrospective cohort study included 884 inpatients undergoing elective cardiovascular surgery. Oral health status was assessed based on the number of remaining teeth, use of dentures, occlusal support, and periodontal status. We investigated postoperative complications related to surgery and postoperative functional recovery by measuring the reacquisition of walking ability, activities of daily living, and length of postoperative hospital stay. ResultsIn this cohort (age 66.9 ± 13.4 years), the mean number of remaining teeth was 18.7 ± 9.4. Patients were grouped based on tertiles of the data distribution of remaining teeth: ≥ 20 teeth (470 patients); 10-19 teeth (137 patients); < 10 teeth (185 patients). The number of missing teeth was associated with age (P < 0.001). The prevalence of postoperative pneumonia and reintubation after surgery was 3.2% and 2.5%, respectively, which was significantly higher in patients with severe tooth loss (P < 0.05 for both). After adjusting for age and other confounding factors, the number of remaining teeth was a statistically significant predictor of functional recovery (P < 0.05). ConclusionsPreoperative oral health status was related to postoperative respiratory complications and independently associated with functional recovery. Preoperative oral intervention may improve functional recovery after cardiovascular surgery.

Purpose The present study aimed to investigate the association between preoperative physical activity (PA) and postoperative functional recovery in gastrointestinal cancer patients. Materials and methods In this prospective study, we included 101 patients who underwent colorectal or gastric cancer surgery. Primary outcome was 6-minute walk distance (6MWD) decline ratio ((postoperative 6MWD value – preoperative 6MWD value)/preoperative 6MWD value × 100 (%)), which was determined as postoperative functional recovery. Patients were divided into two groups according to the median of 6MWD decline ratio: above the median (non-decline group) and below the median (decline group). The International Physical Activity Questionnaire (IPAQ-SV) (the usual seven-day short version) was used to assess preoperative PA and sedentary time. Multivariate logistic regression analysis was performed to identify predictive factors of postoperative functional recovery. Results Preoperative PA (odds ratio (OR): 3.812; 95% confidence interval (CI): 1.326–10.956; p = 0.01), 6MWD (OR: 1.006; 95% CI: 1.002–1.011; p < 0.01), C-reactive protein (OR: 4.138; 95% CI: 1.383–12.377; p = 0.01), and combined resection (OR: 3.425; 95% CI: 1.101–10.649; p = 0.03) were associated with postoperative functional recovery. Conclusions Preoperative PA is a predictor of postoperative functional recovery in patients who undergoing gastrointestinal cancer surgery. Implications for rehabilitation The association between preoperative physical activity (PA) and postoperative functional recovery has been unclear in gastrointestinal cancer patients. We indicated that preoperative PA predicts postoperative functional recovery. Patients who low preoperative PA need to be monitored carefully in the postoperative course. Patients with low preoperative PA may need enhanced postoperative rehabilitation to reduce postoperative functional decline.

Objective To evaluate 3 therapeutic methods for carpal tunnel syndrome (CTS).Methods From May 2005 to September 2009, 162 CTS patients were treated in our hospital. Of them, 96 were mild, 54 were severe, and 12 had complete damage to the median nerve. Conservative therapy, simple carpal tunnel release (CTR) and complete carpal tunnel & palmar aponeurosis release (CTPAR) were selected for different types of CTS. Clinical presentations, electroneurophysiological results and Chen W-S evaluation scores of the patients were compared before and after therapy. Results For slight CTS cases, all the 3 methods improved obviously the clinical presentations. The Chen WS scores were increased from 73.1 ± 6. 5before therapy to 94. 9 ± 8.7 after therapy. There was no significant difference between surgery and conservative therapy. For Severe CTS, all the 3 methods were effective. CTR increased the Chen W-S score by 24.6 ± 8.2 points while CTPAR by 33.9 ± 7.5 points. Of the 3 methods, surgery was superior to conservative therapy and CTPAR was superior to CTR. For complete damage to the median nerve, none of the 3 methods was effective. Conclusions Early diagnosis and treatment is crucial for a fine functional recovery for CTS patients. Different therapeutic methods should be applied for CTS patients according to the severity of their injury. Key words: Carpal tunnel syndrome; Clinical protocols; Treatment outcome

The relationship between preoperative hemoglobin levels and postoperative functional recovery in patients with tibial plateau fractures has not been fully investigated. This study aimed to explore the correlation between preoperative hemoglobin levels and postoperative functional recovery. Patients admitted with tibial plateau fractures between January 2014 and December 2023 were included in this study, and patient data were prospectively collected through follow-up. The indicator of interest in this study was preoperative hemoglobin level, and the primary outcome was the Oxford Knee Score (OKS). Restricted cubic splines (RCS) were used to assess the dose-response relationship between preoperative hemoglobin levels and postoperative functional recovery. Propensity score matching was performed to reduce confounding factors, and multivariate logistic regression analysis was used to evaluate the association between preoperative hemoglobin levels and postoperative functional recovery. Subgroup analyses were conducted to identify potential population heterogeneity and test the robustness of the results. The study found a significant nonlinear relationship between preoperative hemoglobin levels and postoperative functional scores: the adjusted RCS showed a "U"-shaped curve trend, with an initial decrease followed by an increase as preoperative hemoglobin levels increased. After propensity score matching, the analysis showed that the proportion of poor postoperative function in the overweight group was significantly higher than that in the within-weight group (18.22% vs 6.28%), with OR = 3.33 (P < 0.001), indicating that abnormal preoperative hemoglobin levels were an independent risk factor for poor functional recovery after tibial plateau fracture. Subgroup analyses further confirmed that this association remained stable across different subgroups (P > 0.05), indicating the broad applicability and robustness of this risk relationship. Preoperative hemoglobin levels >147.9 or <123.9 g/L are risk factors for poor OKS score in patients with tibial plateau fractures. Perioperative hemoglobin screening can help improve postoperative functional recovery.

The Epidemiology of Carpal Tunnel Revision Over a 1-Year Follow-Up Period

When performed alone, endoscopic carpal tunnel release and endoscopic cubital tunnel release are safe and effective surgical options for the treatment of carpal and cubital tunnel syndromes, respectively. However, there is currently no literature that describes the performance of both procedures concomitantly. We describe the results of 17 cases in which dual endoscopic carpal and cubital tunnel releases were performed for the treatment of concurrent carpal and cubital tunnel syndromes. A retrospective review of all patients in a single surgeon practice that presented with concomitant ipsilateral carpal and cubital tunnel syndromes was performed. Within an 8-month period, 17 patients had undergone 19 concomitant ipsilateral endoscopic carpal and cubital tunnel releases after failing conservative treatment. Pre- and postoperative measurements included subjective numbness/tingling; subjective pain; manual muscle testing of the abductor pollicis brevis (APB), intrinsics, and flexor digitorum profundus (FDP); static two-point discrimination; quick-DASH (Disabilities of the Arm, Shoulder and Hand) scores; grip strength; chuck pinch strength; and key pinch strength. Complete data are available for 15 patients and 17 total procedures. Thirteen male and four female patients (average age of 50.5) underwent dual endoscopic cubital and carpal tunnel release. Two patients were lost to follow-up and eliminated from data analysis. Pre- and postoperative comparisons were completed for median DASH scores, grip strength, chuck pinch strength, and key pinch strength at their preoperative visit and at 12weeks. DASH scores improved significantly from a median of 67.5 to 16 (p = 0.002), grip strengths improved from 42 to 55.0lbs (p = 0.30), chuck pinch strengths improved significantly from 11 to 15.5lbs (p = 0.02), and key pinch strengths increased significantly from 13 to 18lbs (p = 0.003). Average static two-point discrimination decreased from 5.9 to 4.8mm. In terms of pain, 82% of patients had complete resolution of pain, and the remaining 18% experienced pain only with strenuous activity. In terms of numbness/tingling, 100% of patients had complete resolution of median nerve symptoms; 88% of patients had substantial improvement of numbness and tingling symptoms, and 12% had residual ulnar nerve symptoms. In terms of muscle strength, 92% of patients had improvement to 5/5 APB strength, while 100% of patients had improvement to 5/5 intrinsic and FDP strengths. Two minor complications occurred, including one superficial hematoma and one superficial cellulitis. Preliminary data demonstrate that dual endoscopic carpal and cubital tunnel release is a safe and effective treatment option for patients who present with concurrent cubital and carpal tunnel syndromes recalcitrant to non-surgical management. Postoperative results and complications are comparable to endoscopic carpal and cubital tunnel releases performed alone.

Patients with private healthcare plans often defer nonemergent or elective procedures toward the end of the year once they have met their deductible. No previous studies have evaluated how insurance status and hospital setting may affect surgical timing for upper extremity procedures. Our study aimed to evaluate the influence of insurance and hospital setting on end-of-the-year surgical cases for elective carpometacarpal (CMC) arthroplasty, carpal tunnel, cubital tunnel, and trigger finger release, and nonelective distal radius fixation. Insurance provider and surgical dates were gathered from two institutions' electronic medical records (one university, one physician-owned hospital) for those undergoing CMC arthroplasty, carpal tunnel release, cubital tunnel release, trigger finger release, and distal radius fixation from January 2010 to December 2019. Dates were converted into corresponding fiscal quarters (Q1-Q4). Using the Poisson exact test, comparisons were made between the case volume rate of Q1-Q3 and Q4 for private insurance and then for public insurance. Overall, case counts were greater in Q4 than the rest of the year at both institutions. There was a significantly greater proportion of privately insured patients undergoing hand and upper extremity surgery at the physician-owned hospital than the university center (physician owned: 69.7%, university: 50.3%; P < 0.001). Privately insured patients underwent CMC arthroplasty and carpal tunnel release at a significantly greater rate in Q4 compared with Q1-Q3 for both institutions. Publicly insured patients did not experience an increase in carpal tunnel releases during the same period at both institutions. Privately insured patients underwent elective CMC arthroplasty and carpal tunnel release procedures in Q4 at a significantly greater rate than publicly insured patients. This finding suggests private insurance status, and potentially deductibles, influence surgical decision making and timing. Further work is needed to evaluate the impact of deductibles on surgical planning and the financial and medical impact of delaying elective surgeries.

Background. Open or wrist arthroscopic release of carpal tunnel is a relatively safe and reliable method. However, there is still some debate as to which of these various surgical methods is superior. Therefore, this study provides more clinical evidence by comparing the clinical efficacy of open and endoscopic single-channel bowl release in the treatment of carpal tunnel syndrome. Methods. The study conducted a retrospective analysis from January 2010 to January 2021. A total of 105 patients met the inclusion criteria, including 56 patients in the open carpal tunnel Release (OCTR) group and 49 patients in the single channel carpal tunnel release (SCCTR) group. The preoperative, intraoperative, and postoperative symptom improvement and functional recovery of the patients were compared. Results. The results of this study showed that the surgical incision healed well in all patients and complete remission of entrapment symptoms. Compared with the OCTR group, the SCCTR group had reduced surgical and hospital duration, intraoperative blood loss, postoperative scar pain score, and time required to return to normal lifestyle, and the SCCTR group had a lower incidence of sympathetic dystrophy and significantly improved clinical symptoms. Conclusion. Single Channel Carpal Tunnel Release under Carpal Arthroscopy in the treatment of carpal tunnel syndrome can achieve reliable clinical efficacy. It can relieve symptoms such as hand numbness and improve hand function. Postoperative pain and other complications are low, and worthy of clinical promotion.

What's New in Hand and Wrist Surgery.

Background The purpose of our study is to investigate disparities in the patient populations and outcomes of carpal tunnel release (CTR) and trigger finger release (TFR). Methods A retrospective review of 777 CTR and 395 TFR patients from May 2021 to August 2022 was completed. The shortened form of the Disabilities of the Arm, Shoulder, and Hand (DASH) scores (QuickDASH) was recorded to evaluate physical function preoperatively and at one and three months postoperatively. This study was deemed institutional review board-exempt by the institutional clinical research committee. Results Compared to CTR, TFR patients resided in zip codes with higher levels of social vulnerability across dimensions of 'household composition and disability' (p=0.018) and 'minority status and language' (p=0.043). When analyzing QuickDASH scores by demographics and procedure, preoperative scores were statistically significantly higher for non-married (p=0.002), White (p=0.003), and female sex (p=0.001) CTR patients. Further, one-month postoperative scores were statistically higher for White and non-married CTR patients (0.016 and 0.015, respectively). At three months postoperatively, female and non-married patients had statistically significant higher scores (0.010 and 0.037, respectively). In TFR patients, one-month postoperative QuickDASH scores for White and female patients were statistically significantly higher (0.018 and 0.007, respectively). There were no significant differences in QuickDASH scores between rural and non-rural patients, household income (HHI) above or below the median, or the Social Vulnerability Index (SVI) dimensions. Conclusion Our study found marital status, sex, and race were associated with disparities in pre-and postoperative physical function in patients undergoing carpal tunnel or trigger finger release. However, future studies are warranted to confirm and develop solutions to disparities within this population.

Characterization of the changes of ultrasound parameters after carpal tunnel release may be useful for clarifying the effectiveness or the recovery process of the carpal tunnel syndrome treatment. We evaluated strain and morphological changes of the median nerve before and after carpal tunnel release in carpal tunnel syndrome patients. Twenty-two wrists of 20 idiopathic carpal tunnel syndrome patients who underwent open carpal tunnel release were evaluated by ultrasound. Cross-sectional images of the median nerve were obtained at the proximal carpal tunnel. The cross-sectional area, perimeter, aspect ratio of the minimum enclosing rectangle, and strain of the median nerve were measured and compared before and after carpal tunnel release. According to the patient's recovery, the areas under the receiver operating characteristic curves (AUCs) were compared among the parameters. After carpal tunnel release, the area and perimeter significantly decreased, and the strain significantly increased compared with before carpal tunnel release. There were no significant changes in the aspect ratio after carpal tunnel release. The AUCs were 0.663, 0.643, 0.543, and 0.731 for the area, perimeter, aspect ratio, and strain, respectively. Significant decreases in median nerve area and perimeter as well as significant increases in median nerve strain were observed after carpal tunnel release. The results of this study may be useful when considering how the median nerve recovers after carpal tunnel release.

Objective To compare the value of arthroscopic assisted percutaneous internal fixation and open reduction and internal fixation in treatment of tibial plateau fracture.Methods The clinical data of 180 patients of tibial plateau fracture were analyzed retrospectively,including 112 patients of type Ⅱ fracture (group A) and 68 patients of type Ⅲ fracture (group B).The patients in group A and group B were divided into group A1 (56 patients),A2 (56 patients),B 1 (34 patients),B2 (34 patients) respectively according to the odd number and even number of admission date.The patients in group A1 and B1 received open reduction and internal fixation and the patients in group A2 and B2 received arthroscopic assisted percutaneous internal fixation.The postoperative functional recovery was compared and evaluated between the same type of tibial plateau fractures under different treatments.Results In group A1:the postoperative functional recovery,the excellent was 12 patients,the good was 26 patients,the middle good was 12 patients,the bad was 6 patients.The rate of the excellent and the good was 67.9％ (38/56).In group A2:the postoperative functional recovery,the excellent was 19 patients,the good was 34 patients,the middle good was 3 patients.The rate of the excellent and the good was 94.6％(53/56).The rate of the excellent and the good between group A1 and group A2 had significant difference (P ＜ 0.01).After operation for 6 months,the HSS scores of knee joint and degree of flex and extend in group A1 and A2 had significant difference [(73.21 ± 8.32) scores vs.(85.58 ±9.89) scores,(35.6 ±6.6)° vs.(55.1 ±8.8)°] (P ＜0.01).In group B1:the postoperative functional recovery,the excellent was 8 patients,the good was 16 patients,the middle good was 7 patients,the bad was 3 patiens.The rate of the excellent and the good was 70.6％(24/34).In group B2:the postoperative functional recovery,the excellent was 12 patients,the good was 21 patients,the middle good was 1 patient.The rate of the excellent and the good was 97.1％(33/34).The rate of the excellent and the good between group B1 and group B2 had significant difference(P ＜ 0.01).After operation for 6 months,the HSS scores of knee joint and degree of flex and extend in group B1 and B2 had significant difference [(75.32 ± 7.99) scores vs.(86.41 ±10.21) scores,(33.9 ±7.2)° vs.(56.6 ± 10.5)°](P＜0.01).Conclusions The efficacy of arthroscopic assisted percutaneous internal fixation is better than open reduction and internal fixation either in type Ⅱ fracture or in type Ⅲ fracture.This method is mini-invasive and is worthy to spread. Key words: Arthroscopes; Tibial fractures; Percutaneous internal fixation; Open reduction and internal fixation; HSS scores

Relationship of Carpal Tunnel Release and New Onset Trigger Finger.

Carpal tunnel syndrome (CTS) is a common nerve entrapment with a prevalence ranging between 2.7–4.9%, depending on the definition, in a representative adult population (1). Among a pooled analysis of US working populations, prevalence of electrodiagnostically verified CTS was 7.8% and incidence rate 2.3 per 100 person-years (2), while in an Italian working population the incidence rate was 1.4 per 100 person-years (3). The lifetime prevalence of carpal tunnel release (CTR) has been estimated at 3.1% and incidence rate at 1.73 per 1000 person-years in a normal population (4), and somewhat higher (3.35–2.98 per 1000 person-years during an eight-year follow-up) in a population of working age (5), suggesting that a considerable proportion of those with CTS undergo surgical treatment. CTR is an effective treatment to relieve the symptoms of CTS in both the short- and long-term (6). In this issue of the Scandinavian Journal of Work, Environment & Health , Newington et al’s systematic review (7) looked at return to work (RTW) times after CTR and reports a median RTW time of four weeks. This is in a good agreement with the Swedish recommendations for length of sickness absence after CTR (8). Only six studies reported information about the heaviness of work, and – quite expectedly – the RTW times were clearly longer for those with manual duties than non-manual duties, and the longest for those with heavy manual duties. In fact, we lack information about to what extent CTR is effective both as regards symptoms and resumption of work activities among those with heavy manual duties. As CTS can be considered in many jurisdictions as an occupational disease among workers with hand-intensive duties, some of those workers may have had their CTS compensated as an occupational disease under workers’ compensation and retrained to lighter duties after surgery. Change of occupation and retraining to lighter duties may lie behind the finding that those with workers’ compensation showed a longer RTW time compared with those without workers’ compensation or with another type of health insurance. Other processes may also delay RTW, such as litigation for compensation of CTS as an occupational disease. This difference between the compensation systems cannot therefore be directly interpreted as a result of a more generous compensation for sickness absence from the workers’ compensation system compared with a national or other insurance. Newington et al’s review is carefully conducted, transparent, and points out clearly that there is rather little well-documented evidence base on RTW times after CTR. Although a total of 56 studies were included, many of them reported only one summary estimate – often a mean – of the length of sickness absence duration or time to RTW. A minority reported a median, and only eight studies provided a range or interquartile range in addition. Moreover, a quarter of the studies did not even provide the number of persons that were included in their RTW analysis. A main reason for the poor documentation in the reviewed studies may be that the length of sickness absence or time to RTW has not been the primary outcome in most randomized controlled trials assessing the effectiveness of CTR. Even when time to RTW was reported, a very important aspect of sustainability of RTW was not considered. A recent review of RTW outcomes recommended to consider sustainability of RTW in the outcome, and suggested – based on recent studies on other outcomes – to use four weeks or 28 days as the criterion of sustainability (9). Indeed, a recent study from Finland reported a median time of 34 days for sustainable RTW (for 30 days) after CTR in the public sector (10). It would be interesting to know whether there is a difference between any RTW and sustainable RTW, however, so far, no study seems to have addressed this. With regard to recommendations for the length of sickness absence after CTR, time to sustainable RTW would serve as a better evidence base than any RTW. Work participation and long work careers are becoming critical for the sustainability of aging societies. CTR is a fairly common procedure, often carried out due to difficulties or inability to perform work duties. It is rather paradoxical that we know so little about the extent to which this procedure can restore work ability and enhance return to earlier or amended duties and not even how long it typically takes to return to work after CTR. Hopefully, this review will reach clinicians and researchers in both the occupational health and clinical community, such as surgeons, physical therapists, and occupational therapists, and motivate them to pay more attention to RTW to different types of duties after CTR and how to measure this important outcome.

The objective of this study was to evaluate the effects of diabetes mellitus (DM) on the rate of carpal tunnel release (CTR) using a large nationwide cohort in Korea and to identify risk factors, including comorbidities and socioeconomic status (SES), associated with CTR. Patients with a primary or secondary diagnosis of carpal tunnel syndrome (CTS; ICD-10 code: G560) were selected and divided into two groups according to the presence of DM. A Cox proportional hazard model was used to assess the rate of CTR between the two groups. To evaluate the influence of demographic factors, comorbidities, and SES on CTR, multivariate Cox proportional hazard regression models were used to adjust for confounding variables. In total, 12,419 patients with CTS were included in the study: 2487 in DM cohort and 9932 in non-DM cohort. DM duration was negatively related with the rate of CTR (HR = 0.89, 95% CI 0.87–0.91) in CTS patients with DM. The rate of CTR was decreased in patients with DM compared to those without DM in the unadjusted model; however, after adjusting for comorbidities, DM had no significant effect on the rate of CTR. Female sex (HR = 1.50, 95% CI 1.36–1.67) correlated with the rate of CTR, and an inverse relationship between the number of comorbidities and CTR was found (p < 0.001) irrespective of DM. Diabetic polyneuropathy (DPN) was not associated with CTR, and we did not find any factors correlating with CTR in DPN patients. We found that CTS patients with more comorbidities or combined with a longer duration of DM were undertreated in real-word practice. Actual outcomes of CTR in CTS patents with various comorbidities should be investigated in future studies for optimal management of CTS.