Trapeziometacarpal Joint Arthroplasty of the Thumb without Osseous Tunnels and Carpal Tunnel Release via a Radial Approach; Technique, and Results

Abstract Background Numerous surgeries have been described for osteoarthritis of the trapeziometacarpal (TMC) joint. We describe the senior author's experience with his technique of concurrent arthroplasty of the TMC joint, and carpal tunnel release (CTR) via a radial approach. Methods The study is a case series of patients managed over a 3-year period. We included 86 patients over 40 years of age that had concurrent CTR. We used the paired t-test to compare the preoperative and postoperative grip strength and functional scoring (including the Levine-Katz questionnaire for carpal tunnel syndrome, disabilities of the arm shoulder and hand [DASH] score and QuickDASH9). Results Mean age at surgery was 62.8 years, and mean follow-up was 13.1 months. Functional outcomes were analyzed in 65 patients. Grip strength returned to the preoperative measurement by 3 months. Analysis of the nine patients followed up for more than 13 months postoperatively showed a significant increase in grip strength at last follow-up. The grip strength in both hands was also similar beyond 13 months. Significant decreases in the functional scores recorded indicated a reduction in disability, symptom severity, and functional impairment. Conclusions In conclusion, we present the favorable results of this technique of TMC arthroplasty and CTR involving no bone tunnels and short-term immobilization.

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The effect of the involvement of the dominant or non-dominant hand on grip/pinch strengths and the Levine score in patients with carpal tunnel syndrome

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193411425331 ◽

2011 ◽

Vol 37 (5) ◽

pp. 427-431 ◽

Cited By ~ 5

Author(s):

A. Żyluk ◽

I. Walaszek

Keyword(s):

Carpal Tunnel Syndrome ◽

Grip Strength ◽

Carpal Tunnel ◽

Outcome Measurement ◽

Carpal Tunnel Release ◽

Pinch Strength ◽

Dominant Hand ◽

Before And After ◽

Tunnel Syndrome

The Levine questionnaire is a disease-oriented instrument developed for outcome measurement of carpal tunnel syndrome (CTS) management. The objective of this study was to compare Levine scores in patients with unilateral CTS, involving the dominant or non-dominant hand, before and after carpal tunnel release. Records of 144 patients, 126 women (87%) and 18 men (13%) aged a mean of 58 years with unilateral CTS, treated operatively, were analysed. The dominant hand was involved in 100 patients (69%), the non-dominant in 44 (31%). The parameters were analysed pre-operatively, and at 1 and 6 months post-operatively. A comparison of Levine scores in patients with the involvement of the dominant or non-dominant hand showed no statistically significant differences at baseline and any of the follow-up measurements. Statistically significant differences were noted in total grip strength at baseline and at 6 month assessments and in key-pinch strength at 1 and 6 months.

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IDEAS AND INNOVATIONS: RADIAL APPROACH TO CARPAL TUNNEL RELEASE IN CONJUNCTION WITH THUMB CARPOMETACARPAL ARTHROPLASTY

Hand Surgery ◽

10.1142/s0218810405002553 ◽

2005 ◽

Vol 10 (01) ◽

pp. 61-66 ◽

Cited By ~ 2

Author(s):

Tsu-Min Tsai ◽

Luis A. Laurentin-Perez ◽

Michael S. Wong ◽

Makoto Tamai

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Single Incision ◽

Carpal Tunnel Release ◽

Wrist Flexion ◽

Nerve Injuries ◽

Radial Approach ◽

Tunnel Syndrome ◽

Thumb Carpometacarpal

Several authors have written about the co-existence of thumb carpometacarpal arthritis and carpal tunnel syndrome, and 4% to 43% of patients undergoing thumb carpometacarpal arthroplasty also have a carpal tunnel release. Some authors advocate that carpal tunnel release and thumb carpometacarpal arthroplasty should be performed at the same time. We perform a combined thumb carpometacarpal arthroplasty and radial approach carpal tunnel release through a single incision. The purposes of this study are to (1) determine the safety of this approach and (2) evaluate the effectiveness of this approach in decreasing the pain and numbness observed prior to surgery. Eight patients had combined thumb carpometacarpal arthroplasty and radial approach carpal tunnel release. With an average follow up of 14 weeks, all patients reported an improvement in pain and numbness. No nerve injuries occurred, and no difficulty in wrist flexion was observed. One patient had pillar pain persisting at 19 weeks follow-up. One patient had basilar thumb pain at 19 weeks, though this was improved over pre-operative levels.

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Ultrasound Guided Transverse Carpal Ligament Fenestration for Carpal Tunnel Syndrome: A Case Series

Pain Management Case Reports ◽

10.36076/pmcr.2018/2/19 ◽

2018 ◽

pp. 19-26

Author(s):

Yu M. Chiu

Keyword(s):

Carpal Tunnel Syndrome ◽

Minimally Invasive ◽

Local Anesthesia ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Case Series ◽

Transverse Carpal Ligament ◽

Ultrasound Guided ◽

Tunnel Syndrome

Carpal tunnel syndrome is caused by compression of the median nerve under the transverse carpal ligament. We present a description of an ultrasound-guided (USG) percutaneous technique of the transcarpal tunnel and provide a discussion to the evidence in utilizing a minimally invasive technique as an alternative to open and endoscopic carpal tunnel release. USG percutaneous transverse carpal ligament fenestration is a quick, and relatively simple office based treatment for carpal tunnel syndrome. The use of ultrasound provides satisfactory visualization for the procedure and requires very little time and effort for setup. Here, in this case series, we detail the procedure and the results from our follow-up. This report details a case series of 2 patients with confirmed electrodiagnostic findings of mild to severe median neuropathy at the wrist in a university hospital outpatient pain management center. USG percutaneous fenestration of the transcarpal ligament was performed under local anesthesia. Patients were followed up from 4 to 20 weeks. It was found in patient 1, a greater than 60% reduction in pain at 20 weeks follow-up, and patient 2 had at least 50% reduction in pain at 8 weeks follow-up. Both patients had a minimum of 50% improvement in pain and sensory disturbance and without any adverse events. The main advantage of USG transverse carpal ligament fenestration is that it is an office based procedure, requiring local anesthesia only. Minimally invasive USG transcarpal ligament fenestration, in select patients, may be an appropriate tool and even prove to be a surgery-sparing modality. The limitations of this study includes no case-control, small sample size, and the short term follow-up. In conclusion, this case series presents an alternative to a more invasive and costlier procedure including open and endoscopic carpal tunnel release, usually performed in a surgical suite. USG percutaneous transverse carpal ligament fenestration is a quick, and relatively simple office based treatment for carpal tunnel syndrome. The use of ultrasound provides satisfactory visualization for the procedure and requires very little time and effort for setup. Key words: Ultrasound guided, transverse carpal ligament, fenestration, carpal tunnel syndrome

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Arthroscopic Dorsal Capsuloplasty in Scapholunate Tears EWAS 3: Preliminary Results after a Minimum Follow-up of 1 Year

Journal of Wrist Surgery ◽

10.1055/s-0038-1660446 ◽

2018 ◽

Vol 07 (04) ◽

pp. 324-330

Author(s):

Rémy Coulomb ◽

Pascal Kouyoumdjian ◽

Olivier Mares ◽

Benjamin Degeorge

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Case Series ◽

Contralateral Side ◽

Wrist Arthroscopy ◽

Level Of Evidence ◽

Test Range ◽

Flexion Extension ◽

Functional Scores

Purpose We retrospectively evaluated the results of all arthroscopic dorsal scapholunate (SL) capsuloplasty without pinning in patients presenting predynamic instability and dorsal capsuloscapholunate septum lesions on arthro–computed tomography scan after failed medical treatment. Materials and Methods Fifteen patients, mean age 34.3 years, underwent all arthroscopically assisted dorsal capsuloplasty. Patients were assessed preoperatively and postoperatively by a clinical (pain, Watson's test, range of motion, and strength), functional (quick disabilities of the arm, shoulder, and hand), patient-rated wrist evaluation, and Mayo wrist score scores), and radiological (SL gap and dorsal intercalated segmental instability [DISI]) examination. SL tears were evaluated during surgery by European Wrist Arthroscopy Society (EWAS) classification. Results The mean follow-up period was 20.2 months (range, 12–41). Preoperatively, positive Watson's test was noted in all cases. DISI deformity was noted in three cases without any SL gap. The SL instability was graded EWAS IIIB (n = 8) or EWAS IIIC (n = 7). Postoperatively, positive Watson's test was noted in only one case. Activity pain decreased from 7.8 preoperatively to 2.4 postoperatively. Range of motion in flexion–extension increased from 92.9 degrees preoperatively to 126.2 degrees postoperatively. Grip strength increased from 24.2 preoperatively to 38.2 postoperatively. At final follow-up, range of motion in flexion–extension and grip strength were estimated at 87 and 91% compared with contralateral side, respectively. All functional scores were significantly improved at the last follow-up. No radiographic SL gapping in grip views or DISI deformity was noted. Discussion Cadaveric studies demonstrated that the dorsal portion of SL ligament is critical for the stability of the SL complex. The entire arthroscopic SL capsuloplasty technique provides reliable results for pain relief, avoiding postoperative stiffness associated with open procedures. It is an alternative technique for patients with predynamic SL instability after failure of medical management and shall not prelude the resort to any further open procedure. Level of Evidence This is a level IV, case series.

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

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500188 ◽

2019 ◽

Vol 24 (02) ◽

pp. 144-146 ◽

Cited By ~ 1

Author(s):

John Erickson ◽

Daniel Polatsch ◽

Steven Beldner ◽

Eitan Melamed

Keyword(s):

Sleep Quality ◽

Sleep Disturbance ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Continuous Variables ◽

Night Time ◽

Before And After ◽

Tunnel Syndrome ◽

English Speaking

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.

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Comparison of Local-Only Anesthesia Versus Sedation in Patients Undergoing Staged Bilateral Carpal Tunnel Release: A Randomized Trial

Hand ◽

10.1177/1558944719836237 ◽

2019 ◽

Vol 15 (6) ◽

pp. 785-792 ◽

Cited By ~ 1

Author(s):

Garrhett G. Via ◽

Andrew R. Esterle ◽

Hisham M. Awan ◽

Sonu A. Jain ◽

Kanu S. Goyal

Keyword(s):

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Common Disease ◽

Hand Laterality ◽

Included Patient ◽

High Satisfaction ◽

Tunnel Syndrome ◽

Second Procedure ◽

Wide Awake

Purpose: Carpal tunnel syndrome is a common disease treated operatively. During the operation, the patient may be wide-awake or sedated. The current literature has only compared separate cohorts. We sought to compare patient experience with both local-only anesthesia and sedation. Methods: Staged bilateral carpal tunnel release utilizing open or endoscopic technique was scheduled and followed through to completion of per-protocol analysis in 31 patients. Patients chose initial hand laterality and were randomized regarding initial anesthesia method: local-only or sedation. Data collection via questionnaires began at consent and continued to 6 weeks postoperatively from second procedure. Primary outcome measures included patient satisfaction and patient anesthesia preference. Results: At final follow-up, 6 weeks postoperatively, high satisfaction (30 of 31 patients per method) was reported with both types of anesthesia. Among these patients, 17 (54%) preferred local-only anesthesia, 10 (34%) preferred sedation, 2 had no preference, and 2 opted out of response. Although anesthesia fees were approximately $390 lower with local-only anesthesia, total costs for carpal tunnel release were not significantly different with respect to the anesthesia cohorts. Total time in surgical facility was approximately 26 minutes quicker with local-only anesthesia, largely due to shorter time in the post-anesthesia care unit. Scaled comparison of worst postoperative pain following the 2 procedures revealed no difference between local-only anesthesia and sedation. Conclusions: Patients reported equal satisfaction scores with carpal tunnel release whether performed under local-only anesthesia or with sedation. In addition, local-only anesthesia was indicated as the preference of patients in 59% of cases.

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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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Carpal tunnel release: a randomized comparison of three surgical methods

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412475247 ◽

2013 ◽

Vol 38 (6) ◽

pp. 646-650 ◽

Cited By ~ 39

Author(s):

M. B. Larsen ◽

A. I. Sørensen ◽

K. L. Crone ◽

T. Weis ◽

M. E. H. Boeckstyns

Keyword(s):

Grip Strength ◽

Carpal Tunnel ◽

Controlled Trial ◽

Carpal Tunnel Release ◽

Endoscopic Technique ◽

Randomized Controlled ◽

Surgical Methods ◽

Single Blind ◽

Endoscopic Group

A single-blind, randomized, controlled trial was done to compare the results of carpal tunnel release using classic incision, short incision, or endoscopic technique. In total, 90 consecutive cases were included. Follow-up was 24 weeks. We found a significantly shorter sick leave in the endoscopic group. No significant differences in pain, paraesthesiae, range of motion, pillar pain, and grip strength could be found at 24 weeks of follow-up, although intermediate significant differences were seen, especially in grip strength, in favour of endoscopic technique. No major advantage to using a short incision could be found. There were no serious complications in either group. The results indicate that the endoscopic procedure is safe and has the benefit of faster rehabilitation and return to work.

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Mini-open Carpal Tunnel Release

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v19i4.693 ◽

2018 ◽

Vol 19 (4) ◽

pp. 21-27

Author(s):

Paulo Henrique Pires De Aguiar ◽

Carlos Alexandre Martins Zicarelli ◽

Fabio V. C. Sparapani ◽

Pedro Augusto De Santana Jr ◽

Alexandros Theodoros Panagoupolos ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Neurological Deficits ◽

Motor Branch ◽

Tunnel Syndrome ◽

Open Carpal Tunnel Release ◽

Nerve Entrapment Syndrome ◽

Mini Open

Introduction: Median nerve compression is the most common nerve entrapment syndrome. After carpal tunnel release, patients often complain about the scar cosmetic appearance. Objective: The aim of our study was to evaluate the clinical outcome, surgical technique and complications of mini-open carpal release. Methods: We reviewed data from 48 surgical procedures for Carpal Tunnel Syndrome in 32 patients at the Pinheiros Neurologicaland Neurosurgical Clinic in the period of 2000 and 2008. The mean age was 49 years-old. We used a 2 cm incision and microscopic technique to obtain meticulous access of the palmar hand anatomy with special attention to both the recurrent motor branch and palmar cutaneous nerve. Results: Twenty-two patients had total resolution of symptoms. Two patients had no change of neurological symptoms. During the follow up no infection or neurological deficits were observed. Conclusion: Mini-open is a safe and effective approach for carpal tunnel syndrome release. However detailed palmar hand anatomy is mandatory to prevent lesion of branching palmar nerve. The use of microscope is desirable to help identify important structures and avoid complications.

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Relationship between clinical outcomes and nerve conduction studies before and after surgery in patients with carpal tunnel syndrome

10.21203/rs.3.rs-445381/v1 ◽

2021 ◽

Author(s):

Masato Ise ◽

Taichi Saito ◽

Yoshimi Katayama ◽

Ryuichi Nakahara ◽

Yasunori Shimamura ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Grip Strength ◽

Clinical Outcomes ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Carpal Tunnel Release ◽

Characteristic Curve ◽

Objective Assessment ◽

Cutoff Score ◽

Tunnel Syndrome

Abstract Background:Nerve conduction study (NCS) is the only useful test for objective assessment of carpal tunnel syndrome (CTS). However, the relationship between pre- and postoperative NCS and clinical outcomes was unclear. This study aimed to determine whether pre- and postoperative (6 months) NCS could predict patient-oriented and motor outcomes (6 and 12 months postoperatively) in patients with CTS.Methods:Of the 85 patients with CTS, 107 hands were analyzed from March 2011 to March 2020. All patients underwent open carpal tunnel release and were examined using the disabilities of the arm, shoulder and hand (DASH) questionnaire and grip strength (GS) preoperatively and 6 and 12 months. Moreover, NCS was examined preoperatively and 6 months postoperatively. Distal motor latency (DML) and sensory conduction velocity (SCV) were the parameters used for NCS. The correlation coefficient between NCS and DASH or GS was calculated. A receiver operating characteristic curve was utilized to determine the NCS threshold value to predict DASH and GS improvement.Results:The average scores of GS preoperatively and 6 and 12 months postoperatively were 21.3, 22.3, and 22.8, respectively. On the other hand, the average scores of DASH preoperatively and 6 and 12 months postoperatively were 28.8, 18.3, and 12.2, respectively. The average NCS scores (DML and SCV) preoperatively/6 months postoperatively were 7.3/5.4 and 27.8/36.7, respectively. Preoperative NCS did not correlate with DASH and GS. Postoperative SCV correlated with the change in grip strength (6–12 months, r = 0.67; 0–12 months, r = 0.60) and DASH (0–12 months, r = 0.77). Moreover, postoperative DML correlated with the change in DASH (6–12 months, r = -0.33; 0–12 months, r = -0.59). The prediction for the improvement of GS/DASH achieved a sensitivity of 50.0%/66.7% and a specificity of 100%/100%, at an SCV cutoff score of 38.5/45.0 or above. The prediction for improvement of GS/DASH achieved a sensitivity of 83.3%/66.7% and a specificity of 100%/66.7% at a DML cutoff score of 4.4/4.4 or below.Conclusions:NCS at 6 months postoperatively can be used to predict the improvement of clinical outcome after 6 months postoperatively in patients with CTS.

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