A review of Hand Surgery Provision in England.

This study reviews hand surgical activity and the resources available for provision of hand surgery in England in 2001. Operation rates for three common procedures, viz. carpal tunnel release, Dupuytren’s surgery and ganglion surgery, were considered. The local population and the number of hand surgeons in each NHS Hospital Trust were compared. We identified 275 consultant surgeons with an interest in hand surgery working in the NHS in England. Approximately two-thirds were orthopaedic surgeons, almost one-third were plastic surgeons and a small number were accident and emergency surgeons. Half of all hand surgeons worked in large units, with three or more hand surgeons, but almost 20% of hand surgery was delivered in hospitals in which there was no surgeon with a declared interest in hand surgery. Surgery rates for Dupuytren’s contracture varied from 0.04 to 0.36 cases per 1,000 population per annum and for carpal tunnel syndrome varied from 0.25 to 1.31 cases per 1,000 per annum. We found a correlation between rates of surgery and the number of hand surgeons, locally. A recent audit ( Burke, Dias, Heras-Pelou, Bradley, & Wildin, 2004 . Providing care for hand disorders, a reappraisal of need. Journal of Hand Surgery, 29B: 575–579.) has suggested that one hand surgeon is required to meet the needs of a population of 125,000, with a national requirement for 393 hand surgeons. We conclude that there are insufficient hand surgeons in England and believe that the wide local variations in hand surgery rates are indicative of a significant unmet demand for hand surgery in the English population.

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Endoscopic Carpal Tunnel Release

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0098 ◽

2019 ◽

pp. 989-994

Author(s):

Antony Hazel ◽

Neil F. Jones

Keyword(s):

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Hand Surgery ◽

Anatomical Landmarks ◽

Transverse Carpal Ligament ◽

Palmar Arch ◽

Endoscopic Carpal Tunnel Release ◽

Tunnel Syndrome ◽

Carpal Tunnel Release Surgery ◽

Open Carpal Tunnel Release

Conventional open carpal tunnel release surgery is one of most successful procedures in hand surgery and has been demonstrated to be an effective treatment for carpal tunnel syndrome. However, a known sequelae in some individuals who undergo the procedure is “pillar” pain. In an effort to avoid this condition and help people return to work more quickly, the endoscopic technique was developed. Endoscopic carpal tunnel release offers a minimally invasive alternative to other traditional techniques with similar outcomes. By placing the incision proximal to the transverse carpal ligament there is potential for decreased scar sensitivity and pillar pain. The technique is technically demanding. The superficial palmar arch and common digital nerve to the ring and middle fingers are at risk for injury during the procedure. With adherence to anatomical landmarks and the proper visualization, the surgery may be safely performed.

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Physical Therapy Intervention Following Surgical Treatment of Carpal Tunnel Syndrome in an Individual With a History of Postmastectomy Lymphedema

Physical Therapy ◽

10.1093/ptj/82.10.1009 ◽

2002 ◽

Vol 82 (10) ◽

pp. 1009-1016 ◽

Cited By ~ 15

Author(s):

Julie E Donachy ◽

Emily L Christian

Keyword(s):

Physical Therapy ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Hand Surgery ◽

Tourniquet Time ◽

Compression Bandaging ◽

Right Hand ◽

Tunnel Syndrome ◽

Chronic Lymphedema

Abstract Background and Purpose. This case report describes the physical therapy examination, intervention, and outcomes for a patient with lymphedema following breast cancer treatment who underwent carpal tunnel release. Case Description. The patient was a 53-year-old woman with right upper-limb lymphedema and symptoms of carpal tunnel syndrome (CTS) in her right hand who underwent a carpal tunnel release. Management of her lymphedema included the use of general anesthesia with reduced tourniquet time in conjunction with physical therapy, which included use of compression bandaging, limb positioning, and exercise. Outcomes. Following surgical release, the patient' s numbness and pain were alleviated. Right-hand grip strength increased following active exercise. Girth of the forearm decreased 1 to 1.5 cm at the 2 most distal measurement sites, and girth of the arm increased 1.5 to 2 cm 6 months after surgery. Discussion. This case supports the option of elective hand surgery for CTS in an individual with chronic lymphedema.

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Co-existing carpal tunnel syndrome in complex regional pain syndrome after hand trauma

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193409354015 ◽

2009 ◽

Vol 35 (3) ◽

pp. 228-231 ◽

Cited By ~ 10

Author(s):

S. M. Koh ◽

F. Moate ◽

D. Grinsell

Keyword(s):

Carpal Tunnel Syndrome ◽

Range Of Motion ◽

Grip Strength ◽

Complex Regional Pain Syndrome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Pain Syndrome ◽

Hand Surgery ◽

Pain Scores ◽

Tunnel Syndrome

This study highlights the benefits of carpal tunnel release (CTR) in four patients presenting with complex regional pain syndrome (CRPS) after hand surgery who also had carpal tunnel syndrome (CTS) diagnosed clinically and by nerve conduction studies. Three of the patients underwent pre- and postoperative volumetric, circumference, grip strength and range of motion measurements. The Disabilities of the Arm, Shoulder and Hand (DASH) functional outcome measure and pain scores were also used. There was almost complete resolution of CRPS symptoms in all four patients, with notable reductions in oedema and improvements in grip strength and range of motion. There were also improvements in DASH outcome scores and pain scores after CTR.

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Early Postoperative Improvement in Sleep and Pain After Carpal Tunnel Release

Hand ◽

10.1177/1558944718793984 ◽

2018 ◽

Vol 15 (3) ◽

pp. 311-314 ◽

Cited By ~ 1

Author(s):

Steven R. Niedermeier ◽

Robert J. Pettit ◽

Travis L. Frantz ◽

Kara Colvell ◽

Hisham M. Awan

Keyword(s):

Sleep Quality ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Hand Surgery ◽

Outpatient Setting ◽

Compressive Neuropathy ◽

Carpal Tunnel Surgery ◽

Tunnel Syndrome ◽

And Function

Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy of the upper extremity. We sought to assess the subjective improvement in preoperative symptoms related to CTS, particularly those affecting sleep, and describe opioid consumption postoperatively. Methods: All patients undergoing primary carpal tunnel release (CTR) for electromyographically proven CTS were studied prospectively. All procedures were performed by hand surgery fellowship–trained adult orthopedic and plastic surgeons in the outpatient setting. Patients underwent either endoscopic or open CTR from June 2017 to December 2017. Outcomes assessed were pre- and postoperative Quick Disabilities of Arm, Shoulder and Hand (QuickDASH), visual analog scale (VAS), and Pittsburgh Sleep Quality Index (PSQI) scores as well as postoperative pain control. Results: Sixty-one patients were enrolled. At 2 weeks, all showed significant ( P < .05) improvement in QuickDASH scores. At 6 weeks, 40 patients were available for follow-up. When compared with preoperative scores, QuickDASH (51 vs 24.5; P < .05), VAS (6.7 vs 2.9; P < .05), and PSQI (10.4 vs 6.4; P < .05) scores continued to improve when compared with preoperative scores. At 2-week follow-up, 39 patients responded to the question, “How soon after your carpal tunnel surgery did you notice an improvement in your sleep?” Seventeen patients (43.6%) reported they had improvement in sleep within 24 hours, 12 patients (30.8%) reported improvement between 2 and 3 days postoperatively, 8 patients (20.5%) reported improvement between 4 and 5 days postoperatively, and 2 patients (5.1%) reported improvement between 6 and 7 days postoperatively. Conclusions: The present study demonstrates rapid and sustained improvement in sleep quality and function following CTR.

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Utilization of Electrodiagnostic Testing for Carpal Tunnel Syndrome by General Practitioners Prior to Hand Surgery Consultation

Hand ◽

10.1177/1558944718798849 ◽

2018 ◽

Vol 14 (1) ◽

pp. 56-58 ◽

Cited By ~ 1

Author(s):

Joshua Colombo ◽

Smiresh Shah

Keyword(s):

Carpal Tunnel Syndrome ◽

General Practitioners ◽

Clinical Examination ◽

Carpal Tunnel ◽

Hand Surgery ◽

Referral Pattern ◽

Electrodiagnostic Testing ◽

Hand Surgeon ◽

Tunnel Syndrome ◽

Low Rate

Background:Carpal tunnel syndrome (CTS) is the most common peripheral mononeuropathy and thus is frequently encountered by general practitioners (GPs). The aim of this study is to investigate the referral pattern of GPs with regard to electrodiagnostic (EDX) testing for suspected CTS prior to hand surgery consultation, as well as to investigate the results of EDX testing for suspected CTS when requested by GPs prior to evaluation by a hand surgeon. Methods: We retrospectively reviewed patients referred to our hand surgery clinic over a consecutive 2-year period for suspected CTS. Results: A total of 403 patients were referred to our hand surgery clinic from January 1, 2016, to December 31, 2017. Of the 403, 295 (73.2%) were referred by GPs. GPs obtained prereferral EDX testing in 198 (67.1%) of these patients. EDX testing confirmed their diagnosis in 177 patients (89.4%). There were 21 patients (10.6%) identified with normal EDX testing and a more likely diagnosis reached based on clinical examination. Conclusions: GPs make up the majority of our referrals for CTS, and they obtain EDX testing prior to consultation in two-thirds of referrals. GPs appear to accurately utilize EDX testing to confirm their diagnosis prior to referral and have a low rate of normal testing where symptoms are more readily explained by an alternative diagnosis.

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Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.julaug02 ◽

2003 ◽

Vol 8 (4) ◽

pp. 4-5

Author(s):

Christopher R. Brigham ◽

James B. Talmage

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Proper Time ◽

Carpal Tunnel Release ◽

Hand Function ◽

Factors Affecting ◽

Early Results ◽

Medical Evaluation ◽

Nerve Recovery ◽

Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

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The association between surgery for carpal and cubital tunnel syndrome: analysis of incidence and risk factors within a geographical area

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420980983 ◽

2021 ◽

Vol 46 (3) ◽

pp. 260-264

Author(s):

Nick A. Johnson ◽

Oliver Darwin ◽

Dimitrious Chasiouras ◽

Anna Selby ◽

Chris Bainbridge

Keyword(s):

Relative Risk ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Geographical Area ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Level Of Evidence ◽

Tunnel Syndrome ◽

The Relationship ◽

Syndrome Analysis

The relationship between surgery for cubital tunnel and carpal tunnel syndrome was examined in this retrospective study. Between 1997 and 2018, data from consecutive patients who underwent carpal tunnel release (8352 patients), cubital tunnel release (1681 patients) or both procedures (692 patients) were analysed. The relative risk of undergoing cubital tunnel release in the population who had carpal tunnel release compared with those with no carpal tunnel release was 15.3 (male 20.3; female 12.5). The relative risk of undergoing carpal tunnel release in the population who had cubital tunnel release compared with those who did not undergo carpal tunnel release was 11.5 (male 16.5; female 9.1). Our study showed that men and women who undergo carpal tunnel release are over 20 times and 10 times more likely to have cubital tunnel release than those who did not undergo carpal tunnel release, respectively. These findings suggest that the two conditions may share a similar aetiology. Level of evidence: IV

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Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211001715 ◽

2021 ◽

pp. 175319342110017

Author(s):

Saskia F. de Roo ◽

Philippe N. Sprangers ◽

Erik T. Walbeehm ◽

Brigitte van der Heijden

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Meta Analysis ◽

Surgical Techniques ◽

Open Release ◽

Flap Coverage ◽

Tunnel Syndrome

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

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