Open Carpal Tunnel Release Research Articles

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

Ultrasound (US) Changes in the Median Nerve Cross-Sectional Area After Microinvasive US-Guided Carpal Tunnel Release.

To document changes in the median nerve cross-sectional area (CSA) in the proximal carpal tunnel region after ultrasound (US)-guided carpal tunnel release (CTR). Prospective data were collected on 23 consecutive patients (37 wrists) treated with US-guided CTR by the primary author using the same office-based microinvasive technique. Ultrasound was used to measure the largest CSA of the median nerve in the proximal carpal tunnel region both preoperatively and postoperatively. The primary outcome measure was the change in the preoperative versus 6- to 10-week postoperative median nerve CSA. The mean CSA of the median nerve decreased from 16.08 to 12.75 mm2 at 6 to 10 weeks after US-guided CTR (P < .001). During the same period, the mean Boston Carpal Tunnel Questionnaire (BCTQ) symptom score decreased from 3.23 to 1.67 (P < .001), and mean BCTQ functional score decreased from 2.49 to 1.47 (P < .001), both exceeding minimal clinically important differences. Although the primary end point was the median nerve CSA at 6 to 10 weeks, statistically significant reductions in the median nerve CSA, as well as BCTQ scores, were also observed as early as 2 to 4 weeks after US-guided CTR (median nerve CSA, 12.40 mm2 ; BCTQ symptom score, 2.00; BCTQ functional score, 1.75; all P ≤ .03). To our knowledge, this investigation was the largest to date examining changes in the proximal median nerve CSA after US-guided CTR. Statistically significant reductions in the proximal median nerve CSA were observed within 6 to 10 weeks after ultrasound-guided CTR. These reductions were similar to those previously reported for open and endoscopic CTR and validate the ability of US-guided CTR to relieve median nerve compression.

A case series of seven patients with recurrent median nerve neuropathy treated by the revision surgery of median nerve neurolysis and wrapping with radial artery perforator adipose flap

Adhesion neuropathy of the median nerve with persistent pain can be a challenging problem. Currently, coverage of the median nerve with a well-vascularized soft tissue is deemed necessary after secondary neurolysis. Herein, we reviewed the outcomes of seven patients with a persistent median nerve neuropathy after a primary open carpal tunnel release or a median nerve repair, treated with neurolysis and median nerve wrapping with radial artery perforator adipose flaps. During the revision surgery, after a careful and complete neurolysis of the scarred median nerve, the distally based radial artery perforator adipose flap without its fascia was raised and rotated to wrap the median nerve. The mean size of the perforator flap was 1146mm2, which was enough to wrap the median nerve in all patients. At 26 months postsurgery, both the visual analog scale score for pain with tingling, and the patient-reported outcome measures improved. There was no recurrence of the median nerve adhesion neuropathy and no major complications were noted. Tinel's sign at the palmar wrist completely disappeared in four patients and was relieved in three patients. The median distal motor latency becomes recordable, and closer to a normal compound motor action potential postoperatively in all patients. Secondary neurolysis and median nerve wrapping with a radial artery perforator adipose flap, which was modified to be softer and thinner than the radial artery perforator adipofascial flap, was a successful treatment for the recurrent median nerve neuropathy in terms of both pain relief and restoration of the hand function.

Elevated Preoperative Hemoglobin A1c Associated with Increased Wound Complications in Diabetic Patients Undergoing Primary, Open Carpal Tunnel Release.

An increased rate of complications has been demonstrated with increasing hemoglobin A1c value for a variety of orthopedic procedures, including arthroplasty and spine surgery. The authors investigated the effects of elevated hemoglobin A1c value on postoperative complications at the time of carpal tunnel release. This retrospective, cohort study evaluated all diabetic patients with a preoperative hemoglobin A1c value within 90 days of primary, open carpal tunnel release at a single academic institution within the past 10 years. Binary hemoglobin A1c thresholds were tested for association with outcomes of superficial or deep infection, delayed wound healing, and persistent symptoms using chi-square analysis. Multivariable models with adjustment for baseline and operative factors were then constructed. Odds ratios and 95 percent confidence intervals were displayed. Hemoglobin A1c value greater than or equal to 7.8 percent was most strongly associated with an increased risk of all-cause wound healing complications (p = 0.049) at an odds ratio of 4.2 (95 percent CI, 1.0 to 17.7) in adjusted analyses. Six patients (4 percent) experienced delayed wound healing and five patients (4 percent) developed a superficial infection. Six patients (4 percent) reported persistent carpal tunnel syndrome symptoms. Diabetic patients undergoing open, primary carpal tunnel release with a hemoglobin A1c value of 7.8 percent or higher had a higher rate of postoperative wound complications compared to diabetic patients with improved preoperative glucose control. Diabetics with poor glycemic control should be counseled that their risk of postoperative complication is higher. Further work is needed to determine whether delaying surgery to optimize glucose control could result in a reduction of wound healing complications. Risk, II.

A Novel Supraretinacular Endoscopic Carpal Tunnel Release: Instrumentation and Technique (Cadaveric Study)

Purpose Endoscopic carpal tunnel release has been shown to be associated with a shorter return to work compared with open carpal tunnel release in the treatment of carpal tunnel syndrome. Unfortunately, it may be associated with a higher risk for median nerve injury when the carpal tunnel is used as a portal for instrumentation. The purpose of this study was to assess safety in using a newly designed retractor through a supraretinacular approach. Methods We used 8 wrists (4 left and 4 right wrists) from 4 fresh-frozen cadavers for this study. Supraretinacular endoscopic carpal tunnel release using the supraretinacular retractor was performed by a single investigator, followed by exploration of the carpal tunnel and the structures surrounding it. Surgeries were performed using a new surgical instrument consisting of an arch-shaped blade and handle. It includes a retainer adapted to receive a 2.4- or 2.7-mm endoscope and to retain it at the apex of the arch, which can be moved in and out to visualize the entire transverse carpal ligament. The space below the blade is also used as a portal to insert scissors and instrumentation to cut the transverse carpal ligament. Results All 8 carpal tunnels were completely released with no injury to the median nerve, superficial palmar arch, flexor tendon, or violation into Guyon canal. Mean distance of the flexor retinaculum division to the recurrent motor branch, palmar cutaneous branch, and superficial palmar arch was 6.87 ± 2.80, 7.13 ± 5.33, and 9.13 ± 4.42 mm, respectively. All specimens had an extraligamentous recurrent motor branch. Conclusions The retractor and described technique were safe and effective in this cadaveric study. Further clinical trials are necessary before it can be adopted as a safe and reliable technique. Type of study/level of evidence Therapeutic IV.

Open carpal tunnel release and diabetes: a retrospective study using PROMs and national quality registries

ObjectivesTo study patient-reported outcome after open carpal tunnel release (OCTR) for carpal tunnel syndrome (CTS) in patients with or without diabetes using national healthcare quality registries.DesignRetrospective cohort study.SettingData from the...

Open cubital and carpal tunnel release using wide-awake technique: reduction of postoperative pain.

PurposeThis study aimed to compare the efficacy of and patient satisfaction with the wide-awake local anesthesia with no tourniquet (WALANT) technique in open cubital and carpal tunnel release surgery.MethodsFrom January 2016 to February 2017, 20 cubital tunnel syndrome (CuTS) patients were in a wide-awake (WA) group and 22 in a general (GA) anesthesia group in . Also, 20 carpal tunnel syndrome (CTS) patients were in a WA group, 22 in a local anesthesia (LA) group, and 20 in a GA group. Injection pain, perioperative pain, and postoperative pain were assessed using a 10-point pain VAS. In CuTS, functional outcome on the “quick” Disabilities of the Arm, Shoulder, and Hand questionnaire were evaluated. In CTS, subjective outcomes were assessed using the Korean version of the Michigan Hand Outcomes Questionnaire.ResultsBoth CuTS and CTS showed significant postoperative pain reduction in group WA. In CuTS, group WA had less pain than group GA up to 48 hours after surgery (P<0.05). Supplemental opioid injections were used on hospitalization day by 12% of group WA and 35% of group GA. In CTS, the postoperative VAS scores in group WA were lower during the first 24 hours than groups LA and GA (P<0.05). Opioid injections were used on hospitalization day by 5% of WA, 18% of LA, and 32% of group GA. There was no difference in postoperative functional outcomes according to anesthesia method in CuTS or CTS.ConclusionCubital and carpal tunnel surgery using the WALANT technique was comparable in function to other anesthesia methods and superior for pain. Immediate postoperative pain was much lower than other groups, which could reduce the use of opioids during hospitalization.

Dexamethasone for the Reduction of Postoperative Pain Following Open Carpal Tunnel Release: A Randomized Controlled Trial

INTRODUCTION: Carpal tunnel syndrome is one of the most common neuropathies seen in the upper limb. Once the diagnosis is made, multiple treatment modalities are available for management of this condition. Conservative treatments include wrist splinting and corticosteroid injection. Injections often provide symptomatic relief for patients with mild to moderate disease, especially for pain.1 These injections are usually given either as sole treatment, or as a bridge before surgery can be performed. Definitive carpal tunnel release (CTR) surgery is performed either awake with local anesthesia or under procedural anesthesia. Postoperative pain is typically treated with a combination of NSAIDs and narcotics. Nationally, overconsumption of narcotics is a critical issue. The use of steroids in conjunction with local anesthesia has not been studied in the literature. Our objective was to determine whether the addition of dexamethasone to the local anesthesia given during CTR will reduce postoperative pain and the consumption of narcotics postoperatively. METHODS: We conducted a randomized, double-blinded study at a single academic institute. Patients undergoing an elective CTR surgery were included. Exclusion criteria included uncontrolled diabetics, minors, traumatic or emergent case, and patients undergoing a concomitant surgery. Included patients were randomized to either the control or treatment arms. Patients in the treatment arm were given an injection of 10 mg dexamethasone with their local anesthesia at surgery versus local anesthesia alone for the control group. Postoperatively, patients logged their pain scores on a 0–10 scale at set time intervals of 8 hours, 24 hours, 48 hours, 72 hours, and 1 week postoperatively. Patients were also asked to record how many narcotic, acetaminophen, or NSAID pain pills they used. Two-sample Wilcoxon and Matlab-pairs signed-rank tests were then performed to analyze the data. P values were adjusted with Hochberg’s method. RESULTS: Eighty-one patients were enrolled: 40 in the treatment arm and 41 in the control arm. Average pain scores were lower in the steroid group at 8 hours (2.23 SD 3.04 versus 3.45 SD 2.94; P = 0.017), 24 hours (2.61 SD 2.46 versus 3.23 SD 2.88; P = 0.351), and 48 hours (2.00 SD 2.19 versus 2.03 SD 2.51; P = 0.745). Pain scores were higher in the treatment arm at 72 hours (1.74 SD 2.09 versus 1.44 SD 1.87; P = 0.574) and 7 days (1.37 SD 1.76 versus 0.61 SD 1.08; P = 0.031). No P values exceed their Hochberg limits for significance. There was no significant difference in the number of acetaminophen pills (2.93 SD 6.93 versus 1.31 SD 2.96; P = 0.837), NSAID pills (3.56 SD 7.24 versus 2.30 SD 6.51; P = 0.678), and narcotic pills (4.17 SD 5.96 versus 4.36 SD 5.10; P = 0.325) between the 2 groups. CONCLUSION: Intraoperative dexamethasone administration during CTR did not reduce pain levels or number of narcotic pain pills taken in the first postoperative week. Further research evaluating non-narcotic pain reducing modalities for CTR is warranted. REFERENCE: 1. Middleton SD. Carpal tunnel syndrome. BMJ. 2014;6:g6437.

Functional Outcome Of Mini-Open Carpal Tunnel Release In Carpal Tunnel Syndrome

Introduction: Carpal tunnel syndrome is the most common compression neuropathy in clinical practice and is also the most extensively studied. In Mini-open carpal tunnel release, the transverse carpal ligament is transected using a small open cut at the volar aspect of the proximal palm. The objectives of this study were to determine the functional outcome of mini-open carpal tunnel release procedure, to use the Boston Questionnaire to determine the functional outcome following mini open carpal tunnel release which includes pain, numbness, weakness and fine hand activities.&#x0D; Methods: This descriptive cross-sectional was conducted in National After informed consent, the cases who meet the informed criteria were examined and relevant details were filled up in the proforma preoperatively and two weeks post-operatively. Assessment of the patient’s symptom severity and functional status was done with the Boston questionnaire.&#x0D; Results: CTS was most common in the age group of 25-29 years (36.36%) and was predominant in housewives (18.20%). Mean symptom severity scores per person improved from 3.11 pre-operatively to 1.12 post-operatively. Mean functional status scores per person improved from 2.65 pre-operatively to 1.03 post-operatively. There was a statistically significant improvement in postoperative outcomes in our population.&#x0D; Conclusions: The findings in this study indicate that mini-open carpal tunnel release has a good functional outcome.&#x0D; Keywords: carpal tunnel syndrome; compression neuropathy; transverse carpal ligament.

Morphologic Analysis of the Carpal Tunnel and Median Nerve Following Open and Endoscopic Carpal Tunnel Release.

Background: Endoscopic carpal tunnel release (ECTR) has purported advantages over open release such as reduced intraoperative dissection and trauma and more rapid recovery. Endoscopic carpal tunnel release has been shown to have comparable outcomes to open release, but open release is considered easier and safer to perform. Previous studies have demonstrated an increase in carpal tunnel volume, regardless of the technique used. However, the mechanism by which this volumetric increase occurs has been debated. Our study will determine through magnetic resonance imaging (MRI) analysis the morphologic changes that occur in both open carpal tunnel release (OCTR) and ECTR, thereby clarifying any morphologic differences that occur as a result of the 2 operative techniques. We hypothesize that there will be no morphologic differences between the 2 techniques. Methods: This was a prospective study to compare the postoperative anatomy of both techniques with MRI. Nineteen patients with clinical and nerve conduction study-confirmed carpal tunnel syndrome underwent either open or endoscopic release. Magnetic resonance imaging was performed preoperatively and 6 months postoperatively in all patients to examine the volume of the carpal tunnel, transverse distance, anteroposterior (AP) distance, divergence of tendons, and Guyon's canal transverse and AP distance. Results: There was no significant difference in the postoperative morphology of the carpal tunnel and median nerve between OCTR and ECTR at 6-month follow-up on MRI. Conclusion: We conclude that there are no morphologic differences in OCTR and ECTR. It is an increase in the AP dimension that appears to be responsible for the increase in the volume of the carpal tunnel.

Palmar Digital Neuropathy With Anatomical Variation of Median Nerve: Usefulness of Orthodromic Technique: A Case Report

Anatomic variation of palmar digital nerve pathways were reported in several cases. Selective exploration of palmar digital nerves with a nerve conduction study has been challenging, because of technical issues. We report a patient who received bilateral carpal tunnel release operation, complaining of a tingling sensation, and hypoesthesia on the middle and ring fingers. An electrodiagnostic study revealed a sensory neuropathy of palmar digital nerve of the left median nerve, supplying the ulnar side of the middle finger, and radial side of the ring finger. She underwent re-operation of open left carpal tunnel release, and a branching site of common digital nerves of the median nerve was identified not at the palm, but at a far proximal site around the distal wrist crease. Usefulness of an orthodromic sensory conduction study was clarified to eliminate volume conducted response or co-activation of nearby nerves in the patient with selective involvement of palmar digital nerve.

Intraoperative Point of View Video Capture and Surgical Segmentation in Carpal Tunnel Release: A Feasibility Analysis

The purpose of this study was to (1) examine the feasibility of intraoperative point of view video while performing open and endoscopic carpal tunnel release (CTR), (2) define surgical segments of CTR, and (3) describe the duration of various surgical steps of open versus endoscopic CTR in a teaching setting. Fellowship trained hand surgeons reached consensus on surgical segments for CTR. Adult patients 18 and older previously indicated for CTR in clinic were eligible. Head-mounted point-of-view cameras were worn during endoscopic and open CTR by resident surgeons. Video was reviewed to determine segment duration. Independent sample t tests were used for comparison of duration by technique with statistical significance set as p < 0.05. University of Iowa Hospitals and Clinics; 200 Hawkins Dr, Iowa City, IA 52242; Tertiary Academic Medical Center. Orthopedic Surgery Residents and Orthopedic Surgery Faculty. Surgical segments were defined as incision, dissection of superficial soft tissue structures, transection of the carpal ligament, and surgical incision closure. Twelve of 14 video capture events yielded data. In the teaching setting, the average duration of endoscopic CTR was 609.5 seconds (±111.07) versus 547.75 seconds (±82.06) for open with p value = 0.406. No surgical segments were significantly different. Transition time from dissection to ligament transection differed significantly (p = 0.004) between endoscopic (46.88 seconds ± 19.19) and open (9.0 seconds ± 7.90) CTR. Transition time between ligament transection and closure was significantly different (p = 0.029) among endoscopic (50.5 seconds ± 15.0) and open (26.25 seconds ± 2.99) CTR. Point-of-view video capture is feasible for the capture of video during a common hand surgery procedure. A method for managing device battery power is necessary for future applications. CTR can be defined as, and described in, individual procedure segments potentially useful for surgical education as well as efficiency improvements. Identification of surgical segments may aid the development of better objective tools for the assessment of surgeon skill and competency for common orthopedic procedures.

Open Carpal Tunnel Release:Performed Axillary Brachial Plexus Block vs. Wide Awake

Ropivacaine and lidocaine are used in surgical anaesthesia for the upper extremety. The first one is indicated for the axillary brachial plexus block and the second one as an local anaesthetic. A retrospective study was realized to evaluate the differences between the two anaesthetic methods used for the carpal tunnel release.

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.

An Assessment of Sleep Disturbance in Patients before and after Carpal Tunnel Release.

Background: Night time numbness is a key characteristic of CTS and relief of night time symptoms is one of the outcomes most important to patients. This study tested the null hypothesis that there is no difference between sleep quality and night symptoms before and after carpal tunnel release (CTR). Methods: Forty-four, English-speaking adult patients requesting open CTR for electrodiagnostically confirmed carpal tunnel syndrome completed questionnaires before and after surgery. Average age was 59, 24 patients were men and 20 were women. Patient with a primary or secondary sleep disorder were excluded. Before surgery, patients completed the Pittsburg Sleep Quality index (PSQI). At an average of 3 months after surgery, participants completed PSQI questionnaires. Onset of sleep quality improvement was specifically addressed. Differences between preoperative and postoperative sleep quality were evaluated using the paired t-test. Spearman correlations were used to assess the relationship between continuous variables. Results: Of the 44 patients, 32 (72%) were classified as poor sleepers (PSQI > 5.5) prior to surgery. At 3 months follow up, there was a significant improvement PSQI global scores (7.8 ± 5.1 vs 4 ± 3.5, p < 0.001) as well as subdivisions. Daytime dysfunction (0.2 ± 0.4, p < 0.001) and medication use (1.0 ± 1.2 vs 0.9 ± 1.2, p < 0.045) secondary to sleep disturbance and was improved as well. In all patients, onset of improvement was within 24 hours of surgery. Conclusions: CTR is associated with improvement in sleep quality at 3 months follow-up. CTR improves daytime dysfunction related to the sleep disturbance. The onset of sleep improvement is 24 hours after surgery in most cases.

Which Stitch? Replacing Anecdote with Evidence in Minor Hand Surgery.

Summary:There is currently no consensus on the optimal suture type for palmar skin closure following open carpal tunnel release and trigger finger release. We performed a retrospective analysis of patients in the Palo Alto Veterans Affairs (PAVA) Health Care System who underwent these procedures over a 2-year period to compare 30-day wound outcomes following closure with poliglecaprone 25 (Monocryl), nylon, and chromic gut suture. Out of 312 PAVA cases (133 carpal tunnel release, 179 trigger finger release), incisions closed with Monocryl were significantly less likely to develop dehiscence (Monocryl 2.1%, nylon 10.5%, chromic 10.3%; P = 0.006) and infection (Monocryl 1.6%, nylon 7.4%, chromic 13.8%; P = 0.003), or lead to additional wound-related encounters (Monocryl 8.0%, nylon 16.8%, chromic 24.1%; P = 0.012). On multivariable logistic regression, suture type and diabetes were independent predictors of 30-day wound complications and extra encounters. At PAVA, compared with Monocryl, closures with nylon and chromic were significantly more likely to dehisce and/or become infected [nylon: odds ratio (OR), 5.0; 95% CI, 1.9–13.3 and chromic: OR, 9.3; 95% CI, 2.7–32.4; P = 0.002], and to be associated with an additional encounter (nylon: OR, 2.4; 95% CI, 1.1–5.3 and chromic: OR, 4.5; 95% CI, 1.6–12.9; P = 0.007). This has led to using Monocryl as the standard closure for these cases at PAVA.

Splinting after Carpal Tunnel Surgical Treatment: Does It Really Matter?

Background: Splinting of the wrist after carpal tunnel release (CTR) has been practiced by many surgeons especially in North America. The main reason wasto prevent possible adverse events of bowstringing of flexor tendons and the median nerve, pillar pain, entrapment of the median nerve in scar tissue and wound dehiscence. Studies on the effect of splinting after standard CTR had dismal results. The duration of splinting in standard CTR has been either too long (for 2-4 weeks) or too short (48 hours only). Objective: The aim of our study was to compare the effects of post-operative splinting for duration of one week with no splinting. Patients and Methods: All 20 of our patients underwent a standardized open CTR. Post operatively, they were randomized into a splinted (n=10) and a non-splinted (n=10) group. The splint was kept for 2 weeks. Patients were reviewed at regular intervals of one week, two weeks and three months. At each follow up, these patients were clinically assessed for outcome of the Boston questionnaire. Results: All patients presented with significant improvement in the post-operative evaluation within each group. However, there was no significant difference between the two groups for any of the outcome measurements at sequential and at final follow-up. Conclusion: We concluded that wrist splinting in the immediate post-operative period has no advantage when compared with the non-splinting wrist after a standard open carpal tunnel release.

Splinting after Carpal Tunnel Surgical Treatment: Does It Really Matter?

Background: Splinting of the wrist after carpal tunnel release (CTR) has been practiced by many surgeons especially in North America. The main reason wasto prevent possible adverse events of bowstringing of flexor tendons and the median nerve, pillar pain, entrapment of the median nerve in scar tissue and wound dehiscence. Studies on the effect of splinting after standard CTR had dismal results. The duration of splinting in standard CTR has been either too long (for 2-4 weeks) or too short (48 hours only). Objective: The aim of our study was to compare the effects of post-operative splinting for duration of one week with no splinting. Patients and Methods: All 20 of our patients underwent a standardized open CTR. Post operatively, they were randomized into a splinted (n=10) and a non-splinted (n=10) group. The splint was kept for 2 weeks. Patients were reviewed at regular intervals of one week, two weeks and three months. At each follow up, these patients were clinically assessed for outcome of the Boston questionnaire. Results: All patients presented with significant improvement in the post-operative evaluation within each group. However, there was no significant difference between the two groups for any of the outcome measurements at sequential and at final follow-up. Conclusion: We concluded that wrist splinting in the immediate post-operative period has no advantage when compared with the non-splinting wrist after a standard open carpal tunnel release.

Comparison of functional outcome of mini versus open carpal tunnel release: A prospective study

Comparison of functional outcome of mini versus open carpal tunnel release: A prospective study

Multistate Comparison of Cost, Trends, and Complications in Open Versus Endoscopic Carpal Tunnel Release.

Background: Surgical carpal tunnel release is performed by either open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR). The purpose of this study was to assess differences in intraoperative and postoperative complications, trends, and costs between OCTR and ECTR. Methods: State Ambulatory Surgery and Services Databases (SASD) files for California, Florida, and New Jersey were queried for patients who underwent OCTR and ECTR between 2000 and 2014. Patient demographics, comorbidities, intraoperative and postoperative complications, and cost were compared between OCTR and ECTR. The frequency of each procedure was used to formulate trends in OCTR and ECTR. Results: A total of 571 403 patients were included in this study. Sex was significantly different by a small percentage (OCTR = 64.8% female, ECTR = 65.4% female). A higher proportion of Hispanic patients underwent ECTR (P < .001). The patients who underwent OCTR had a greater comorbidity burden in terms of diabetes and rheumatoid arthritis (P < .001). None of the aforementioned complication rates were statistically significant between the 2 procedures. Endoscopic carpal tunnel release was significantly more costly by almost $2000. Open carpal tunnel release has remained stable over the years studied, whereas ECTR increased 3-fold. Conclusions: Our findings demonstrate no significant differences between OCTR and ECTR regarding intraoperative and postoperative complications and patient outcomes. Endoscopic carpal tunnel release was found to be significantly more costly.