Rates of and Risk Factors for Trigger Finger after Open Carpal Tunnel Release

2021 ◽  
Author(s):  
Jeremy E. Raducha ◽  
Winston Jiang ◽  
Lindsey Kahan ◽  
James Houston Dove ◽  
Christopher Cochran ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Ring Finger ◽  
Middle Finger ◽  
Chi Square ◽  
Level Of Evidence ◽  
Patient Demographics ◽  
History Of ◽  
Chi Square Analysis ◽  
Open Carpal Tunnel Release

Abstract Background We have anecdotally noticed a higher rate of trigger fingers (TFs) developing in patients who have undergone carpal tunnel release (CTR). Questions/Objective Is the rate of TFs after CTR greater compared to the nonoperative hand? Is the thumb more commonly involved postoperatively compared with spontaneous TFs? Do particular associated comorbidities increase this risk? Patients and Methods We queried our institutional database for patients who had undergone open CTR during a 2-year period and recorded the development of an ipsilateral TF after a CTR or a contralateral TF in the nonoperative hand. Patient demographics, comorbidities, concurrent initial procedures, time to diagnosis, and finger involvement were recorded. Results A total of 435 patients underwent 556 CTRs during this period. Furthermore, 46 ipsilateral TFs developed in 38 of 556 cases (6.83%) at an average of 228.1 ± 195.7 days after surgery. The thumb was most commonly involved (37.0%) followed by the ring finger (28.3%). The incidence rate of TF in the nonoperative hand during this period was 2.7%, with the ring finger and middle finger most commonly involved (33.3 and 28.6%, respectively). Only history of prior TF in either hand was found to be a significantly associated on Chi-square analysis and multivariable regression (p < 0.001). Conclusion In patients with carpal tunnel syndrome, ipsilateral TFs occurred after 6.83% of CTRs, compared with a rate of 2.7% in the nonoperative hand, making it an important possible outcome to discuss with patients. The thumb was more commonly involved in triggering in the surgical hand compared with the nonoperative hand. Patients with a history of prior TFs in either hand were more likely to develop an ipsilateral TF after CTR. Level of Evidence This is a Level III, retrospective study.

A Prospective, Randomized Study with an Independent Observer Comparing Open Carpal Tunnel Release with Endoscopic Carpal Tunnel Release

1996 ◽  
Vol 21 (2) ◽  
pp. 202-204 ◽  
Author(s):  
M. B. JACOBSEN ◽  
H. RAHME
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Randomized Study ◽  
Clinical Signs ◽  
Ring Finger ◽  
Independent Observer ◽  
Randomised Study ◽  
Endoscopic Carpal Tunnel Release ◽  
Significant Difference ◽  
Open Carpal Tunnel Release

In order to define the role of two-portal endoscopic carpal tunnel release, a prospective randomised study with an independent observer was performed to compare endoscopic and open surgery. Thirty-two hands in 29 patients, with symptoms, clinical signs and EMG changes consistent with idiopathic carpal tunnel syndrome were randomised to either endoscopic carpal tunnel release or open release. No significant difference in sick leave between the two groups could be found, being a mean of 17 days (range 0–31 days) with endoscopic surgery, and 19 days (range 0–42 days) with open conventional surgery. No differences in surgical results were found, but three patients in the endoscopic group suffered transient numbness on the radial side of the ring finger.

Open Carpal Tunnel Release: Comparison of a Long Versus Short Incision

1998 ◽  
Vol 6 (2) ◽  
pp. 89-92
Author(s):  
Vicki L Kruger ◽  
Morris TM Rebot
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Workers Compensation ◽  
Repetitive Motion ◽  
Motion Patterns ◽  
Endoscopic Release ◽  
History Of ◽  
Incision Technique ◽  
Open Carpal Tunnel Release ◽  
Postoperative Complaints

VL Kruger, MTM Rebot. Open carpal tunnel release: Comparison of a long versus short incision. Can J Plast Surg 1998;6(2):89-92. A total of 225 adults with carpal tunnel release of 313 wrists were studied to compare the outcome of a long (at least 3.5 cm) with that of a short (2.0 cm or less) incision technique. The two groups were compared for postoperative complaints, length of time until full function was regained, rate of referral to rehabilitation and the effect of Workers’ Compensation status. The surgical technique and rehabilitation protocol are described. The number and severity of postoperative complaints were significantly reduced in the short incision group. In the non-Workers’ Compensation group, 96% of short incision patients resumed full function within 28 days. This finding compares favourably with published results for endoscopic release, and is superior to results obtained with the long incision. Workers’ Compensation patients required longer to recuperate, with 78% regaining full function within 28 days. of those with Workers’ Compensation, 47% of the long incision group and 27% of the short incision group required out-patient therapy. for the non-Workers’ Compensation group, this percentage decreased to 21% of those with the long incision and 3% with the short incision. A history of vocational or avocational repetitive motion patterns was the most common indicator for therapy and accounted for 67% of rehabilitation referrals.

scholarly journals Outcomes Following Carpal Tunnel Release in Patients Receiving Workers’ Compensation: A Systematic Review

Hand ◽  
2017 ◽  
Vol 13 (2) ◽  
pp. 137-142 ◽  
Author(s):  
John C. Dunn ◽  
Nicholas A. Kusnezov ◽  
Logan R. Koehler ◽  
Dennis Vanden Berge ◽  
Ben Genco ◽  
...  
Keyword(s):  
Systematic Review ◽  
Return To Work ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Statistical Significance ◽  
Standard Form ◽  
Outcome Data ◽  
Workers Compensation ◽  
Chi Square ◽  
Patient Demographics

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

Pre-operative electrodiagnostic testing predicts time to resolution of symptoms after carpal tunnel release

2015 ◽  
Vol 41 (2) ◽  
pp. 137-142 ◽  
Author(s):  
J. R. Fowler ◽  
M. Munsch ◽  
Y. Huang ◽  
W. C. Hagberg ◽  
J. E. Imbriglia
Keyword(s):  
Carpal Tunnel Syndrome ◽  
No Value ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Carpal Tunnel Release ◽  
Nerve Conduction Studies ◽  
Level Of Evidence ◽  
Electrodiagnostic Testing ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release

The purpose of this study was to determine if nerve conduction studies predict time to resolution of symptoms after carpal tunnel release. A total of 56 patients undergoing open carpal tunnel release were prospectively enrolled. Pre-operative presence of nocturnal symptoms and daytime numbness/tingling were documented. Pre-operative nerve conduction studies were reviewed and classified as mild, moderate, or severe. After open carpal tunnel release, patients were contacted by phone within 48 hours, at 1 week, and then at 2-week intervals for up to 9 months or until both nocturnal and daytime symptoms had resolved. This study found that patients with mild or moderate carpal tunnel syndrome experience a faster time to resolution of daytime numbness and tingling when compared with patients with severe carpal tunnel syndrome. Nocturnal symptoms resolved quickly in both groups. The results of this study are in contrast to previous studies that found little to no value of nerve conduction studies in predicting post-operative functional and subjective outcomes. Level of Evidence: IV

Return to work following ultrasound guided thread carpal tunnel release versus open carpal tunnel release: a comparative study

2021 ◽  
pp. 175319342110512
Author(s):  
Derek B. Asserson ◽  
Taylor J. North ◽  
Peter C. Rhee ◽  
Allen T. Bishop ◽  
Jeffrey S. Brault ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Return To Work ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Work Status ◽  
Ultrasound Guided ◽  
Level Of Evidence ◽  
Hospital Employees ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release

A retrospective review of hospital employees at a single employer institution who underwent ultrasound guided thread carpal tunnel release (TCTR) or open carpal tunnel release (OCTR) between January 2018 and August 2020 was performed to ascertain differences in return-to-work status. Patient age, sex, occupation, handedness, severity of carpal tunnel syndrome, prior treatments and surgical outcomes were reviewed. A total of 18 patients underwent TCTR and 17 patients underwent OCTR. The TCTR group averaged 12 days to return to work without restrictions, as opposed to 33 days for the OCTR group. Resolution of symptoms was afforded in all patients without any complications regardless of surgical technique. While both TCTR and OCTR were effective, our data indicates that TCTR resulted in a shorter return to work. Level of evidence: III

scholarly journals Factors Affecting Operative Duration in Isolated Open Carpal Tunnel Release

2018 ◽  
Vol 08 (02) ◽  
pp. 108-111
Author(s):  
Richard Hinds ◽  
David Fiedler ◽  
John Capo ◽  
S. Yang
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Procedure Time ◽  
Level Of Evidence ◽  
Factors Associated ◽  
Time Of Surgery ◽  
Operative Duration ◽  
Open Carpal Tunnel Release

Background Open carpal tunnel release (CTR) is one of the most commonly performed operative procedures with operative duration being a primary metric of operating room efficiency. The purpose of this study was to identify factors associated with prolonged operative duration, in performing CTR. Materials and Methods CTR cases performed by a single surgeon from September 2013 to October 2015 were reviewed. Patient age at the time of surgery, sex, location of surgery (specialty orthopaedic hospital versus ambulatory surgery center), body mass index (BMI), American Society of Anesthesiologists classification, total operative duration (TOD), and procedure time (PT) were recorded. Obesity was defined as BMI > 30 and morbid obesity was defined as BMI > 35. Data were analyzed to identify factors associated with prolonged TOD or PT. Results One hundred and nine consecutive patients underwent isolated CTR. Mean age at time of surgery was 62 years (range: 24–92 years). Nonobese patients were found to have significantly shorter TOD than obese patients (22.3 vs. 24.4 minutes). Similarly, patients who were not morbidly obese had significantly shorter TOD than morbidly obese patients (22.6 vs. 26 minutes). No other factors were associated with prolonged TOD. No difference in PT was found between normal weight, obese, and morbidly obese groups. Conclusions TOD, but not procedure time, is significantly affected by obesity. Our findings are relevant when scheduling and preparing obese patients for surgery, which may have a significant impact on health resource utilization. Level of Evidence This is a Level III, economic/decision analysis study.

Risk of Neurovascular Injury with Limited-Open Carpal Tunnel Release: Defining the “Safe-Zone”

2001 ◽  
Vol 26 (5) ◽  
pp. 484-487 ◽  
Author(s):  
T. L. ATIK ◽  
B. SMITH ◽  
M. E. BARATZ
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Ring Finger ◽  
Safe Zone ◽  
Ulnar Deviation ◽  
Radial Deviation ◽  
Neurovascular Structure ◽  
Middle Ring ◽  
Open Carpal Tunnel Release ◽  
Neurovascular Structures

Limited-open carpal tunnel release was performed in ten cadaver arms using the “Safeguard” system. The “Safeguard” guide was intentionally placed off of the longitudinal middle/ring finger axis, either in 15° of radial deviation or 15° of ulnar deviation. Despite the errant placement, carpal tunnel release was performed without damage to any neurovascular structure. The proximity of neurovascular structures to the middle/ring finger axis was measured in all ten cadaver specimens. From this, a “safe-zone” was defined for endoscopic or limited-open carpal tunnel release. The “safe-zone” expands when surgery is performed from distal to proximal. The area of the “safe-zone” is greatest when a protective guide is placed between the bursal sac of the carpal canal and the flexor retinaculum.

scholarly journals Mini-open carpal tunnel release technique

2021 ◽  
Vol 27 (2) ◽  
pp. 52-57
Author(s):  
Mihajlo Mitrović ◽  
Dražen Jelača
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Intraoperative Complications ◽  
Ring Finger ◽  
Superficial Fascia ◽  
Wrist Flexion ◽  
Compressive Neuropathy ◽  
Release Technique ◽  
Open Carpal Tunnel Release ◽  
Mini Open

Introduction/Aim: Carpal tunnel syndrome (CST) is the most common cause of upper extremity compressive neuropathy. Until the introduction of endoscopy, the dominant surgical method was classic open surgery. The objective of the paper is to examine the efficacy, safety and economic value of the mini-open carpal tunnel release technique using a longitudinal 2 cm long incision in the carpal region. Methods: The diagnosis was made based on clinical examination, followed by an ENMG. The study includes only patients with idiopathic CTS, while those who have developed CTS as a result of secondary causes have been excluded from the study. All patients were operated on under local anaesthesia, WALANT, without the use of a tourniquet. A longitudinal incision 2 cm long is made in the line of the radial edge of the ring finger, 2-3 cm distal to the wrist flexion crease, immediately proximal of the Caplan cardinal line and ulnar to the thenar crease. Upon cutting through the skin and subcutaneous soft tissue, the superficial fascia is identified and then cut with the same scalpel in the same direction and the same length. The transversal ligament is then identified and carefully incised with a scalpel enough to allow further decompression with the use of scissors. Using standard surgical scissors for the hand, the ligament is cut proximally to the forearm fascia and then distally until a faint crackling sound is heard, which means that the ligament had been completely cut. This must be checked by inserting the Freer elevator proximally and distally to the edge of the ligament. Now it is possible to identify the nerve and accompanying hand flexor tendons. Sutures are placed only on the skin and a roll of gauze is fixed to the wound with an elastic bandage to provide compression. The first check-up is on the very next day and the patient is advised to start doing hand exercises. The sutures are removed 10-14 days after surgery. Results: From January 2018 to December 2019, 35 carpal tunnel decompressions were performed on 30 patients using the mini-open decompression technique and standard surgical scissors. The surgery was performed on 22 patients in the operating room and 8 patients in the infirmary. There were no intraoperative complications. All patients reported no night pain from the very first day after surgery. Pillar pain, incision pain and hand weakness were progressively becoming less pronounced during the next 12 weeks. At the final check-up, only one patient still had pronounced symptoms that required a reintervention. The rest of the patients had completely recovered. Even though the endoscopic procedure for carpal tunnel decompression is constantly evolving, the classic open method and newly developed mini-open carpal tunnel release technique remain the treatments of choice. Conclusion: Our research shows that the mini-open carpal tunnel release technique is a quick, efficient, safe and cheap surgical technique for treating carpal tunnel compressive neuropathy.

Diagnostic Value of a Carpal Tunnel Corticosteroid Injection in Patients with Negative Electrodiagnostic Studies

2020 ◽  
Author(s):  
Brian M. Katt ◽  
Casey Imbergamo ◽  
Fortunato Padua ◽  
Joseph Leider ◽  
Daniel Fletcher ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Corticosteroid Injection ◽  
Carpal Tunnel Release ◽  
False Negative ◽  
False Negative Rate ◽  
Signs And Symptoms ◽  
Diagnostic Value ◽  
Symptom Improvement ◽  
Study Cohort ◽  
Chi Square Analysis

Abstract Introduction There is a known false negative rate when using electrodiagnostic studies (EDS) to diagnose carpal tunnel syndrome (CTS). This can pose a management dilemma for patients with signs and symptoms that correlate with CTS but normal EDS. While corticosteroid injection into the carpal tunnel has been used in this setting for diagnostic purposes, there is little data in the literature supporting this practice. The purpose of this study is to evaluate the prognostic value of a carpal tunnel corticosteroid injection in patients with a normal electrodiagnostic study but exhibiting signs and symptoms suggestive of carpal tunnel, who proceed with a carpal tunnel release. Materials and Methods The group included 34 patients presenting to an academic orthopedic practice over the years 2010 to 2019 who had negative EDS, a carpal tunnel corticosteroid injection, and a carpal tunnel release. One patient (2.9%), where the response to the corticosteroid injection was not documented, was excluded from the study, yielding a study cohort of 33 patients. Three patients had bilateral disease, yielding 36 hands for evaluation. Statistical analysis was performed using Chi-square analysis for nonparametric data. Results Thirty-two hands (88.9%) demonstrated complete or partial relief of neuropathic symptoms after the corticosteroid injection, while four (11.1%) did not experience any improvement. Thirty-one hands (86.1%) had symptom improvement following surgery, compared with five (13.9%) which did not. Of the 32 hands that demonstrated relief following the injection, 29 hands (90.6%) improved after surgery. Of the four hands that did not demonstrate relief after the injection, two (50%) improved after surgery. This difference was statistically significant (p = 0.03). Conclusion Patients diagnosed with a high index of suspicion for CTS do well with operative intervention despite a normal electrodiagnostic test if they have had a positive response to a preoperative injection. The injection can provide reassurance to both the patient and surgeon before proceeding to surgery. Although patients with a normal electrodiagnostic test and no response to cortisone can still do well with surgical intervention, the surgeon should carefully review both the history and physical examination as surgical success may decrease when both diagnostic tests are negative. Performing a corticosteroid injection is an additional diagnostic tool to consider in the management of patients with CTS and normal electrodiagnostic testing.

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