Carpal Tunnel Release In Patients Research Articles

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.

The Association of Perioperative Glycemic Control With Postoperative Surgical Site Infection Following Open Carpal Tunnel Release in Patients With Diabetes.

The primary goal of the study was to evaluate the association of hemoglobin A1c (HbA1c) levels in diabetic patients with the incidence of surgical site infection (SSI) following open carpal tunnel release (CTR). Our secondary objective was to calculate an HbA1c level in diabetic patients that predicted SSI after open CTR. A national private-payer insurance database was queried for patients who underwent open CTR using Current Procedural Terminology (CPT) code 64721. Patients who underwent concomitant procedures were excluded. Diabetic patients who had their HbA1c level checked within 3 months of surgery were stratified into 6 mutually exclusive groups based on HbA1c levels in 1.0 mg/dL increments from <6.0 to >10 mg/dL. The incidence of SSI was determined for each group by either a diagnosis or procedure for SSI within 1 year using CPT and International Classification of Diseases, 9th Revision (ICD-9) codes. A receiver operating characteristic (ROC) analysis was performed to determine an HbA1c level above which the risk of postoperative SSI was significantly increased. 7958 diabetic patients who underwent open CTR and had an HbA1c recorded within 3 months of surgery were assessed. The incidence of SSI within 1 year was associated with HbA1c levels. The inflection point of the ROC curve corresponded to an HbA1c level between 7 and 8 mg/dL. Increased HbA1c levels are associated with increased SSI rates in diabetic patients undergoing open CTR. A perioperative HbA1c between 7 and 8 mg/dL could serve as a threshold for an increased risk of SSI following open CTR.

Minimally Invasive Palmaris Longus Abductorplasty for Severe Carpal Tunnel Syndrome.

Camitz abductorplasty is the most commonly used tendon transfer in patients with severe carpal tunnel syndrome with significant muscle wasting and loss of opposition. This procedure requires a long incision in the palm to harvest a strip of palmar aponeurosis to lengthen the palmaris longus tendon, allowing it to reach the abductor pollicis brevis insertion. Several complications have been attributed to this extensive dissection in the palm. We describe a minimally invasive palmaris longus abductorplasty using a strip of free flexor carpi radialis tendon graft to achieve the necessary length. This can be done together with carpal tunnel release in patients with severe carpal tunnel syndrome.

Patient-Related Risk Factors for Infection Following Open Carpal Tunnel Release: An Analysis of Over 450,000 Medicare Patients

To establish the rate of postoperative infection after open carpal tunnel release (CTR) on a national level using an administrative database and define relevant patient-related risk factors associated with its occurrence. The PearlDiver patient records database was used to query the 100% Medicare Standard Analytic Files retrospectively from 2005 to 2012 for patients undergoing open CTR using Current Procedural Terminology code 64721. Postoperative infection within 90 days of surgery was assessed using both International Classification of Diseases, Ninth Revision codes for diagnoses ofpostoperative infection or pyogenic arthritis of the wrist and Current Procedural Terminology codes for procedures for these indications, including either open or arthroscopic irrigation and debridement. We used a multivariable binomial logistic regression model that allows for assessmentof the independent effect of a variable while controlling for remaining variables to evaluate which patient demographics and medical comorbidities were associated with an increasedrisk for postoperative infection. Adjusted odds ratios and 95% confidence intervals werecalculated for each risk factor, with P < .05 considered statistically significant. A total of 454,987 patients metall inclusion and exclusion criteria. Of these patients, 1,466 developed a postoperative infection, corresponding to an infection rate of 0.32%. Independent positive risk factors for infection included younger age, male sex, obesity (body mass index of 30 to 40), morbid obesity (body mass index greater than 40), tobacco use, alcohol use, and numerous medical comorbidities including diabetes, inflammatory arthritis, peripheral vascular disease, chronic liver disease, chronic kidney disease, chronic lung disease, and depression. The current study reinforced conventional wisdom regarding the the overall low infection rate after CTR and revealed numerous patient-related risk factors that are independently associated with an increased risk of infection after open CTR in patients enrolled in Medicare. Prognostic II.

Treatment outcome in patients with clinically defined carpal tunnel syndrome but normal electrodiagnostic test results: a randomized controlled trial

Little is known about treatment effect of carpal tunnel release in patients with clinically defined carpal tunnel syndrome (CTS), but normal electrodiagnostic test results (EDX). The aim of this study was to determine whether this category of patients will benefit from surgical treatment. 57 patients with clinically defined CTS and normal EDX were randomized for surgical treatment (n=39) or non-surgical treatment (n=18). A six-point scale for perceived improvement as well as the Boston Carpal Tunnel Questionnaire was completed at baseline and at follow-up after 6months. A significant improvement of complaints was reported by 70.0% of the surgically treated patients and 39.4% reported full recovery 6months after surgery. Furthermore, both Functional Status Score and Symptom Severity Score improved significantly more in the surgically treated group (p=0.036 and p<0.001, respectively). This study demonstrates that most patients with clinically defined CTS and normal EDX results will benefit from carpal tunnel release. Therefore, this group of CTS patients must not a priori be refrained from surgery.

Electrophysiological and functional outcome after carpal tunnel release in patients with carpal tunnel syndrome: A prospective evaluation

Background: The Carpal tunnel syndrome (CTS) is median nerve entrapment neuropathy at wrist and is one of the commonly diagnosed disabling condition of the upper extremity. The only scientifically established disease modifying treatment is carpal tunnel release (CTR). Electrophysiological study helps in detecting and aiding in the diagnosis of CTS and helps in determining level of improvement after release. Material and Methods: Two year Prospective Study conducted in Tata Main Hospital, Jamshedpur on 33 cases of carpal tunnel syndrome. All patients underwent open carpel tunnel release. Electrophysiological and functional outcome was assessed using Nerve Conduction Study (NCS) and Boston Carpal Tunnel Questionnaire (BCTQ) both preoperatively and at 1 month, 3 months and 6 months postoperatively. Results: The CTS was most common in age group 40-50 years. Females were more affected with the ratio of 7:1. Mean BCTQ score preoperatively was 2.9. Post-operative at 1 month it showed marked improvement in mean score to 1.83. At 3 and 6 month follow up it reduced to 1.58 and 1.51 respectively. NCS were assessed using mean values of Nerve sensory latency (NSL), Nerve Motor Latency (NML), Nerve Sensory Velocity (NSV), and Nerve Motor Velocity (NMV). Preoperative evaluation shows higher latency (NSL 5.23±0.88, NML 5.23±0.63) and lower velocity (NSV 30.12±3.09, NMV 30.28±4.30). Both of which improved following CTR with mean NSL 4.46±0.59, NML 4.72±0.47, NSV 39.55±1.93, and NMV 36.55±5.32 at 1 month. Further follow up at 3 and 6 month also showed significant improvement. Conclusions: Boston Carpal Tunnel Questionnaire is good tool to evaluate functional outcome after carpal tunnel release. Nerve Conduction Studies serve as a valuable tool to assess follow up as it can provide reassurance to the patient that their operation is successful and that there is further potential for clinical improvement.

The Effect of Hand Dominance on Patient-Reported Outcomes of Carpal Tunnel Release in Patients with Bilateral Carpal Tunnel Syndrome.

There is a paucity of studies in published literature that examines the effect of hand dominance on the resolution of symptoms following a carpal tunnel release. The objective of this study is to examine the effect of hand dominance on the resolution of symptoms following surgical decompression in patients with severe and moderate carpal tunnel syndrome. Bilateral carpal tunnel release (total 90 open and 84 endoscopic) was performed on 87 patients (11 males, 76 females) presenting with bilateral severe or moderate carpal tunnel syndrome of equal severity. Patient-reported outcome of resolution of symptoms were recorded, with patients followed up until complete resolution of symptoms or last recorded consultation (mean follow-up duration 11.4 months, range 3.1 to 32.4 months). In patients with bilateral severe carpal tunnel syndrome, a larger proportion of non-dominant hand (75.4%) achieved complete resolution compared to dominant hand (72.1%), and did so at a statistically shorter time (mean: 52.3 days) than the dominant hand (mean: 81.0 days). However, there was no statistically significant difference between proportion of patients and time taken before complete resolution of symptoms between dominant and non-dominant hand in patients with bilateral moderate carpal tunnel syndrome. Symptoms in the non-dominant hand resolved faster after carpal tunnel release in patients with severe carpal tunnel syndrome. We postulate that greater daily activity by the dominant hand compared to the non-dominant hand may be a contributing factor to its slower rate of symptoms resolution post-surgically in patients with bilateral severe carpal tunnel syndrome. This effect of hand dominance is not evident in post-surgical patients with moderate carpal tunnel syndrome.

Patient-reported outcomes of carpal tunnel release surgery in patients with bilateral severe carpal tunnel syndrome.

IV.

Neurophysiological recovery 5 years after carpal tunnel release in patients with diabetes.

The long-term results of neurophysiological recovery after carpal tunnel release in patients with diabetes have not been studied. Thirty-five patients with diabetes and carpal tunnel syndrome (CTS) were matched with 31 patients without diabetes who had idiopathic CTS, and 27 and 30 patients, respectively, participated in this follow-up study. Nerve conduction results at 5 years were compared with previously published results at baseline and 1 year. Significant neurophysiological improvement continued from 1 to 5 years after carpal tunnel release for patients with and without diabetes. However, wrist-palm sensory conduction velocity was still abnormal for 85% and 43% of patients with and without diabetes, respectively. Although diabetes had an impact on 4 of 10 measured neurophysiological parameters, the influence of peripheral neuropathy seemed insignificant. After carpal tunnel release, significant long-term neurophysiological improvement is possible for patients with diabetes, and it is not influenced by the presence of peripheral neuropathy. Muscle Nerve 56: E59-E64, 2017.

Outcomes Following Carpal Tunnel Release in Patients Receiving Workers' Compensation: A Systematic Review.

Carpal tunnel syndrome (CTS) is a common occupational pathology, representing a high percentage of workers' compensation (WC) claims. The literature was reviewed for all studies evaluating CTS outcomes including WC patients between 1993 and 2016. A total of 348 articles were identified; 25 of which met inclusion and exclusion criteria. A systematic review was generated; patient demographics, outcomes, and complications were recorded. Weighted averages were calculated for the demographic and outcome data. Categorical data such as complications were pooled from the studies and used to determine the overall complication rate. Statistical significance was determined between WC and non-WC cohorts when applicable with the chi-square statistic. The WC cohort included 1586 wrists, and the non-WC cohort included 2781 wrists. The WC cohort was younger and more often involved the dominant extremity. The WC cohort was less likely to have appropriate physical exam findings confirming diagnosis and electrodiagnostic studies. WC patients took almost 5 weeks longer to return to work, were 16% less likely to return to preinjury vocation, and had lower Standard Form (SF)-36 scores. Finally, WC patients had nearly 3 times the number of complications and nearly twice the rate of persistent pain. WC patients undergoing carpal tunnel release (CTR) fare poorly as compared with non-WC patients in nearly every metric. Higher rates of postoperative pain with delayed return to work can be anticipated in a WC cohort. In addition, WC patients receive suboptimal preoperative workup, and it is possible that unnecessary surgery is being completed in these cases. These findings are important to consider when treating the WC patient with CTS.

Can flexor tenosynovectomy and microsurgical epineurectomy improve clinical outcomes following open carpal tunnel release?

Introduction: The purpose of this study was to comparatively evaluate the clinical outcomes of open carpal tunnel release with or without flexor tenosynovectomy and epineurectomy for the treatment of idiopathic carpal tunnel syndrome. Methods: In this prospective single-blinded study, 61 wrists of 47 patients randomized to open carpal tunnel release without (Group-1) or with (Group-2) flexor tenosynovectomy and microsurgical epineurectomy. Physical examination including Phalen and Tinel’s signs, visible thenar atrophy, two-point discrimination, and grip strength measurement was performed. Visual Analogue Scale (VAS), Quick Disability of Arm Shoulder Hand (DASH) Questionnaire, Symptoms Severity Scale, Functional Status Scale, and electrophysiological study were assessed. Results: The increase in the grip strength and Quick Disability of Arm Shoulder Hand Questionnaire score were significantly better in flexor tenosynovectomy and microsurgical epineurectomy group. The average pre-operative two-point discrimination was 6.3 ± 2 mm in Group-1 and 5.8 ± 1.7 mm in Group-2. Post-operatively at the end of 12 months, the mean two-point discrimination was measured as 5.9 ± 1.6 mm in Group-1 and 5.6 ± 1.3 mm in Group-2. When we compare the two groups according to the changes in VAS, Quick-DASH, symptoms severity scale, and functional status scale, only Quick-DASH score improvement was significantly better in Group-2 (p < 0.05). Improvements in VAS, symptoms severity scale, and functional status scale did not differ significantly. Conclusion: We do not recommend routine flexor tenosynovectomy and microsurgical epineurectomy during open carpal tunnel release in patients with idiopathic carpal tunnel syndrome.

Clinical analysis of the correlation between preoperative severity and duration of symptoms and the outcomes of carpal tunnel decompression

Objective To investigate the relationship between the severity and duration of preoperative symptoms and the outcomes of carpal tunnel release in patients with carpal tunnel syndrome. Methods Forty patients of carpal tunnel syndrome treated from January 2013 to June 2014 were divided into two groups, namely symptom severity group and symptom duration group, based on the severity and duration of the symptoms. Postoperative recovery of these patients was assessed using carpal tunnel syndrome evaluation criteria after standard carpal tunnel release. The excellent and good recovery rate in each group was calculated. The distribution of excellent and good recovery was analyzed. Results In symptom severity groups the excellent and good recovery rate was 95.83% in the moderate group and 92.31% in the severe group. The difference was not statistically significant(P>0.05). However distribution of the recovery was quite different, showing more excellent recovery in the moderate group and more good recovery in the severe group. In symptom duration groups the recovery rates were not significantly different(P>0.05). Functional recovery of opposition was the best, followed by sensory recovery. Grip strength recovery was the poorest. Conclusion Preoperative duration of the symptoms does not affect the surgical outcomes in carpal tunnel syndrome patients. Surgical release can greatly improve functions in both moderate and severe carpal tunnel syndrome cases although better recovery is seen in moderate cases. Thumb opposition recovers the best, while grip strength recovery is the poorest. Key words: Carpal tunnel syndrome; Treatment outcome; Symptom duration; Symptom severity

Effects of Metabolic Syndrome on the Outcome of Carpal Tunnel Release: A Matched Case-Control Study

To compare outcomes of carpal tunnel release in patients with or without metabolic syndrome. In a prospective consecutive series, 35 patients with metabolic syndrome and surgically treated carpal tunnel syndrome (CTS) were age- and sex- matched with 37 control patients without metabolic syndrome. Grip, pinch strength, perception of touch with Semmes-Weinstein monofilament, and Boston Carpal Tunnel Questionnaires (BCTQ) were assessed preoperatively and at 3, 6, and 12 months postoperatively. Patients with metabolic syndrome had more severe electrophysiologic grade of CTS than those without metabolic syndrome, but the 2 groups had similar preoperative grip/pinch strength and BCTQ scores. The BCTQ symptom score for the metabolic syndrome group was significantly greater than that of the control group at 3 months, and the BCTQ function score of the metabolic syndrome group was significantly greater than that of the control group at 3 and 6 months' follow-up. However, there was no significant difference in BCTQ symptom or functional scores between groups at 12 months' follow-up. There was no significant difference in grip strength between groups through 12 months' follow-up whereas the pinch strength of the control group was significantly greater than that of the metabolic syndrome group at 12 months' follow-up. Semmes-Weinstein monofilament test results were significantly greater in the control group than in the metabolic syndrome group at 3 and 6 months' follow-up but were similar at 12 months. Patients with CTS and metabolic syndrome have delayed functional recovery after carpal tunnel release, but noteworthy improvements in symptom severity and hand function are similar to those in patients without metabolic syndrome 1 year after surgery. Prognostic II.

The Benefit of Carpal Tunnel Release in Patients With Electrophysiologically Moderate and Severe Disease

To compare change in numbness and pain after carpal tunnel release in patients with electrophysiologically moderate and severe disease. We tested the primary null hypothesis that there is no difference in the total Carpal Tunnel Symptoms Scale score 3 months after surgery between patients with moderate and those with severe disease. Ninety-five patients (47 in the moderate cohort, and 48 in the severe cohort) who had miniopen carpal tunnel release between November 2011 and November 2013 were identified from our prospectively collected database. For each patient, the total Carpal Tunnel Symptoms Scale score, as well the numbness and pain subscale scores, at the preoperative and postoperative (2-wk, 1-mo, 2-mo, 3-mo, ≥ 1-y) visits were documented. The data were analyzed with repeated-measures analysis of variance. Three months after surgery, patients with moderate carpal tunnel syndrome (CTS) reported, on average, no symptoms, and patients with severe disease had reduced but unresolved symptoms. Although symptoms diminished in both groups from the preoperative assessment to the 2-week postoperative assessment, patients with severe CTS had comparatively more severe symptoms at all time points with the exception of pain at 2 weeks and 1 year or longer after surgery, at which times there was no significant difference. At 1 year or longer after surgery, 1 (2%) patient with moderate CTS and 9 (19%) patients with severe CTS reported continued symptoms. Preoperative electrodiagnostic severity was the factor most predictive of symptom scores. Patients with severe CTS experience considerable reduction in symptoms after surgery but should be informed that recovery may be more prolonged and, in some cases, incomplete 1 year after carpal tunnel release, particularly with regard to numbness. Prognostic III.

Risk of Postoperative Infection Following Carpal Tunnel Release in Patients with Diabetes Mellitus

PURPOSE: The goals of this study were to determine the postoperative risk of infection in diabetic versus non-diabetic patients, as well as the influence of prophylactic antibiotics and HbA1c values. METHODS: Electronic charts of all patients undergoing carpal tunnel release from January 2002 to September 2012 at the Louis Stokes Cleveland VAMC were reviewed for incidence of postoperative infection. Infection was defined as any wound complication requiring the administration of antibiotics, excluding prophylactic antibiotics, or a diagnosis code of postoperative infection. The progress notes of any patient who received antibiotics perioperatively were further reviewed to determine the indication and subsequently classified as having a postoperative infection if appropriate. Charts were also reviewed for age at time of surgery, diabetic status at time of surgery, sex, and perioperative HbA1c. Statistics were performed with chi square and descriptive statistics. RESULTS: 528 patients underwent 658 surgeries. 260 (35.1%) cases had DM at the time of surgery. 92.2% of cases were male with a mean age of 62.2 years. Of all cases, 177 (26.9%) received perioperative antibiotics: 88 (49.7%) received these antibiotics as prophylaxis and 27 (15.3%) for SSI. The cases that received prophylactic antibiotics included 57 cases with DM and 31 without DM. Of patients with SSI, 8 (29.6%) were diabetic versus 19 (70.4%) non-diabetic (p>0.05). Overall, 3.1% of diabetic and 4.8% of non-diabetic patients experienced SSI. When patients with prophylactic antibiotics were excluded, 3.8% of diabetic and 4.9% of non-diabetic patients experienced SSI (p>0.05). Incidence of infection in diabetic patients was not significantly lower in patients on prophylactic antibiotics (p>0.05), nor in non-diabetic patients. Diabetic patients with HbA1c greater than or equal to 7% did not have significantly different risk of SSI compared to those with HbA1c less than 7% (p>0.05). SUMMARY: No significant differences were observed in the incidence of SSI following CTR in diabetic versus non-diabetic patients. These observations persisted when patients on prophylactic antibiotics were excluded from statistical analysis. Neither prophylactic antibiotic use nor strict glycemic control in diabetics is associated with a significantly decreased risk of SSI. CONCLUSIONS: Diabetic patients may not be at increased risk of SSI following CTR when compared to non-diabetic patients. Neither prophylactic antibiotics nor strict glycemic control may be warranted to improve the risk of SSI following CTR.

Risk of Postoperative Infection Following Carpal Tunnel Release in Patients With Diabetes Mellitus: A Review of 658 Surgeries: Level 3 Evidence

Diabetic and non-diabetic patients do not experience significantly different rates of postoperative surgical site infection following carpal tunnel release. Neither prophylactic antibiotics nor perioperative control of HbA1c to less than 7% are associated with a significantly lower risk of SSI.

Carpal Tunnel Release in Patients With Diabetes: A 5-Year Follow-Up With Matched Controls

To compare clinical outcomes 5 years after carpal tunnel release among patients with and without diabetes. In a prospective consecutive series, 35 patients with diabetes (median age, 54 y; 15type 1 and 20 type 2 diabetes) with carpal tunnel syndrome were age- and sex-matched with 31 control patients without diabetes (median age, 51 y) with idiopathic carpal tunnel syndrome. Exclusion criteria were other nerve entrapment, cervical radiculopathy, inflammatory joint disease, thyroid disorder, previous wrist fracture, and long-term exposure to vibrating tools. Participants were examined independently at baseline, 1 year, and 5 years after surgery for sensory function (Semmes-Weinstein), motor function (abductor pollicis brevis muscle strength and grip strength), cold intolerance, and completion of the Boston Carpal Tunnel Questionnaire symptom severity and functional status score. Five years after surgery, the overall attendance rate for clinical examinations and completion of the Boston Carpal Tunnel Questionnaire were 86% and 95%, respectively. Between 1 and 5 years after surgery, there was a tendency toward a decrease in sensory function but an increase in motor function, with no statistically significant difference between groups. Cold intolerance demonstrated long-term significant improvement for patients with diabetes. The improvement in symptom severity and functional status score, as well as the large effect size, were maintained at 5 years in both patient groups. Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes. Furthermore, improvement in cold intolerance in patients with diabetes suggests the potential for the long-term regeneration of small nerve fibers. Prognostic I.

Carpal tunnel release in patients with diabetes result in poorer outcome in long-term study

The aim of this prospective study was to compare the results of surgical decompression of carpal tunnel syndrome (CTS) in patients with diabetes mellitus with those with idiopathic CTS. The results of surgical decompression of CTS in 27 patients with diabetes mellitus were compared with 42 patients with idiopathic CTS. All patients underwent surgical release of transverse carpal ligament by the mini-incision of palm technique. Patient self-administered Boston Questionnaire (BQ) for the assessment of severity of CTS symptoms and hand functional status was evaluated before and 6 months and 10 years after surgery. After surgical release, all the patients of both groups reported an absence of pain, disappearance or reduction of paresthesia, and improvement in hand function. Six months after surgery, there was a significant improvement of symptomatic and functional BQ scores compared with preoperative state in both groups. Ten years after surgery, there was statistical difference in preoperative and postoperative 10th year functional BQ score between DM (-) and DM (+) (p < 0.01). DM status affected statistically functional BQ score between preoperative and postoperative 10th year. Diabetes mellitus was a risk factor for poor outcome of surgical decompression of CTS. Patients with diabetes had worse surgical outcome compared with patients with idiopathic CTS in long-term follow-up.

Clinical Outcomes of Endoscopic Carpal Tunnel Release in Patients 65 and Over

To examine outcomes of endoscopic carpal tunnel release (ECTR) in patients 65 and older. We hypothesized that this population could expect relief of pain, night pain/numbness, and numbness. A retrospective review was conducted of all patients 65 years of age and over who had ECTR for nerve conduction study-confirmed carpal tunnel syndrome (CTS) from October 2007 to July 2010. The charts were reviewed for demographic data, symptoms and physical findings, patient satisfaction, and 3 patient-reported outcome scores. Preoperative and postoperative results for pain, night pain/numbness, and numbness were compared. Logistic regression analysis was used to assess whether age influenced symptom resolution. Boston carpal tunnel, Short Form-36 and Disabilities of the Arm, Shoulder, and Hand scores were compared between patients with mild, moderate, or severe CTS. A total of 78 patients had ECTR. Their ages ranged from 65 to 93 years (mean, 73 y). Before surgery 69% of patients had constant numbness. Night pain/numbness was present in 65 patients before surgery, and 61 had complete resolution. All 70 patients who presented with pain reported complete relief by the 6-month follow-up. Following ECTR, the average Boston carpal tunnel symptom severity, functional status, and Disabilities of the Arm, Shoulder, and Hand scores were 1.5,1.5, and 13, respectively. At final evaluation, 79% of patients were very satisfied or satisfied with their outcome. A significant number of patients were found to have improvement in pain, night pain/numbness, and numbness following ECTR. This study has demonstrated relief of symptoms in a statistically significant number of patients following ECTR. We found that preoperative CTS severity, based on nerve conduction study result, did not significantly correlate with patient outcome following ECTR. Advanced symptoms at presentation do not preclude symptom resolution and should not be a contraindication to ECTR. Therapeutic III.

Diffusion tensor imaging of the median nerve before and after carpal tunnel release in patients with carpal tunnel syndrome: feasibility study

To evaluate diffusion tensor imaging (DTI) indices of the median nerve pre and postoperatively in patients with carpal tunnel syndrome (CTS) to determine whether indices acquired prior to surgery differ from those acquired postoperatively. Following IRB approval, ten patients with a diagnosis of CTS were prospectively recruited. Eight patients completed the study (seven women, one man). All had bilateral asymmetric symptoms, with subsequent carpal tunnel release on the more symptomatic side. DTI of both wrists were performed using single-shot spin-echo echo-planar imaging (TR/TE, 7,000/103ms; b value 1,025s/mm(2)) preoperatively, 6weeks and 6months after carpal tunnel release. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the median nerve at the level of the distal radioulnar joint and pisiform were determined by one investigator blinded to clinical data, side, and time relative to surgery. All patients had resolution of symptoms on the surgical side at 6months. A significant increase in FA (p = 0.018) and decrease in ADC (p = 0.017) were found proximally at 6months compared to baseline on the operative side. A significant increase in FA was observed on the operative side distally at 6weeks (p = 0.012) and 6months (p = 0.017). There was a significant difference in the percentage change in FA values from baseline to 6months on the operative side in comparison with the non-operative side (p = 0.017). A significant increase in FA and decrease in ADC of the median nerve are seen following decompression surgery in patients with CTS.