Strickland’s Surgery in the Recurrent Carpal Tunnel Syndrome

Abstract

General Objective: Describe the evolution of patients with recurrent or persistent carpal tunnel syndrome operated with Strickland’s technique. Materials and Methods: This cross-sectional, descriptive study, was conducted at the Mexican Social Security Institute, Hospital of Traumatology and Orthopedics “Lomas Verdes” through the Hand Surgery Service, from March 1, 2015 until August 7, 2015. Data were obtained on a single moment in time by two collection instruments validated to assess the results of the management of carpal tunnel syndrome: the Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH] and the Boston carpal tunnel syndrome questionnaire, applied to each research participant. Fourteen adult patients who underwent revision surgery for carpal tunnel syndrome Strickland technique of both sexes were evaluated. They were asked to rate the variables regarding 2 points in time: after their first median nerve release surgery and after revision surgery with Strickland technique. The functional behavior, disability and evolution of symptoms before and after revision surgery were then determined by the 2 questionnaires objectively. The study complies with the ethical standards of the institution and the current in the nation. Results: During the study, 14 patients, a total of 16 hands affected with recurrent or persistent carpal tunnel syndrome, underwent revision surgery with Strickland’s technique. Most of the participants were female, 93.75 %. All limbs evaluated were still active conducting formal or informal (housewife) jobs and most patients were still in the useful working life. Two questionnaires (the QuickDASH and Boston questionnaire for carpal tunnel syndrome) were applied to assess functional, symptomatic and developments regarding disability before and after revision surgery with Strickland’s technique, resulting in decreased overall disability average of 78.4% to 64.19% (SD of 13.26 and 15.93 respectively, P = .01), occupational disability decreased from 82.43% to 59.77% (SD of 10.75 and 15.47, respectively, P = .01), the severity of symptoms decreased from 4.1 to 3.05 points (SD of 0.57 and 0.88, respectively, P = .01), and functionality improved from 4.06 to 3.49 points (SD of 0.57 and 0.76, respectively, P = .05). The decrease in general and work disability and symptomatic and functional improvement, all favorable results, are statistically significant because there is a P value < .05 as student T and Wilcoxon test. The dependent variables (occupational disability scale of severity of symptoms and functional status scale) are directly related with the independent variable (general disability) except age, which has a dispersed distribution in the graphic. The correlation coefficient of Spearman was calculated (not normally distributed data). There is a direct and positive correlation between variables. Correlation values and P value < .01. By analysis of variance (ANOVA), it showed that at least one of the independent variables are linearly related to the dependent variable (F = 63.75, P < .01). Conclusions: The patients with recurrent or persistent carpal tunnel syndrome have a tendency toward partial, but significant, improvement in function and symptoms as well as to the decreases in general and occupational disability after undergoing Strickland’s surgery.