Carpal Tunnel Release Group Research Articles

Simultaneous versus staged bilateral carpal tunnel release via open and endoscopic surgeries: a retrospective propensity score-matched patient comorbidity analysis.

Carpal tunnel syndrome (CTS) presents bilaterally in nearly 60%-70% of affected patients. Bilateral carpal tunnel release (CTR) can be performed in a staged or simultaneous fashion. There remains a limited understanding of the optimal preoperative factors to use for patient selection when determining simultaneous versus staged bilateral CTR. Moreover, it is unclear how these factors influence postoperative outcomes. In this study, the authors aimed to identify and compare preoperative comorbidities and postoperative outcomes in patients who had undergone simultaneous versus staged open and endoscopic bilateral CTR. The authors performed a retrospective analysis of data collected from the TriNetX database. Patients with bilateral CTS who had been treated from February 1, 2002, to February 1, 2022, were dichotomized by their bilateral release approach: simultaneous or staged within 3 months. The resulting groups were analyzed separately by open versus endoscopic techniques. Next, cohorts were analyzed for preoperative comorbidities to identify possible factors for surgical determination. Then, they were propensity score matched on demographics and comorbidities. Postoperative outcomes within 6 months of surgery were measured with and without matching. After matching, 9286 and 3709 patients remained in the open and endoscopic groups, respectively. Those who had undergone staged surgeries via an open or endoscopic approach had more preoperative comorbidities. After matching, staged open release was associated with significantly higher rates of postprocedural care, hand/joint pain, limb pain, trigger finger, and upper respiratory tract infections. Simultaneous open release was associated with higher rates of emergency room visits. Staged endoscopic release was associated with significantly higher rates of postprocedural care, limb pain, and trigger finger. No significant outcomes were favored in the simultaneous endoscopic group. Before matching, patients who had undergone staged CTR had significantly higher rates of preoperative medical comorbidities compared with patients in the simultaneous CTR group. Moreover, staged CTR was significantly associated with higher rates of postoperative complications. After matching on demographics and comorbidities, staged CTR was still associated with higher rates of postoperative complications, suggesting that preoperative comorbidities do not influence postoperative outcome. Further prospective studies could be used to validate these results and provide new findings for the management and treatment of these groups.

Postoperative Functional Analysis of Double Crush Versus Single Peripheral Nerve Decompression: A Retrospective Study.

Double crush (DC) syndrome patients presenting with C6-7 radiculopathy and median nerve compression in the carpal tunnel report greater nerve irritability and weakness postdecompression than isolated peripheral nerve decompression. We hypothesize that patient-reported outcome is inferior following release at both cervical spine and wrist versus a single site of decompression. Patients that underwent either anterior cervical decompression and fusion (ACDF) for C6-C7 radiculopathy, carpal tunnel release (CTR), or both within 5 years (DC) were identified. A total of 477 patients were analyzed (157 DC, 203 CTR, and 117 ACDF). Post-operative outcome Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Neck Disability Index, and visual analog scale (VAS) scores were collected at an average of 2 years postoperatively. QuickDASH scores were higher in the DC group versus CTR group (36 vs 22, P < .0002). Postoperative disability in the ACDF group was significantly higher than the DC group (50 vs 36, P < .017). There were no differences between ACDF and DC groups in arm pain intensity, but the CTR group demonstrated significantly greater arm pain intensity than the DC group (5.7 vs 3.6, 10-point scale, P < .01). Patients undergoing ACDF and CTR have greater postoperative disability than those undergoing CTR alone, but less postoperative functional disability and pain than ACDF alone, indicating cervical radiculopathy may contribute a greater proportion of long-term disability postoperatively. Additionally, CTR had greater postoperative arm pain than DC patients, potentially indicating high rates of undiagnosed cervical radiculopathy or other sources of arm pain in these patients.

Unplanned Office Visits Following Outpatient Hand Surgery.

Returning to the office for an unplanned visit postoperatively can be burdensome to both the patient and provider. The purpose of this study was to quantify the rate of unplanned office visits after common soft tissue hand surgeries and assess the reasons for these unplanned visits. Patients who underwent common soft tissue hand surgeries over a 6-month time period were queried from an electronic medical record database. Manual chart review was performed to record patient demographics, unplanned visits within 3 months postoperatively, and specific reasons for unplanned visits. A total of 1648 postoperative follow-up visits in 1224 patients were included in analysis. Within 3 months of surgery, 6.3% (103/1648) of postoperative visits were found to be unplanned. There was no difference in the rate of unplanned visits among the included surgeries (P = .46). The most common reasons for an unplanned office visit overall were wound problems (34%), pain (23.3%), and stiffness (17.5%). The trigger finger release group had significantly more patients return to the office for stiffness (P = .01), the De Quervain release group had significantly more patients return for pain (P = .02), and the carpal tunnel release group had significantly more patients return for persistent symptoms (P < .05). Unplanned office visits represented about 1 of 16 postoperative visits. Orthopedic surgeons should be aware of the most common reasons for these visits and be prepared to address these problems promptly. Preoperative patient education on these potential problems may help decrease the frequency of unplanned follow-up visits.

Mini-transverse incision using a novel bush-hook versus conventional open incision for treatment of carpal tunnel syndrome: a prospective study

PurposeThis study aimed to investigate the outcomes of a mini-transverse incision with a bush-hook versus a conventional open incision for carpal tunnel release (CTR).MethodsThis was a prospective study. The decision to receive either technique (mini-transverse incision with a bush-hook or conventional open incision) was primarily based on patients’ choice. Patients’ symptom severity, functional status, and symptomatic pain were measured at pre-operation, 1 month, and 3 and 6 months postoperatively, and any relevant complications were recorded. Kelly’s scale was used to evaluate the overall clinical efficacy.ResultsEighty-nine patients were included in the open CTR group and 85 patients in the mini-transverse incision group. The mini-transverse incision group had a significantly smaller incision (4.4±0.6 vs 44.8±3.7 mm), shorter surgical time (7.8±1.9 vs 21.2±3.4 min), and shorter hospital stay (3.7±1.6 vs 5.9±2.0 days) than did the open CTR group. Both groups showed significant improvements from baseline levels (all P<0.001). At postoperative 1 month and 3 months, the transverse incision group showed a significantly better VAS, SSS, and FSS (all P<0.05), but the difference was non-significant at 6 months except for FSS (P=0.022). Also, mini-transverse incision showed a significantly reduced time to return to work and activities, trend to a higher rate of excellence, and good and fewer complications than did the open CTR.ConclusionsThe mini-transverse incision exhibited better performance in surgery-related measures, symptomatic remission, functional recovery, and postoperative morbidity, thus could be considered a promising technique alternative.

Pain Management After Carpal Tunnel Release Surgery: A Prospective Randomized Double-Blinded Trial Comparing Acetaminophen, Ibuprofen, and Oxycodone

Adequate postoperative pain control in hand surgery is a multifactorial issue affecting patient satisfaction, outcomes, and safety. However, prescription opioid abuse is becoming an increasingly prevalent problem in the Unites States. The purpose of this study was to determine if there was a difference in pain levels or pill consumption when using nonopioids, ibuprofen (IBU) and acetaminophen (ACE), versus an opioid, oxycodone (OXY), after carpal tunnel release (CTR) performed exclusively under local anesthesia without sedation. Patients scheduled for primary unilateral CTR under local anesthesia alone were randomized to receive 10 deidentified opaque capsules of either OXY 5 mg, IBU 600 mg, or ACE 500 mg after surgery. Both the patient and the surgeon were blinded to the distributed medication. Patients reported the worst pain experienced daily (0-10 scale), the number of pills consumed daily, and any adverse effects from postoperative days 0-5. Analgesic pill-type distribution between the 105 patients who completed the study was 37 OXY, 34 IBU, and 34 ACE. For the endoscopic CTR group, mean total pills consumed from the day of surgery through postoperative day 5 for OXY, IBU, and ACE were 2.9, 4.2, and 2.7, respectively. The average worst daily pain scores for all days for the OXY, IBU, and ACE groups were 2.8, 2.5, and 2.8, respectively. For the open CTR group, mean total pills consumed from the day of surgery through postoperative day 5 for OXY, IBU, and ACE were 3.7, 5.1, and 4.2, respectively. The average worst daily pain scores for all days for the OXY, IBU, and ACE groups were 3.4, 2.5, and 2.3, respectively. Four of 5 adverse events were reported by OXY group patients, but all were minor with no reoperations or readmissions. We recommend using nonopioids such as ACE and IBU in the postoperative management after CTR surgery, and regardless of the medication prescribed, we advise prescribing no more than 5-10 pills after surgery. Therapeutic II.

Systematic review and pooled analysis of the rate of carpal tunnel syndrome after prophylactic carpal tunnel release in patients with a distal radius fracture

The aim of this study was to determine the rate of carpal tunnel syndrome (CTS) in patients with a volar plated distal radius fracture (DRF), with or without prophylactic carpal tunnel release (CTR). The PubMed database was searched for studies reporting on CTS in patients with a DRF fixed by a volar plate. Selected patients were those who underwent prophylactic CTR versus patients who did not. Pooled rates of CTS were calculated using inverse — variance weighting assuming a random effects model. Tests for heterogeneity were applied. In this study, 172 patients in the CTR group and 1839 patients in the non-CTR group were included. The pooled rate for CTS in the CTR group was 28.1% (95% CI: 11.8% to 48.2%) while it was 4.4% (95% CI: 3.1% to 6.0%) in the non-CTR group. CTR is of no prophylactic value for postoperative CTS in volar plated DRF patients.

Prospective Evaluation of an Opioid Reduction Protocol in Hand Surgery.

We investigated whether written guidelines for surgeons and educational handouts for patients regarding safe and effective opioid use after hand surgery could reduce prescription sizes while achieving high patient satisfaction and a low refill rate. All patients undergoing isolated carpal tunnel release or distal radius volar locked plating in a hand surgery group practice during a 6-month period were prospectively enrolled. Surgeons prescribed analgesics at their own discretion based on written guidelines. Patients received an educational handout regarding safe opioid use and disposal, a diary to record daily pain visual analog scale score and consumption of opioid and over-the-counter (OTC) analgesics, and a pain catastrophizing scale questionnaire. Collected data were compared with a retrospective cohort of the same surgeons, procedures, and period 1 year earlier. In the carpal tunnel release group (121 patients), average prescription size was 10 opioid pills, compared with 22 in the prior year. Average consumption was 3 opioid pills, supplemented with 11 OTC pills. In the volar locked plating group (24 patients), average prescription size was 25 opioid pills, compared with 39 in the prior year. Average consumption was 16 opioid pills, supplemented with 20 OTC pills. Patient satisfaction was comparably high in both groups. Eight patients required opioid refills overall. Patients with pain catastrophizing scale greater than 10 used more than twice as many opioid pills. Of 109 patients with leftover opioids, 10 reported proper disposal. Written guidelines and educational handouts significantly reduced the number of prescribed opioid pills by 35% to 55% while achieving high patient satisfaction and a low refill rate. We recommend 5 to 10 opioid pills for carpal tunnel release and 20 to 30 for distal radius volar plating. Pain catastrophizing is associated with greater opioid consumption and may help target patients for additional support. Potential for opioid abuse and diversion may persist despite these interventions. Therapeutic II.

Does routine carpal tunnel release during fixation of distal radius fractures improve outcomes?

ObjectiveThis case-control study was designed to test the hypothesis whether carpal tunnel release (CTR) during fixation of distal radius 23-C2 AO fractures improves outcomes. MethodsThirty-five consecutive patients who sustained distal radius fractures of the dominant hand participated in this study. Patients were allocated into two groups: (a) The ORIF + CTR (16 patients (11 males and 5 females)); (b) the ORIF and NOT CTR 19 patients (12 males and 7 females). Patient assessment included visual analogic scale of pain (VAS), the subjective Mayo Wrist Score (MWS), electromyograms (EMG) at 3 month and 6 months from the day of injury and complications. All patients had the same physiotherapy treatment algorithm following surgery. Patient follow up took place at 1 month, 3, 6, and 12 months. ResultsA the T12 month follow up point the VAS average was 0.8 (range 0–3) in ORIF + CTR group compared to 1.2 (range 0–3) in the ORIF and NOT CTR. The MWS average was 98.7 (range 95–100) in ORIF + CTR group versus 97.6 (range 95–100) in ORIF no CTR group. There was no statistical significance (p > 0.5) between the two groups during the follow up period. Patients in the sixth month of ORIF + CTR had no suffering of the median nerve, while 31.58% of patients in ORIF and no CTR found to have carpal tunnel syndrome. ConclusionsRoutine release of the transverse carpal ligament at the time of fracture fixation may reduce the incidence of postoperative median nerve dysfunction.

Comparison of morphologic consequences of open and endoscopic carpal tunnel release

ObjectivesThe objective of this study is to evaluate the carpal canal morphologic consequences following endoscopic carpal tunnel release compared with open approach. Methods48 Patients with CTS were enrolled in our prospective trial. Participants were classified in 2 groups: 24 patients underwent open surgery technique and 24 underwent endoscopic carpal tunnel decompression. Carpal canal shape and volume, configuration and position of contents, were analyzed by using imaging techniques. ResultsPreoperative carpal canal volume in endoscopic patient group averaged 5.7±1.4 cc and 7.3±2.9 cc at 6 weeks postoperatively (28%±7%, p=0.018). In contrast preoperative carpal canal volume in open carpal tunnel release group averaged 4.9±1.1 cc (and increased to 6.2±1.7 cc at 6-week follow up investigation (36%±5%, p=0.002).Preoperative carpal arch width calculation in endoscopic carpal tunnel release group averaged 21.7±1.1mm and 21.5±1.9mm in open carpal tunnel release patients (p=0.6575). Postoperative carpal arch width measurements in endoscopic carpal tunnel decompression group averaged 22.6±4.1mm and 22.1±2.9mm in open carpal tunnel release patient population at 6-week follow-up investigation (p=0.628). ConclusionEndoscopic approach causes an increment in carpal canal volume comparable to open technique and provides equivalent anatomic outcomes and will produce at least equivalent long-term clinical relief.

Comparative Results of Standard Open and Mini Open, KnifeLight Instrument-Assisted Carpal Tunnel Release

The purpose of our study was to compare the results of standard open and mini open (approximately 1.5-cm incision), KnifeLight instrument (Stryker Instruments, Kalamazoo, Michigan, USA) assisted carpal tunnel release (CTR) concerning symptomatic, functional, and electrophysiological aspects, as well as complications during early and late postoperative follow-up. Seventy-five patients who did not improve with nonsurgical methods and were planned to undergo surgery were separated into two groups. Patients in the first group (n = 37) underwent surgery with standard open CTR (Group A); patients in the second group (n = 38) underwent surgery with mini open KnifeLight instrument assisted CTR (Group B). Preoperative and 6-month postoperative electrophysiological values and functional utilization of the operated hand of both groups were compared. Nerve conduction studies were used for electrophysiological evaluation, visual analog scale (VAS) was used for pain evaluation, symptom severity scale (SSS) was used for symptomatic evaluation, and functional status scale (FSS) was used to evaluate hand functions that are the part of the Boston Carpal Tunnel Questionnaire. All evaluations were done preoperatively and repeated at postoperative month 6. Also, to determine early effects of surgical procedures, SSS and FSS scales were repeated at postoperative week 2 and month 3. Groups were also compared for complications and need for reoperation. No significant difference was detected between the two groups at postoperative month 6 on VAS and electrophysiological values. Postoperative week 2 FSS and SSS scores of Group B were significantly lower than Group A. Although scores were lower in Group B at month 3, there was no statistically significant difference. Six months after surgery, no significant difference was detected between the two groups in mean SSS and FSS scores. Postoperative complications and reoperation rates were lower in Group B but the difference was not statistically significant. After 6 months the results of both techniques for CTR are comparable. Mini open KnifeLight instrument assisted CTR is easy to perform and is superior to standard open CTR in the early post-operative period.

Comparison of 2 Surgical Approaches for Volar Locking Plate Osteosynthesis of the Distal Radius

To determine whether a volar radial (Henry) exposure to the distal radius is associated with less median nerve dysfunction than a direct volar exposure of the distal radius through the carpal tunnel that has been abandoned due to median nerve problems. Over an 18-month period, all patients with distal radius fractures treated with volar locking plate osteosynthesis were consecutively integrated into this therapeutic study. A direct volar midline approach ulnar to the flexor tendons and median nerve including prophylactic carpal tunnel release (CTR) was routinely performed from July 2003 to December 2004 (CTR group). Due to median nerve problems, this approach was abandoned and a distal part of the classical Henry approach (HRY) through the flexor carpi radialis (FCR) tendon sheath was performed for volar locking plate osteosynthesis in a second period from April 2005 to May 2006 (HRY group). In this group, the carpal tunnel was released only in selected cases. Data were collected prospectively for both groups. Analysis included clinical examination, the Patient-Rated Wrist Evaluation, and radiological follow-up up to 1 year after surgery. Eighty-three patients entered the CTR group during the initial series. Thirty-one patients showed median nerve dysfunction 6 weeks after surgery. In the second period of observation, 91 patients entered the HRY group. The carpal tunnel was therapeutically decompressed in 18 patients, leaving the carpal tunnel untouched in 91 patients. Temporary median nerve paraesthesia was seen in 4 patients without CTR in the HRY group 6 weeks after surgery. After 1 year, persistent median nerve irritation was observed in 4 patients of the CTR group and none of the HRY group. Grip strength, range of motion, and Patient-Rated Wrist Evaluation were similar after 1 year. The direct volar approach to the distal radius with routine CTR should be abandoned because it was associated with an increased rate of temporary and persistent median nerve irritation compared to the distal part of the classic Henry approach in our series. Therapeutic III.

Endoscopic versus open carpal tunnel release: A short-term comparative study

Objective:To compare the results of endoscopic carpal tunnel release (CTR) with open CTR in patients with idiopathic Carpal tunnel syndrome (CTS).Materials and Methods:Seventy-one patients with CTS were enrolled in a prospective randomized study from May 2003 to December 2005. All patients had clinical signs or symptoms and electro-diagnostic findings consistent with carpal tunnel syndrome and had not responded to nonoperative management. Sixty-one cases were available for follow-up. Endoscopic CTR was performed in 30 CTS patients and open CTR was performed in 31 wrists (30 patients). Various parameters were evaluated, including each patient's symptom amelioration, complications, operation time, time needed to resume normal lifestyle and the frequency of revision surgery. All the patients were followed up for six months.Results:During the initial months after surgery, the patients treated with the endoscopic method were better symptomatically and functionally. Local wound problems in terms of scarring or scar tenderness were significantly more pronounced in patients undergoing open CTR compared to patients undergoing endoscopic CTR. Average delay to return to normal activity was appreciably less in group undergoing endoscopic CTR. No significant difference was observed between the endoscopic CTR group and open CTR group in regard to symptom amelioration, electromyographic testing and complications at the end of six months.Conclusion:Short-term results were better with the endoscopic method as there was no scar tenderness. Results at six months were comparable in both groups.

Comparison of Clinical Results of Minimal Incision Versus Endoscopic Carpal Tunnel Release

Purpose : The purpose of our study was to compare the clinical results of minimal incision carpal tunnel release with those of endoscopic release. Materials and Methods : We analyzed 27 patients (41 cases) who had been treated by minimal incision carpal tunnel release and 20 patients (29 cases) treated by single portal endoscopic carpal tunnel release. The average follow up period was 35.2 months. Results were compared between the two groups by assessing subjective satisfaction, postoperative symptoms, grip and pinch strength, two point discrimination and time to recovery. Results : According to Cseuz's criteria, the results were excellent or good in 38 cases (93%) in minimal incision carpal tunnel release group, and in 27 cases (93%) in the endoscopic carpal tunnel release group. Subjective symptoms, grip power, pinch strength, thenar muscle atrophy, two point discrimination test and recovery time were similar in the two groups. Conclusion : We suggest that minimal incision carpal tunnel release and endoscopic carpal tunnel release are equally efficient methods for the treatment of carpal tunnel syndrome.

透析患者における手根管症候群再発例の検討

Over a three year period (1994-1996), we performed 18 carpal tunnel releases in long-term hemodialysis patients. Six of these patients were a second carpal tunnel release group, with their symptoms recurring 1 to 8 years (mean: 4.3 years) after their first carpal tunnel release. In this study we reviewed the difference between the first carpal tunnel release group and the recurrent group.Although, there was no significant difference between the two groups in regard to preoperative objective symptoms and the number of distal motor latencies, complications appeared to be a prominent feature in the recurrent group.Microscopic examination showed amyloid depositions in the membranous tissue surrounding the median nerve in the recurrent group and this may cause the recurrence of symptoms.We conclude that it is necessary to follow patients after re-operation because factors which prevent recurrence are still unclear.