Carpal Tunnel Release In Patients Research Articles

Comparative Analysis of Comorbidities and Outcomes in Endoscopic versus Open Treatment of Carpal Tunnel Release in Patients with Rheumatoid Arthritis

Abstract Background: Rheumatoid arthritis (RA) is a known risk factor for carpal tunnel syndrome, possibly because the inflammation causes compression of the median nerve. Endoscopic and open carpal tunnel release (ECTR and OCTR) have been studied extensively in the general population but less so in patients with RA. The purpose of our study was to analyze outcomes and patient-specific comorbidities associated with ECTR and OCTR in patients with RA. Methods: We conducted a retrospective cohort study using the PearlDiver database to identify patients with RA who underwent either ECTR or OCTR between 2010 and 2014. Demographic data, comorbidities, and complication rates were analyzed. We used univariate and multivariable analysis to assess differences between the treatment methods. Results: Comparing 4,234 patients who underwent OCTR to 683 patients who underwent ECTR, we found no significant differences in medical comorbidities such as hypertension, obesity, chronic kidney disease, hypothyroidism, and diabetes mellitus. Patients who underwent ECTR were significantly more likely to require a repeat procedure within 90 days of the initial procedure. However, this difference was not consistent in multivariate analysis controlling for comorbidities. Conclusion: Our study found that RA and ECTR were identified as independent risk factors for revision release, with ECTR showing a higher likelihood of repeat procedures within 90 days compared with OCTR. Despite similar demographics and comorbidities in the two study cohorts, use of OCTR outpaced ECTR use in the study period. Future research should explore further characterization of repeat procedures in this higher risk patient subset.

Carpal tunnel release under local anesthesia with or without distal median nerve block: Double-blind randomized clinical trial

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity, and its surgical treatment is carpal tunnel release (CTR). It is mostly performed in local anesthesia. There are no clinical randomized controlled trials (RCTs) comparing local infiltration anesthesia with or without a distal median nerve block in CTR. The aim of the PERSONNEL trial (carPal tunnEl ReleaSe lOcal iNfiltratioN mEdian bLockade) is to assess whether a distal median nerve block reduces pain during and after the procedure in addition to local anesthesia. Methods: This is a single-center randomized clinical superiority trial comparing local anesthesia alone and local anesthesia with a distal median nerve block for CTR in patients with CTS. Adult patients will be randomized in one university hospital in Finland, and the intended sample size is 118. The primary outcome is the mean pain level after the procedure during 72 h using a visual analogue scale (VAS). The secondary outcomes include expected pain; pain during the injection of the anesthetic solution caused by pressure, burning, needle sting, and total pain; worst pain during the surgery; duration of anesthesia; number of experienced needle stings; Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ); pain killer consumption;, patient satisfaction using Net Promoter Score (NPS); and complications. Discussion: Patient satisfaction is a crucial factor in modern healthcare. A distal median nerve block may reduce pain during and after CTR, potentially increasing patient satisfaction with the given treatment. It can also be hypothesized that better postoperative pain control may prevent complications, for example, complex regional pain syndrome. However, we lack adequate evidence to justify the use of distal median nerve block, which can itself predispose patients to complications, for example, median nerve injury. Therefore, there is a need for adequate RCTs to assess its efficacy. The results of this study can be used to optimize anesthesia for carpal tunnel surgery, improve patient satisfaction, and possibly prevent complications. Registration: ClinicalTrials.gov NCT05372393.

Prophylactic Carpal Tunnel Release During Volar Plating of Distal Radius Fractures: A Review

PurposePatients who fracture their distal radius are at risk for developing carpal tunnel syndrome (CTS). Carpal tunnel syndrome occurs acutely; other patients may present with signs and symptoms of carpal tunnel syndrome weeks or months after the distal radius fracture. Because CTS may present in a delayed fashion after a distal radius fracture, some surgeons will perform carpal tunnel release in patients who undergo open reduction and internal fixation (ORIF) even in those patients who do not have clinical evidence of carpal tunnel syndrome – a prophylactic carpal tunnel release. In the current systematic review, we evaluated the literature regarding prophylactic carpal tunnel release in the setting of operative treatment of distal radius fractures. MethodsWe conducted our literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Figure 1).1 The search strategy reflected “prophylactic carpal tunnel release during treatment of distal radius fractures,” and was conducted in February 2024. Included studies are summarized in Table 1. Results6 studies met inclusion criteria. Publication dates ranged from 2001 to 2018. 5 studies investigated clinical symptoms and/or electromyography: 3 out of 5 studies found worsening or persistent median neuropathy, and 2 out of 5 studies found improvement or no further development of symptoms in their respective patient cohorts. The 6th study found no difference in patient reported outcomes between either approach. ConclusionsThere were no differences in wrist range of motion, post-operative grip strength, or patient reported outcomes within each of the study cohorts. Based on the findings from the studies included in this review, we do not believe that there is sufficient evidence supporting prophylactic CTR in the setting of operative treatment of distal radius fractures.

Radius palmar plate removal without carpal tunnel release: Correlation between plate position and median nerve symptoms

We aimed to report the clinical results of volar plate removal without carpal tunnel release in patients with late-onset median neuropathy and to evaluate the relationship between plate position and median nerve symptoms. Part I. Twelve consecutive patients with late-onset median neuropathy treated with volar plate removal without carpal tunnel release were enrolled for analysis. Pre- and post-operative Tinel sign, Phalen and Ten test, subjective rating of tingling sensation, Mayo wrist score and Disabilities of the Arm, Shoulder and Hand (DASH) score were collected. Part II. 232 consecutive patients underwent volar plating for distal radius fracture. The relationships between median nerve symptoms and volar plate prominence on the Soong classification, fracture classification, gender and age were investigated. All cases except one showed complete symptom resolution at final follow-up, with negative Tinel sign and Ten test score of 10/10. Tingling was rated 0 at final follow-up. Mean Mayo wrist and DASH scores improved to 86.7 and 23.1, respectively. The incidence of the median nerve symptoms in our cohort was 5.6%. Even though the odds ratio in Soong grade 2 was 4.0957 (95% CI, 0.93–16.9) compared to the combination of grades 0 and 1, no statistically significant relationship was found between the median nerve symptoms and volar plate prominence (p > 0.05). Plate removal without carpal tunnel release adequately relieved symptoms of late-onset median neuropathy after volar plating in patients with distal radius fracture. Level of EvidenceIV; Therapeutic.

Carpal Tunnel Release Performed during Distal Radius Fracture Surgery.

Background Carpal tunnel release (CTR) may be concomitantly performed along with distal radius fracture open reduction internal fixation (DRF ORIF) to prevent carpal tunnel syndrome; however, there is little to no literature investigating the rate, risk factors, and complications associated with CTR. Questions/Purposes The purpose was to determine (1) the rate of CTR performed at time of DRF ORIF, (2) factors associated with CTR, and (3) whether CTR was associated with any complications. Patients and Methods In this case-control study, adult patients who underwent DRF ORIF from 2014 to 2018 were identified from a national surgical database. Two cohorts were analyzed, (1) patients with CTR and (2) patients without CTR. Preoperative characteristics and postoperative complications were compared with determine factors associated with CTR. Results Of the 18,466 patients, 769 (4.2%) had CTR. Rates of CTR in patients with intra-articular fractures with two or three fragments were significantly higher than the rate of CTR for patients with extra-articular fractures. Underweight patients underwent CTR at a significantly lower rate compared with overweight and obese patients. The American Society of Anesthesiologists ≥3 was associated with a higher rate of CTR. Male and older patients were less likely to have CTR. Conclusion The rate of CTR at time of DRF ORIF was 4.2%. Intra-articular fractures with multiple fragments were strongly associated with CTR at time of DRF ORIF, while being underweight, elderly, and male were associated with lower rates of CTR. These findings should be considered when developing clinical guidelines to assess the need for CTR in patients undergoing DRF ORIF. This is a retrospective case control study and reflects level of evidence III.

Minimal Invasive Surgery by Wongsiri Technique versus Standard Open Carpal Tunnel Release: A Randomized Trial

Objective: To study the results of carpal tunnel release in patients with carpal tunnel syndrome with Minimal invasive surgery by Wongsiri technique compared to the standard open technique. Materials and Methods: Randomized trial in patients who released carpal tunnel into two groups with 20 patients each. The study group underwent minimally invasive surgery using the Wongsiri technique while the other group had the standard open surgery. Postoperative results at one month were compared for time to return to work, residual numbness, wound satisfaction, and complication such as hand stiffness, pillar pain, painful scar, and infection. Results: There were no statistically significant difference between the two groups of patients in gender, age, occupation, and duration of preoperative symptoms. The results one month after surgery showed that patients in the minimally invasive surgery group returned to work faster than the standard open surgery at 7.32±1.85 and 17.45±5.45 days, respectively (p<0.001). There was no difference in residual numbness at 1.80±0.57 and 1.69±0.49 (p=0.170). Patients in the minimally invasive surgery group were more satisfied with the wound cosmetic at 4.78±0.50 and 3.90±0.32 (p<0.001). Hand stiffness was found less in patients with minimally invasive surgery at 1 and 5 (p<0.001). There was no difference in pillar pain, with one and two cases (p=0.556). There was no painful scar, or infection. Conclusion: Minimally invasive carpal tunnel released by the Wongsiri technique is a surgical method that reduces hand stiffness. The patients returned to work quicker and were more satisfied with the wound cosmetic. Keywords: Carpal tunnel syndrome; Standard open carpal tunnel release; Minimally invasive carpal tunnel released; Wongsiri technique

Prevalence and Subtypes of Tenosynovial Amyloid in Patients Undergoing Carpal Tunnel Release

The purpose of this study was to determine the prevalence and subtypes of amyloid in tenosynovial biopsies of patients undergoing carpal tunnel release (CTR). A retrospective review was performed involving patients who underwent CTR from June 2020 to July 2021. Prior to this period, a protocol had been established to obtain routine intraoperative tenosynovial biopsies. Tenosynovium was preserved in formalin and stained with Congo red for amyloid. Positive specimens were sent to an external laboratory for confirmation and subtyping by mass spectrometry. Men 50 years or older and women 60 or older were included for analysis. Acute, traumatic, and revision cases were excluded. Of 185 patients who underwent CTR with tenosynovial biopsy, 54 (29%) demonstrated positive Congo red stain, confirmed by the external laboratory. A subtype analysis revealed wild-type transthyretin (TTR) in 44 patients (80%), mixed wild-type TTR with κ light chains in 1 patient, and hereditary TTR in 1 patient. Patients with positive specimens were significantly older than those who tested negative (77 vs 68 years, respectively), and positivity increased by decade for both sexes. Male sex, atrial fibrillation, and spinal stenosis were significantly more prevalent among positive cases. There were no complications from the biopsies. We confirmed evidence of amyloidosis in the tenosynovium of 29% of men 50 years or older and women 60 or older who underwent CTR. The majority demonstrated wild-type TTR. As these patients are at risk of developing cardiomyopathy, there is an opportunity for early detection, monitoring, and interventions known to improve outcomes. Considering the low cost of Congo red staining and the potential value of subtyping with regard to treatment of cardiomyopathy, our findings support routine tenosynovial biopsy during CTR in patients who meet the age criteria. Differential diagnosis or symptom prevalence study II.

A Systematic Review of the Outcomes of Carpal Ligament Release in Severe Carpal Tunnel Syndrome

Indications for surgical treatment of severe carpal tunnel syndrome (CTS) are controversial. The aim of this study was to review the outcomes reported in the literature of carpal tunnel release in patients with severe CTS. A systematic review of the outcomes of carpal tunnel release in patients with severe CTS was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome measures included change in symptoms, sensation (2-point discrimination, light touch), thenar atrophy, strength (power and pinch grip), electrophysiology, median nerve morphology, and patient-reported outcome measures. Outcomes are reported by ranges of the percentage of patients/hands improved in the included studies. Thirty-eight papers were selected, representing 2,531 patients and 2,712 hands. Demographic information on age and sex were available for a total of 1,542 patients. Mean age ranged from 49.8 to 83 years and 72% were female. All studies that assessed patient-reported outcome measures before and after surgery reported significant improvements. Complete resolution of paresthesia occurred in 55%-98% of hands across different studies. Resolution of numbness occurred in between 39% and 94% of hands. Pain completely resolved in 64%-100% and weakness in 60%-75% of hands. Two-point discrimination and light touch improved postoperatively. Power grip, key, tripod, index-thumb pulp pinch, and thumb opposition increased. Motor and sensory amplitudes, distal motor latencies, and sensory conduction velocities improved. Patient-reported outcomes indicated symptomatic improvement and reduced disability. Symptomatic improvement following carpal tunnel release in patients with severe CTS can occur. Patients should be counseled about the unpredictability of the outcomes and factors that might affect outcomes. Therapeutic IV.

Function of Microscopic Carpal Tunnel Release in Cases Resistant to Conservative Therapy

Purpose: To determine the outcome of microscopic carpal tunnel release in patients with carpal tunnel syndrome who failed to respond to conservative treatment.
 Methodology: This descriptive case series was carried at Department of Neurosurgery, D.H.Q Hosptial Charsadda over 1 year from Jan 2019 to Dec 2020, indicate the sampling method used to select the study participants involving 94 patients; both men and women with ages in the range 30-70 years diagnosed of carpal tunnel syndrome who failed to respond to conservative treatment and were planned for surgical release. Microscopic CTS release was performed and outcomes were assessed in terms of improvement in VAS score for wrist pain, symptom severity score and function status scale 3 and 6 months after the surgery. Recurrence of symptoms was also noted. A written informed consent was obtained from every patient. Indicate the method of data collection and data analysis
 Findings: The mean age of the patients with carpal tunnel syndrome was 41.6±7.9 years. There was slight female predominance with male to female ratio of 1:2.1. History of diabetes was recorded in 29 (31.0%) patients while 34 (37.0%) patients were obese. Right hand was more frequently involved (53.0%) than the left hand (47.0%). The mean VAS score for wrist pain reduced from 7.9±1.2 at baseline to 1.8±0.7 3 months after the surgery (p- value<0.001). Similar improvements were also noted in symptom severity score (3.8±0.8 to 1.6±0.8; p- value<0.001) and function status scale (2.7±0.8 to 1.5±0.8; p-value<0.001) at the end of 3 months after the surgery. Recurrence was not observed in any patient at the end of 6 months follow-up.
 Recommendation: Microscopic carpal tunnel release was found to relieve patient’s symptoms and improve wrist function yet with minimal scarring and without recurrence which advocates its preferred use in future practice provided necessary surgical skills and hardware are available.

Dynamic Ultrasound Assessment of Median Nerve Mobility Changes Following Corticosteroid Injection and Carpal Tunnel Release in Patients With Carpal Tunnel Syndrome.

Decreased median nerve (MN) mobility was found in patients with carpal tunnel syndrome (CTS) and was inversely associated with symptom severity. It is unclear whether MN mobility can be restored with interventions. This study compared the changes in MN mobility and clinical outcomes after interventions. Forty-six patients with CTS received an injection (n = 23) or surgery (n = 23). Clinical outcomes [Visual Analogue Scale; Boston Carpal Tunnel Questionnaire (BCTQ), which includes the Symptom Severity Scale and Functional Status Scale; median nerve cross-sectional area; and dynamic ultrasound MN mobility parameters (amplitude, and R2 value and curvature of the fitted curves of MN transverse sliding)] were assessed at baseline and 12 weeks after the interventions. At baseline, the BCTQ-Functional Status Scale and median nerve cross-sectional area showed significant inter-treatment differences. At 12 weeks, both treatments had significant improvements in BCTQ-Symptom Severity Scale and Visual Analogue Scale scores and median nerve cross-sectional area, but with greater improvements in BCTQ-Functional Status Scale scores observed in those who received surgery than in those who received injections. MN mobility was insignificantly affected by both treatments. The additional application of dynamic ultrasound evaluation may help to discriminate the severity of CTS initially; however, its prognostic value to predict clinical outcomes after interventions in patients with CTS is limited.

Effects of diabetes mellitus on the rate of carpal tunnel release in patients with carpal tunnel syndrome

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.

Long-Term Outcomes and Mortality Following Carpal Tunnel Release in Patients Older Than 80 Years of Age

The objectives of this study were 1) to assess the long-term patient-reported outcomes of carpal tunnel release (CTR) in patients 80 years of age or older, and 2) to determine the long-term mortality rate of this population after CTR. We performed a retrospective study of 96 patients who underwent CTR at 80 years of age or older from July 2008 to June 2013. Mortality was assessed by medical records, the Social Security Death Index, and telephone contact. Living patients were contacted for long-term follow-up, and functional outcomes and patient satisfaction were assessed. The mean age of the 96 patients at time of CTR was 84.1 years, including 89 octogenarian patients and 7 nonagenarian patients, and 67% were female. At an average of 9 years from surgery, the mortality rate of our cohort was 53% (51 of 96 patients). Five patients died within 1 year after CTR; no factor associated with early mortality after CTR was identified in the bivariate analysis. Telephone follow-up at an average of 9 years after CTR was available for 15 patients. Mean Boston Carpal Tunnel Syndrome Questionnaire symptom severity score was 1.6 points, mean Boston Carpal Tunnel Syndrome Questionnaire functional status score was 1.8 points, mean Quick Disabilities of the Arm, Shoulder and Hand score was 27.9, and mean satisfaction was 7.1. Eighty percent of patients reported that they would rechoose CTR. There are long-term benefits from CTR in patients 80 years of age or older. The mortality rate of this cohort mirrors that of the general population, and CTR is justified in this elderly age group both for the magnitude and duration of treatment effect.

Ultrasound of the Median Nerve in the Surgical Treatment of Severe Carpal Tunnel Syndrome.

High-resolution ultrasound (HRU) has demonstrated utility in the diagnosis and treatment of carpal tunnel syndrome (CTS) by measuring the cross-sectional area (CSA) of the median nerve. We investigated whether HRU could be helpful in evaluating outcomes of carpal tunnel release in patients with severe CTS. Patients greater than 18 years of age with severe CTS on electrodiagnostic (EDX) studies and scheduled to have carpal tunnel release were enrolled. At baseline visit within 6 weeks preoperatively, HRU was used to measure median nerve CSA at the carpal tunnel inlet and forearm, and the wrist/forearm ratio (WFR) was calculated. Patients also completed the Boston Carpal Tunnel Questionnaire (BCTQ). Ultrasound and BCTQ were repeated at 6 weeks and 6 months postoperatively. Twelve patients completed the study (average age, 69 years; range, 52-80 years). The WFR improved significantly at 6 weeks and reached normal levels at 6 months. The CSA at the wrist also improved at 6 months, although this did not reach statistical significance (P = .059). Boston Carpal Tunnel Questionnaire symptoms and function scores improved significantly at 6 weeks and 6 months. High-resolution ultrasound provides an objective assessment of surgical outcomes in cases of severe CTS, demonstrating normalization of WFR in our series of successful cases. Future study of poor outcomes may help determine whether improvement in WFR and CSA can provide reassurance and support for observation rather than reoperation. Ultrasound also provides anatomical evaluation and may be helpful in cases with medicolegal or psychosocial issues while potentially being less costly and better tolerated than EDX or magnetic resonance imaging.

Outcome of carpal tunnel release in patients with normal nerve conduction studies

BackgroundWe evaluated outcome after carpal tunnel release (CTR) in patients with clinically diagnosed carpal tunnel syndrome (CTS) but normal results in nerve conduction studies (NCS), and compared these results with those from a prospective group of patients with NCS-verified CTS. MethodsOver a 5-year period, we prospectively included 103 patients with clinical CTS. NCS were done at inclusion, with surgeon and patient being kept blind regarding the result. The patients underwent endoscopic CTR. QuickDASH and satisfaction score were recorded preoperatively and 4 months after surgery. 94 patients, 47 of whom had NCS-verified CTS, completed the study. ResultsA significant improvement in QuickDASH score (18 and 20 points respectively, p < 0.01) was found for both groups. Satisfaction score was significantly higher in the group with NCS-verified CTS. However, the overall satisfaction rates were 87% in the normal NCS group and 95% in the group with abnormal NCS. ConclusionsClinical outcome after CTR in patients with normal NCS was favourable and similar to that obtained in patients with NCS-verified CTS. Nonetheless, patients with normal result in NCS gave a lower satisfaction score.

Outcomes of Patients with and without Nighttime Awakening Symptoms After Carpal Tunnel Release.

Background: A common symptom associated with carpal tunnel syndrome (CTS) is nighttime awakening (NTA), which typically resolves quickly following carpal tunnel release (CTR). The early improvement in those who do not wake-up at night is less clear. This study investigates outcomes following CTR in patients with preoperative NTA symptoms compared to those without at 6 weeks and 3 months. Methods: Patients diagnosed with CTS who proceeded with CTR and agreed to participate in a prospective study completed the Boston Carpal Tunnel Questionnaire (BCTQ) and Michigan Hand Outcome Questionnaire (MHQ) at their preoperative appointment and 6-week and 3-month follow-ups. We compared outcomes between time points for improvement. Results: Of 45 patients, 37 patients with NTA had BCTQ scores of 3.09, 1.86, and 1.50 at preoperative, 6-week, and 3-month follow-up, respectively, and MHQ scores of 56.68, 74.91, and 81.01. NTA patients had improvement of both BCTQ and MHQ at 6 weeks and 3 months. Nonawakening patients had BCTQ scores of 2.58, 2.15, and 1.86 and MHQ scores of 57.94, 62.71, and 72.16, respectively. This cohort did not have significant improvement of MHQ at 6 weeks, but did at 3 months. The BCTQ severity scores in the nonawakening patients had significant improvement at both 6 weeks and 3 months, but did not at either time point for the BCTQ functionality scores. At 6 weeks, 2/37 patients continued to have NTA and no patients had NTA at 3 months. Conclusion: Patients with CTS and NTA symptoms had significant improvements in BCTQ and MHQ at 6 weeks and 3 months. Patients who did not awaken at night did not have significant improvements when evaluating BCTQ functional results, although they did improve when analyzing for BCTQ for symptom severity and MHQ, but not to the same level as those that do awaken and improvement was slower based on MHQ scores.

The Risk of Complications after Carpal Tunnel Release in Patients Taking Acetylsalicylic Acid as Platelet Inhibition: A Multicenter Propensity Score-Matched Study.

Carpal tunnel release is one of the most common procedures in hand surgery. There is only scarce evidence regarding whether platelet inhibitors increase the risk of developing postoperative hemorrhage in carpal tunnel release. This is a multicenter, propensity score-matched study including 635 carpal tunnel releases in 497 patients. Multivariate regression models were adjusted with the propensity score, which was developed to mitigate differences in patients with and without platelet inhibition with acetylsalicylic acid. Propensity score matching provides results close to the statistical quality of randomized controlled trials. The primary study endpoint was postoperative bleeding complication, defined as acute bleeding leading to reoperation or hematoma leading to physician visit. Patient satisfaction, functional outcome measured with the Boston Carpal Tunnel Questionnaire, and onset of surgical-site infection were also analyzed. Bleeding complications were observed in 56 procedures (8.8 percent). After propensity score matching, there was no significant difference between the patients with and without acetylsalicylic acid treatment (p = 0.997). History of thyroid disease (p = 0.035) and of rheumatoid arthritis (p = 0.026) were independent risk factors, whereas higher body mass index might have a beneficial effect (p = 0.006). Patients with postoperative bleeding had significantly impaired functional outcome as measured with the Boston Carpal Tunnel Questionnaire (p = 0.026). Median satisfaction in the investigated study population was 10 of 10 points and did not differ significantly between the antiplatelet and the non-antiplatelet cohorts (p = 0.072) CONCLUSION:: Carpal tunnel release under platelet inhibition with acetylsalicylic acid is safe and can be performed without interruption of such medication. Therapeutic, III.

Subjective Outcomes of Carpal Tunnel Release in Patients with Diabetes and Patients without Diabetes

Introduction This study aims to compare the subjective outcomes of carpal tunnel surgery in the patients with diabetes and patients without diabetes, and it tries to determine the difference between insulin-dependent and noninsulin-dependent patients.Materials and Methods This retrospective cohort study compares subjective outcomes of 35 patients with type 2 diabetes and 35 patients without diabetes who had a unilateral carpal tunnel release. None of the patients with diabetes had neuropathy. All the patients had surgery by a single surgeon with miniopen incision under local anesthesia. The patients were evaluated before surgery and 6 months after surgery using two Brigham and Women's Carpal Tunnel QuestionnairesResults Carpal tunnel release was improved based on symptom severity scale (SSS) and functional status scale scores in patients with diabetes and nondiabetic patients. However, the mean SSS scores were higher in patients without diabetes 6 months after the surgery. Comparison between the mean SSS scores of the patients with diabetes showed higher scores in noninsulin-dependent patients. In patients with diabetes, SSS scores were positively correlated with carpal tunnel syndrome and diabetes durations.Conclusion The outcomes of carpal tunnel release were improved in both patients with diabetes and patients without diabetes suffering from median nerve compression at the wrist. However, the duration of diabetes and its treatment can be related to the severity of the disease symptoms after the carpal tunnel releasing surgeries. In some diabetic patients, the severity of the symptoms was persistent.Level of Evidence This is a prognostic level IV study.

Utility of local anesthesia for open carpal tunnel release in patients with psychiatric diagnoses

PurposeCarpal tunnel release, one of the most commonly performed procedures in Veterans Affairs (VA) medical centers, is often performed under local anesthesia alone. In this patient population, there is an increased prevalence of psychiatric disorders. Our hypothesis is that there is no difference in operating time, request for sedation, or complications in the veteran population with or without a recognized psychiatric history. MethodsA retrospective cohort study was performed at a VA medical center from January 2013 to January 2017 by the senior surgeon (E.S.L). Patients were divided into two groups: patients with no known psychiatric history (n = =33) and patients with an active psychiatric diagnosis (n = =25), including post-traumatic stress disorder, anxiety disorder, bipolar disorder, depression, substance abuse, or panic disorder. Primary endpoints included operation time, time in operating room, request for sedation, and complication rates. ResultsFifty-nine percent of patients successfully underwent wide-awake hand surgery, while 41% requested sedation. Patients with no known psychiatric history had a 45.5% rate of requesting sedation compared to 36% in those with a psychiatric diagnosis. No patients converted from wide-awake surgery to sedation. There was no statistically significant difference in operation time, time in the operating room, need for sedation, or complication rate between all groups. ConclusionsWide-awake hand surgery is an excellent technique that can be safely used in patients with a history of psychiatric illness. Without the need for monitored anesthesia care, the cost for carpal tunnel releases done in military medical centers could decrease dramatically. Type of StudyPrognostic Level of EvidenceLevel II

Outcomes of Mini-Open Carpal Tunnel Release in Patients With Unrecordable Preoperative Nerve Conduction Potentials at a Minimum of 5 Years

Background: The aim of this study is to assess the outcomes of carpal tunnel release (CTR) in a cohort of patients with preoperatively unrecordable median nerve sensory and motor potentials in comparison with historical controls at minimum 5-year follow-up. Methods: We retrospectively identified 1297 patients who underwent CTR at a tertiary care referral center from July 2008 to June 2013. After exclusion criteria and review of available preoperative nerve conduction studies, 24 patients who underwent CTR with preoperative unrecordable sensory and motor nerve potentials were identified. Fifteen living, mentally capable patients were contacted by telephone for follow-up. Our primary outcome measure was the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Secondary outcome measures included Disabilities of the Arm, Shoulder, and Hand (DASH) score, pain on a 0 to 10 Likert scale, and satisfaction on a 0 to 10 Likert scale. Results: Our response rate was 80% (12 out of 15) of eligible patients. Mean follow-up was 6.9 years in our study (range, 5.4-9.5 years). The mean BCTQ symptom score was 1.4, and the mean BCTQ functional score was 1.8. Mean DASH score was 15.2. On average, patient-reported pain was 0.3 and satisfaction was 8.3. No difference was found in outcomes of CTR in patients with end-stage carpal tunnel syndrome compared with historical means. Conclusions: Patients with end-stage carpal tunnel syndrome do not have worse long-term patient-reported outcomes after CTR compared with the general population. Unrecordable nerve potentials are not a contraindication for CTR.

Ultrasound-guided percutaneous carpal tunnel release in patients on hemodialysis: early experiences and clinical outcomes.

Purpose: The purpose of the current study was to evaluate the effectiveness of ultrasound-guided percutaneous carpal tunnel release in hemodialysis patients with carpal tunnel syndrome.Methods: From February 2009 to April 2013, a prospective review of 113 consecutive cases of ultrasound-guided percutaneous carpal tunnel release was carried out in 84 hemodialysis patients. Results were analyzed by clinical subjective scale, two self-administered questionnaires, and functional evaluations at seven time points (1 week and 1, 3, 6, 12, 18, and 24 months).Results: Satisfactory symptom improvement in patients was 82%, 80%, 86%, 89%, 90%, 91%, and 90% at 1 week and 1, 3, 6, 12, 18, and 24 months postoperatively, respectively. Moderate pain was suffered in 11.5% of patients within 1 week, 8.8% within 1 month, 2.7% within 3 months, and none after 12 months postoperatively. Static two-point discrimination and Semmes–Weinstein monofilament examinations presented significant improvements after 1 week and 1 month postoperatively and with time. Postoperative grip power demonstrated recovery and a significant increase after 3 and 6 months postoperatively. Three-jaw chuck-pinch strength showed significant increase after 1 month postoperatively. There were no operative complications.Conclusion: Ultrasound-guided percutaneous carpal tunnel release is an effective and safe procedure in hemodialysis patients with carpal tunnel syndrome. The advantages include a less invasive procedure, no tourniquet needed, only limited infiltration anesthesia, minimal soft-tissue exploration, and relatively short operation time. Our data suggest this technique can reliably relieve clinical symptoms, with early restoration of grip and pinch strength.