Open Carpal Tunnel Release Surgery Research Articles

Carbon Footprint of Open Carpal Tunnel Release Surgery Performed in the Procedure Room Versus Operating Room Setting.

Environmental sustainability is an important issue in health care because of large amounts of greenhouse gases attributable to hospitals. The operating room has been highlighted as one of the highest contributors, prompting several initiatives by organizations focused on the care of hand and upper extremity conditions. This study aimed to quantify and compare the carbon footprint of a common hand surgery in two different surgical settings, the procedure room (PR) and operating room. We hypothesized that open carpal tunnel release (oCTR) will generate a greater environmental impact in the operating room than in the PR. This was a retrospective review of oCTRs performed at a tertiary care medical center. Current procedural technology codes isolated a single cohort of patients who underwent bilateral oCTR, one side performed in the PR and the contralateral side in the operating room. Current published emission conversions were used to calculate carbon footprint at our institution based on energy expenditure necessary for the creation and disposal of waste and sterilization of surgical equipment. Surgery time was combined with heating, ventilation and air conditioning/lighting energy consumption to estimate facility emissions. Fourteen patients had bilateral oCTR surgery performed in both settings. Open CTR performed in the operating room generated 3.7 kg more solid waste than when performed in the PR. In total, emissions from oCTR performed in the operating room generated 32.4 kg CO2, whereas oCTR in the PR emitted 13.0 kg CO2 per surgery. Performing a common hand procedure (oCTR) is more environmentally sustainable in the PR than in the operating room, with a 60% reduction in carbon footprint. Greater effort should be made to perform surgery in the PR instead of the operating room in appropriately indicated patients. Surgical sets should be evaluated for the necessity of included equipment and unnecessary waste.

Wrist & Hand

The April 2024 Wrist & Hand Roundup360 looks at: Lunocapitate versus four-corner fusion in scapholunate or scaphoid nonunion advanced collapse: a randomized controlled trial; Postoperative scaphoid alignment, smoking, and avascular necrosis determine outcomes; Grip strength signals broader health concerns in females with distal radius fractures; Clearing the smoke: how smoking status influences recovery from open carpal tunnel release surgery; Age matters: assessing the likelihood of corrective surgery after distal radius fractures; Is pronator quadratus muscle repair required after anterior plate fixation for distal radius fractures?; Efficacy of total wrist arthroplasty: a comparative analysis of inflammatory and non-inflammatory arthritis outcomes; A comprehensive review of the one-bone forearm as a salvage technique.

The Effect of Proprioceptive Training on Hand Function and Activity Limitation After Open Carpal Tunnel Release Surgery: A Randomized Controlled Study

ObjectiveTo investigate the effect of proprioceptive training on hand function and activity limitation in patients undergoing open carpal tunnel release surgery. DesignRandomized controlled study. SettingA university hospital. ParticipantsThirty patients were included in the study and randomized to proprioceptive training (PT) and conventional rehabilitation (CR) groups. InterventionOne week after surgery, both groups received CR for 6 weeks. All participants were asked to perform home-based exercises daily in 3 sets with 10 repetitions. For the PT group, a 6-step PT program was conducted starting from Week 6. Both groups received face-to-face interventions twice a week for 12 weeks. Main Outcome MeasuresThe outcome measures included the Purdue Pegboard Test (PPT), the joint position sense test (JPST), the Boston Carpal Tunnel Questionnaire, and the Patient-Specific Functional Scale. In total, 3 assessments were performed (at 1, 6 and 12 weeks postoperatively). ResultsIn the PT group, the results for PPT were statistically significant (P<.05). Although there was a greater decrease in the absolute angular error value (JPST) of the PT group compared to the CR group, the difference was nonsignificant (P>.05). Similar reductions in activity limitation were seen in both groups (PT: 176%, CR: 175%). Symptom severity decreased by 40% in the PT group vs 32% in the CR group. The effect sizes were larger for the changes between the second and third assessments in the PT group compared to the CR group in all parameters tested. ConclusionWhen applied after carpal tunnel release surgery, PT may potentially to improve hand functions, reduce activity limitation, increase participation in activities of daily living, and thus improve quality of life.

Surgical outcome of open carpal tunnel release: A 2-year case series study at Zliten Teaching Hospital, Libya

Carpal tunnel syndrome (CTS) is the most commonly diagnosed peripheral neuropathy, with a prevalence of 1 &amp;ndash; 16% within the general population. If left untreated, it can lead to permanent dysfunctionality and disability. This study aimed to determine the outcomes and complications associated with open carpal tunnel release surgery (OCTR), compare the presentation of CTS symptoms before and after the operation, and investigate the factors contributing to post-operative complications. To achieve these objectives, a case series design was employed, and the study was conducted at the Department of Orthopedics and Traumatology in Zliten Teaching Hospital, Libya, from January 2016 to December 2018. A total of 256 patients who had opted to undergo OCTR of the transverse carpal ligament during the preoperative stage were enrolled and prospectively followed up for 2 years. The post-operative follow-up analysis revealed a statistically significant reduction in symptoms such as dull aching discomfort in the hand and forearm, as well as paresthesia and numbness when compared to the pre-operative period (10.2% vs. 90.5%; P &lt; 0.0001). However, there were no significant differences in clumsiness (18.8% vs. 25.8%; P = 0.256) or thenar muscle atrophy (1.6% vs. 5.0%; P = 0.194). The majority of the patients (90.6%) expressed high levels of satisfaction with the procedure, reporting no recurrence of symptoms. In contrast, only 9.4% of patients experienced post-operative complications. The study findings revealed no significant correlation between post-operative complications and body mass index (P = 0.194). Nonetheless, a statistically significant association was observed between the severity of nerve conduction and post-operative complications (P = 0.011). In summary, the open release of the transverse carpal ligament resulted in positive surgical outcomes.

Use of Tourniquet Under Sedation Anesthesia or the Walant Techniques in Bilateral Carpal Tunnel Surgery: A Comparative Analysis

Aim: The objective of the study was to compare the outcomes and patient satisfaction of two different anesthesia techniques; wide-awake-local anesthesia-no tourniquet (WALANT) and sedation anesthesia with a tourniquet, in open carpal tunnel release surgery for bilateral cases.&#x0D; Material and Methods: The study included 57 patients (41 female, 16 male) who underwent carpal tunnel release surgery between January 2016 and September 2021. The files were retrospectively evaluated and included in the present study. Patient evaluations were conducted using QuickDASH and Michigan Hand Outcomes Questionnaire scores before surgery, on the 15th day after suture removal, and at six months postoperatively. Surgical duration and complications were also recorded. Statistical analyses were performed to compare the outcomes between the two groups.&#x0D; Results: Both QDash and MHQ scores were analyzed for anesthesia effects on hands. The study's reliability was ensured by an 85% statistical power, 95% confidence level, and p

The effect of Centella Asiatica cream on scar development in patients who underwent open carpal tunnel release surgery

AimTo evaluate the efficacy of the Centella asiatica extract in a cream preparation for the prevention of scar tenderness formation in patients who underwent conventional open carpal tunnel release (CTR) surgery. Material and MethodsA total of 280 patients with carpal tunnel syndrome who underwent CTR surgery were individually randomized into the intervention (n = 140) and control (n = 140) groups. In the intervention group, a petroleum cream mixture consisting of 1% Centella asiatica extract was applied to the patients’ wrist for 6 months after the sutures were removed. In the control group, no intervention was applied. The Vancouver Scar Scale (VSS), Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) functional score, and Visual Analog Scale (VAS) satisfaction scores were assessed preoperatively and postoperatively. Follow-up evaluations were scheduled at 1, 3 and 6 months after CTR surgery. ResultsThe overall VSS score of the intervention group significantly improved at 3-6 months (-1.260, p = .040). At 6 months after surgery, the mean QuickDASH functional score was 18.54 (range 0.00-63.64, SD 17.4) in the intervention group and 28.70 ± 12 (range: 2.27-40.91) in the control group (p < .04). At 6 months after surgery, the mean VAS satisfaction score was 1.46 ± 1.95 (range: 0-4) in the intervention group and 2.48 ± 1.02 (range: 0-4) in the control group (p < .03). ConclusionThe Centella asiatica cream applied to the wrist after CTR surgery was found to be beneficial in preventing scar tenderness in the thenar and hypothenar regions of the hand.

Modelling and in vivo evaluation of tendon forces and strain in dynamic rehabilitation exercises: a scoping review

ObjectivesAlthough exercise is considered the preferred approach for tendinopathies, the actual load that acts on the tendon in loading programmes is usually unknown. The objective of this study was to...

“A RANDOMIZED CONTROLLED TRIAL OF OPEN CARPAL TUNNEL RELEASE SURGERY VS LOCAL STEROID INJECTION FOR CARPAL TUNNEL SYNDROME”

BACKGROUND: Carpal tunnel syndrome (CTS) is the most prevalent form of peripheral nerve entrapment and a leading cause of occupational impairment. Non-surgical and surgical treatment options are the two basic types of treatment. Steroid injection does not improve symptoms like surgery according to the previous researches. Nevertheless, additional research is required to further evaluate the comparative studies. OBJECTIVES: To compare the clinical and functional results of open carpal tunnel release (CTR) surgery VS local steroid injection (LSI) for carpal tunnel syndrome. METHODS: This is prospective randomized, single blind, controlled study. Forty patients who were clinically and electrophysiologically conrmed to have idiopathic CTS were enrolled in the study after informed consent. Patients were randomized and assigned into 2 groups of 20 patients each. Group-1 was managed by and Group-2 was managed by open carpal tunnel release single injection of steroid. Patients were followed every 4 weeks up to 24 week. They were assessed clinically and functionally based on Boston Carpal Tunnel Assessment Questionnaire (BCTQN). CONCLUSION: In our study we used Boston Carpal Tunnel Assessment Questionnaire (BCTQN), due to its ease of administration and responsiveness to clinical change, which can be considered as a valuable tool to evaluate functional outcome. Our ndings suggest that both local steroid injection and surgical decompression are effective treatments in alleviating symptoms in primary CTS at 24 weeks follow-up. Surgery group had statistically signicant improvement in comparison with steroid injection in terms of objective functional score in the 24 weeks followup, although clinical relevance of those differences remains to be dened. Hence we conclude, The steroid injection is a feasible non-expensive and effective therapy in most of the cases of CTS on the other hand surgical release is a day care, safe and effective treatment even in mild to moderate CTS. But cost effectiveness, cost benet analysis and surgery related morbidity should be evaluated in further clinical trials with larger sample size and longer follow up period.

Prospective Evaluation of Surgical and Anesthetic Technique of Carpal Tunnel Release in an Orthopedic Practice

The goal of this study was to determine whether the type of anesthesia (monitored anesthesia care [MAC] vs wide-awake local anesthesia no tourniquet technique [WALANT]) or the surgical technique (mini-open vs endoscopic) would affect patient satisfaction with postoperative pain control, postoperative pain, or opioid use after carpal tunnel release (CTR). The hypothesis was that endoscopic and open CTR surgery would have the same patient satisfaction with postoperative pain control, postoperative pain, and opioid use, but WALANT surgery would have higher patient satisfaction with postoperative pain control, postoperative pain, and opioid use than MAC. This prospective study examined all patients undergoing carpal tunnel surgery by 4 hand surgeons at our institution. Two surgeons perform primarily 1-incision endoscopic CTR and the other 2 perform mini-open CTR. Two surgeons perform all procedures under WALANT; the other 2 employ MAC with a local anesthetic. Postsurgical questionnaires were completed at the 2-week postoperative visit. Patients reported remaining pills, average pain, highest pain, lowest pain, and overall satisfaction with postoperative pain control. A total of 93 patients underwent CTR by the 4 participating hand surgeons. Of these, 43 underwent open CTR and 50 underwent endoscopic CTR. Sixty-two were performed under MAC and 31 with WALANT. With regard to anesthesia type, overall there was 5.5 mean morphine equivalents (MME) less prescribed and an average of 3.6 MME more remaining on the first postoperative visit with WALANT compared with MAC. Patient satisfaction with postoperative pain control was an average score of 7.9 for MAC and 7.4 for WALANT. With regard to surgical technique, overall, there was 15.2 MME less prescribed and an average of 1.03 MME more remaining on the first postoperative visit with endoscopic CTR compared with open CTR. Patient satisfaction with postoperative pain control between endoscopic and open release demonstrated an average score of 7.1 and 8.0, respectively. This study demonstrates minimal differences in opioid pain medication use, patient satisfaction with postoperative pain control, and pain scores in a comparison of surgical technique as well as anesthesia type. Therapeutic IV.

Analysis of surgical options for patients with bilateral carpal tunnel syndrome

BackgroundBilateral endoscopic carpal tunnel release is a modality offered for the treatment of the median nerve compression neuropathy. This retrospective study compares outcomes for patients undergoing open carpal tunnel release versus bilateral endoscopic carpal tunnel release. We hypothesized that there is no significant difference in postoperative complication rates between unilateral open and bilateral endoscopic carpal tunnel release surgery. MethodsThe authors identified all patients who underwent open carpal tunnel release, unilateral endoscopic carpal tunnel release and bilateral endoscopic carpal tunnel release at a university hospital from 2012 to 2014. Cases were identified using CPT billing codes and the data was assessed using an analysis of variance (ANOVA). All endoscopic carpal tunnel releases were done by the same surgeon (AP), and greater than 90% of open procedures were done by a different same surgeon (DF). ResultsThe total combined complication rate was 24.7% with no significant difference (p > .05) between techniques. There were no major complications necessitating a return to the operating room. Variables that had a statistically significant difference between groups (p < .05) included mean tourniquet time, mean total procedure time, and return to work as determined from the number of follow-up appointments. ConclusionsThe study demonstrates equivocal complication profiles and decreased cost associated with bilateral endoscopic tunnel release as compared to sequential open carpal tunnel release. Endoscopic bilateral carpal tunnel release for patients with bilateral carpal tunnel syndrome offers a safe and effective alternative to open carpal tunnel release.

Carpal tunnel surgery: predictors of clinical outcomes and patients\u2019 satisfaction

BackgroundCarpal tunnel syndrome (CTS) is the most common peripheral neuropathy. Moreover, carpal tunnel release (CTR) surgery generally has excellent results. The present study aimed to investigate the predictors of clinical outcomes and satisfaction in patients with CTR.MethodsIn this observational prospective cohort study, 152 patients with open carpal tunnel release surgery were investigated. Complete clinical examinations were performed and recorded before the surgery, two weeks after the surgery and 6 months after the surgery. The Boston Carpal Tunnel Questionnaire (BCTQ) were assessed on admission and at last follow-up visits to evaluate clinical outcomes. Patients’ satisfaction was determined by a 10-point verbal descriptor nominal scale (1 = very poor, 5 = fair and 10 = excellent) and recorded during the last follow -up visits.ResultsAmong 152 patients who were investigated, there were 118 (77.6%) females and 34 (22.36%) males. Overall, surgery improved the outcomes based on Symptom Severity Scale (SSS) and Functional Status Scale (FSS) (P < 0.05). Most of the considered variables did not show significant effects on clinical outcomes and patients’ satisfaction. However, duration of symptoms and electrophysiological severity were the predictors of the change score in SSS(P < 0.05). As well as, age was the only predictor of the change score in FSS (P < 0.05). Finally, according to the linear regression model, the pre-operative grip strength and age were the independent predictors of post-operative satisfaction (P < 0.05).ConclusionsResults of the present study revealed that there was a significant improvement in clinical outcomes after CTS surgery. Stronger pre-operative grip strength and younger age were independent predictors of higher post-operative satisfaction. These results can be used in pre-operative counseling and management of post-operative expectations.

Comparison of Wrist Arthroscopy, Small Incision Surgery, and Conventional Surgery for the Treatment of Carpal Tunnel Syndrome: A Retrospective Study at a Single Center

BackgroundThis study aimed to compare the efficacy and safety of wrist arthroscopy, small incision surgery, and conventional open carpal tunnel release surgery for the treatment of carpal tunnel syndrome.Material/MethodsPatients with carpal tunnel syndrome (n=111) were treated with wrist arthroscopy (n=33), small incision surgery (n=40), and conventional open carpal tunnel release surgery (n=38). Incision length, duration of surgery, degree of intraoperative bleeding, recovery time, and findings at postoperative follow-up at one month, three months, and six months after surgery were recorded. Assessment included the two-point discrimination test, the grip and pinch strength test, the visual analog scale (VAS) score for pain, the Levine questionnaire, and Kelly’s therapeutic evaluation.ResultsIncision length, duration of surgery, intraoperative bleeding, and recovery time were significantly reduced in the wrist arthroscopy group and the small incision surgery group compared with the conventional surgery group (p<0.05). There were no significant differences in the two-point discrimination or grip and pinch strength test (p>0.05). Postoperatively, at one month, the VAS score, Levine score, and Kelly’s therapeutic evaluation in the wrist arthroscopy group and the small incision surgery group were significantly lower compared with the conventional surgery group (p<0.05). Scar length and scar tenderness in the conventional surgery group were significantly increased compared with the wrist arthroscopy group and the small incision surgery group (p<0.05).ConclusionsWrist arthroscopy, small incision surgery, and conventional open carpal tunnel release surgery were effective for the treatment of carpal tunnel syndrome, but conventional surgery resulted in more postoperative complications.

Factors Correlated with Unfavorable Outcome after Carpal Tunnel Release Surgery.

Objectives:Carpal tunnel release surgery has excellent results. The aim of this study was to identify which baseline clinical and demographic factors could predict a good outcome from surgery. Understanding the impact of prognostic factors will enable surgeons to indicate surgical intervention better, provide appropriate preoperative counseling, and manage expectations postoperatively.Materials and Methods:A prospective, observational study included 620 carpal tunnel syndrome patients (age 42.38 ± 11.18 years; mean ± standard deviation). After the diagnosis had been confirmed by electrodiagnostic studies, patients underwent open carpal tunnel release surgery. Patients were evaluated initially after 2 weeks and eventually after 6 months. Surgical outcome was compared with presurgical findings.Results:Response to surgery was good in 89.4% and 94.2% after 2 weeks and 6 months, respectively. Factors correlated significantly with unfavorable outcome of surgery included old age, longer duration of symptoms, negative Phalen's test, abnormal two-point discrimination test, and weakness of abductor pollicis brevis muscle. Gender, retrograde radiation, and nocturnal symptoms did not correlate with surgical outcome.Conclusion:Elderly patients with longstanding disease, neurological deficits, and negative Phalen's test may not respond to surgery as others. This should be kept in mind in preoperative counseling and postoperative expectations.

Flexor Tendon Laceration Due to Carpal Tunnel Release Surgery: An Impossible Complication.

A 55-year-old woman presented with active flexion loss in distal interphalangeal joint of the left little finger following an open carpal tunnel release surgery done 6 months back ([Fig. 1], [Video 1] [available in the online version of this article]). Clinical examination showed no sensory and motor loss in the median and ulnar nerve distribution in the hand. The previous surgical scar in the palm was opened under axillary block with zig zag extensions. The flexor digitorum profundus of the little finger was found cut and separated ([Fig. 2]). The primary repair in this situation was found to be very remote. Hence, the tendon ends were refreshed, bridged with palmaris longus tendon graft harvested from the same side, and sutured by Pulvertaft method. The postoperative was uneventful with no complications. The little finger physiotherapy was started and gradually she had returned back to her normal life with good functional outcome.

Choosing the most efficacious scoring method for carpal tunnel syndrome.

The aim of this study was to determine the most efficacious hand-specific questionnaire to determine functionality in patients with carpal tunnel syndrome. The study included 89 patients who underwent open carpal tunnel release surgery within three years prior to the study. A visual analog scale was used to assess the intensity of pain and paresthesia symptoms. Each participant completed the Boston Carpal Tunnel Questionnaire (BCTQ), the Michigan Hand Outcome Questionnaire (MHQ), the quick form of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the Duruoz Hand Index (DHI). The BCTQ, pain and paresthesia results were assumed as gold standards. Correlations between the MHQ, QuickDASH, and the DHI were analyzed. A correlation analysis between the variables was tested using Spearman's rho test or Pearson's test for variables. The QuickDASH was well correlated with pain, paresthesia and the BCTQ (p<0.001). The questionnaires complied with each other. In addition to its complicated scoring, the MHQ contained detailed subparameters with similar questions and takes a long time to complete. Further studies may confirm the effective usage of the DHI. The easier QuickDASH questionnaire appears to be more practical for carpal tunnel release patients.

Outcome analysis of limited open carpal tunnel release: A prospective study

Background: Carpal tunnel syndrome (CTS) is the most common peripheral compressive neuropathy, involving median nerve at the wrist. Traditionally, three different surgical techniques have been described open or standard, minimal invasive or limited open, and endoscopic surgeries. However, the results of each method are conflicting. The goal of our study was to assess the clinical outcome including complication rates following limited open carpal tunnel release. Patients and Methods: The study included patients with idiopathic CTS undergoing limited open carpal tunnel release surgery. The Boston Carpal Tunnel questionnaire was used to assess the symptom severity and functional status pre and post surgical interventions. Results: Twenty two patients (27 hands) underwent limited open carpal tunnel release, and all patients completed the questionnaire. The mean age of patients was 44.9 years with a mean duration of follow-up was 16.2 months. The average surgical wound length (scar length) was 2.7 cm. The median time to return to work was 14 days (range: 7-31). There was a significant improvement in pre to post operative symptom severity score (SSS) and functional status score (FSS). The statistical correlation was significant between pre and post operative SSS and FSS scores. One patient had a superficial infection which was treated conservatively. No patient had pillar pain, scar tenderness, and nerve injuries. Conclusion: The limited open carpal tunnel release surgery is the simple, safe, and effective mode of treatment.

Carpal Tunnel Release Surgery and Venous Hypertension in Early Hemodialysis Patients without Amyloid Deposits

Aim. Carpal tunnel syndrome (CTS) is one of the frequent problems of the patients who underwent hemodialysis (HD). The role of venous hypertension due to arteriovenous fistula (AVF) has not been clarified completely; therefore, we aimed to investigate the role of venous hypertension due to AVF in hemodialysis patients who had CTS. Patients and Methods. We included 12 patients who had been receiving HD treatment for less than 8 years and the newly diagnosed CTS patients with the same arm of AVF. All patients were diagnosed clinically and the results were confirmed by both nerve conduction studies and electromyography. Open carpal tunnel release surgery was performed on all of them. Venous pressure was measured in all patients before and after two weeks of surgery. Results. There were significant differences before and after the surgery with regard to pressures (P > 0.05). After the surgery, all carpal ligament specimens of the patients were not stained with Congo red for the presence of amyloid deposition. Conclusion. Increased venous pressure on the same arm with AVF could be responsible for CTS in hemodialysis patients. Carpal tunnel release surgery is the main treatment of this disease by reducing the compression on the nerve.

Ulnar Neuropathy at the Wrist in a Patient with Carpal Tunnel Syndrome after Open Carpal Tunnel Release

Ulnar neuropathy at the wrist is rarely reported as complications of carpal tunnel release. Since it can sometimes be confused with recurrent median neuropathy at the wrist or ulnar neuropathy at the elbow, an electrodiagnostic study is useful for detecting the lesion in detail. We present a case of a 51-year-old woman with a two-week history of right ulnar palm and 5th digit tingling sensation that began 3 months after open carpal tunnel release surgery of the right hand. Electrodiagnostic tests such as segmental nerve conduction studies of the ulnar nerve at the wrist were useful for localization of the lesion, and ultrasonography helped to confirm the presence of the lesion. After conservative management, patient symptoms were progressively relieved. Combined electrodiagnostic studies and ultrasonography may be helpful for diagnosing and detecting ulnar neuropathies of the wrist following carpal tunnel release surgery.

Clinical study of pillar pain after carpal tunnel release

Objective To investigate the causes of postoperative pillar pain after carpal tunnel release.Methods From December 2006 to October 2008, 27 patients (30 sides) with carpal tunnel syndrome were treated with conventional open carpal tunnel release surgery (OCTR). Postoperatively the area of pillar pain was measured and function of the affected wrist evaluated. Results Postoperative follow-up period ranged from 10 to 30 months. Eleven patients had pillar numbness around the surgical incision, while 8 patients had unilateral or bilateral pillar pain. Conclusion The area of pillar pain or pillar numbness was positively correlated to the length of surgical incision. The presence or absence of pillar pain should not be considered as a standard to assess the effectiveness of OCTR. There is no association between the type of incision and the occurrence of pillar pain. Key words: Carpal tunnel syndrome; Surgical procedures,operative; Pillar pain

P28-22 One-year clinical and electrodiagnostic follow-up after open carpal tunnel release surgery

P28-22 One-year clinical and electrodiagnostic follow-up after open carpal tunnel release surgery