A comparison of outcomes of carpal tunnel release for
                    carpal tunnel syndrome in patients diagnosed with and without
                    electrophysiological studies

AbstractRecords were analysed from the institutional database, including 943 patients (1089 hands) with CTS who were operated on in the authors’ department over a period of four years (2012 to 2015). The diagnosis of CTS was made solely on the basis of clinical findings in 551 patients (58 %); 392 patients (42 %) also had electrodiagnostic tests performed, for various reasons. Patients were followed-up at 1 and 6 months with assessments that included the Levine scores, filament tests, grip and pinch strength. No significant differences in Levine scores were found at the 1 and 6 month assessments. Statistically significant differences were noted in 3-point pinch strength and sensation: however, these were not clinically meaningful. The results of the study show that the results of carpal tunnel release in patients with typical symptoms are no better after electrodiagnostic tests.

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The results of carpal tunnel release for carpal tunnel syndrome diagnosed on clinical grounds, with or without electrophysiological investigations: a randomized study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412445162 ◽

2012 ◽

Vol 38 (1) ◽

pp. 44-49 ◽

Cited By ~ 19

Author(s):

A. Żyluk ◽

Z. Szlosser

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Carpal Tunnel Release ◽

Randomized Study ◽

Clinical Importance ◽

Nerve Conduction Studies ◽

Pinch Strength ◽

Tunnel Syndrome ◽

To Receive

We compared the results of carpal tunnel release in patients with the diagnosis of carpal tunnel syndrome based on only clinical grounds and those diagnosed on clinical and electrophysiological grounds. Ninety-three patients, 83 women (89%) and ten men (11%), meeting the criteria of ‘typical’ carpal tunnel syndrome, were randomly assigned to receive carpal tunnel release with ( n = 45, 48%) or without ( n = 48, 52%) nerve conduction studies. Patients were followed-up at 1 and 6 months, by assessments that included the Levine scores, filament tests, grip and pinch strength. No significant differences in Levine scores were found at the 1 and 6 months assessments. Statistically significant differences were noted in three-point pinch strength and sensation; however, they were not of clinical importance. The results of the study show that the results of carpal tunnel release in patients with typical symptoms are no better after nerve conduction studies and, therefore, nerve conduction studies can be omitted.

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Thumb Function and Electromyography Result after Modified Camitz Tendon Transfer

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

10.1142/s0218810417500290 ◽

2017 ◽

Vol 22 (03) ◽

pp. 275-280 ◽

Cited By ~ 3

Author(s):

Claire Marie Durban ◽

Bernard Antolin ◽

Chung Ying Sau ◽

Sheung Wai Li ◽

Wing Yuk Ip

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Pinch Strength ◽

Muscle Recovery ◽

Abductor Pollicis Brevis ◽

Palmaris Longus ◽

Contralateral Hand ◽

Tunnel Syndrome ◽

Open Carpal Tunnel Release

Background: Various techniques of opponensplasty have been developed with the aim of restoring the thumb function. The modified Camitz opponensplasty is a simple technique done together with an open carpal tunnel release. It restores thumb palmar abduction soon after the procedure, during such time that the abductor pollicis brevis (APB) is still recovering. The aim of this study was to assess the recovery and level of activity of the abductor pollicis brevis and palmaris longus (PL) muscles during thumb opposition and abduction after performing the modified Camitz opponensplasty. Methods: The records of 21 patients who underwent modified Camitz opponensplasty for severe carpal tunnel syndrome were reviewed. Thumb function was evaluated using the Van Wetter Apogee test, Kapandji index, tripod pinch strength, and power grip. Electromyography was utilized to evaluate APB recovery; ultrasonography was employed to evaluate PL activity. Results: Twenty patients reached 80% of the abduction height of the contralateral hand; the Kapandji index was good in thirteen. Palmaris longus activity was evaluated together with the APB muscle recovery. There was significant improvement in the average grip strength and average tripod pinch strength. However, this did not correlate with the degree of neurologic and muscular recovery of the APB. We surmise that the palmaris longus augmented the abductor pollicis brevis muscle even in those with full muscle recovery. Conclusions: The modified Camitz opponensplasty is a practical option for patients suffering from severe carpal tunnel syndrome with diminished thumb function.

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A Prospective, Randomized Trial Comparing Open and Endoscopic Carpal Tunnel Release Within the Same Patient

Hand ◽

10.1177/1558944718812129 ◽

2018 ◽

Vol 15 (3) ◽

pp. 322-326 ◽

Cited By ~ 4

Author(s):

Brett M. Michelotti ◽

Kavita T. Vakharia ◽

Diane Romanowsky ◽

Randy M. Hauck

Keyword(s):

Carpal Tunnel Syndrome ◽

Functional Status ◽

Carpal Tunnel ◽

Symptom Severity ◽

Carpal Tunnel Release ◽

Demographic Data ◽

Pinch Strength ◽

Postoperative Time ◽

Tunnel Syndrome ◽

A Prospective Study

Background: Surgical management of carpal tunnel syndrome includes performing an endoscopic (ECTR) or open (OCTR) carpal tunnel release. Several studies have shown less postoperative pain and improvement in grip and pinch strength with the endoscopic technique. The goal of this study was to prospectively examine outcomes, patient satisfaction, and complications after both ECTR and OCTR in the opposite hands of the same patient. Methods: This was a prospective study in which patients with bilateral carpal tunnel syndrome underwent surgical release with both techniques, with initial operative approach randomized in the more symptomatic hand. Demographic data and functional outcomes were recorded, including the pain score, 2-point discrimination, Semmes-Weinstein monofilament testing, thenar strength testing, grip strength, carpal tunnel syndrome functional status score, carpal tunnel syndrome symptom severity score, and overall satisfaction. Results: Thirty patients completed the study; there were no significant differences in any measure at any of the postoperative time points. Symptom severity and functional status scores were not significantly different between groups at any evaluation. Subjectively, 24 of 30 patients did state they preferred the ECTR, mostly citing less pain as their primary reason, although pain scores were not significantly different. Differences in overall satisfaction were also not significant. Conclusions: Both techniques are well tolerated with no differences in outcomes. With the added cost and equipment associated with ECTR, and no added benefit, the usefulness of ECTR is questionable.

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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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Pre- and post-operative comorbidities in idiopathic carpal tunnel syndrome: cervical arthritis, basal joint arthritis of the thumb, and trigger digit

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412445441 ◽

2012 ◽

Vol 38 (1) ◽

pp. 50-56 ◽

Cited By ~ 16

Author(s):

J.H. Kim ◽

H.S. Gong ◽

H.J. Lee ◽

Y. H. Lee ◽

S.H. Rhee ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

De Quervain’S Disease ◽

Basal Joint ◽

Before And After ◽

Electrophysiological Studies ◽

Idiopathic Carpal Tunnel Syndrome ◽

Tunnel Syndrome ◽

Joint Arthritis

We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain’s disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain’s disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome.

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The diagnostic efficacy of clinical findings and electrophysiological studies in carpal tunnel syndrome

The European Research Journal ◽

10.18621/eurj.2017.5000195868 ◽

2016 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Nilufer Buyukkoyuncu Pekel ◽

Pelin Nar Senol ◽

Demet Yildiz ◽

Ahmet Kasim Kilic ◽

Deniz Kamaci Sener ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Clinical Findings ◽

Diagnostic Efficacy ◽

Electrophysiological Studies ◽

Tunnel Syndrome

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Transfer of the flexor carpi radialis to the abductor pollicis brevis tendon for the restoration of tip-pinch in severe carpal tunnel syndrome

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413481303 ◽

2013 ◽

Vol 39 (2) ◽

pp. 175-180 ◽

Cited By ~ 5

Author(s):

J. R. Danoff ◽

M. V. Birman ◽

M. P. Rosenwasser

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Pinch Strength ◽

Abductor Pollicis Brevis ◽

Flexor Carpi Radialis ◽

Pinch Grip ◽

Tunnel Syndrome ◽

Open Carpal Tunnel Release ◽

Patients Experience

In patients with severe thenar atrophy secondary to carpal tunnel syndrome, we hypothesize that following open carpal tunnel release, concomitant transfer of the abductor pollicis brevis (APB) origin to the flexor carpi radialis (FCR) tendon will lead to improved patient function restoring palmar abduction and thumb opposition. We evaluated 14 patients through questionnaires and seven patients through additional physical examination (thumb range of motion, ability to tip pinch, grip/pinch strength) for a mean follow-up of 2.8 years. All patients showed evidence of palmar abduction with 71% demonstrating the ability to oppose the thumb to the tip and base of the small finger. The transfer of the APB origin to the FCR tendon can restore thumb abduction and opposition for thenar paralysis secondary to severe carpal tunnel syndrome. Patients experience good functional outcomes with the majority experiencing restored thumb opposition.

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A comparison of outcomes of carpal tunnel release in diabetic and non-diabetic patients

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412469781 ◽

2012 ◽

Vol 38 (5) ◽

pp. 485-488 ◽

Cited By ~ 16

Author(s):

A. Zyluk ◽

P. Puchalski

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Pinch Strength ◽

Diabetic Patients ◽

Operative Outcomes ◽

Tunnel Syndrome ◽

Diabetes Patients

The coexistence of diabetes might complicate the diagnosis and operative outcomes of carpal tunnel syndrome. We retrospectively compared the results of carpal tunnel release in diabetic and non-diabetic patients. The group included 386 patients, 322 female (83%) and 64 male (17%) with a mean age of 57 years. A total of 41 patients (11%) were diabetic, whereas 345 (89%) did not have diabetes. Patients were followed-up at six months, by assessments that included Levine scores, filament tests, grip and pinch strength. No significant differences in any of the measured variables were found at the six-month assessment. The results of the study show that carpal tunnel release in diabetic and non-diabetic patients are similarly beneficial.

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Carpal Tunnel Syndrome and Hand Function

Canadian Journal of Plastic Surgery ◽

10.1177/229255039300100103 ◽

1993 ◽

Vol 1 (1) ◽

pp. 44-46

Author(s):

G Allan Taylor

Keyword(s):

Informed Consent ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Hand Function ◽

Pinch Strength ◽

High Incidence ◽

Tunnel Syndrome ◽

Loss Of Strength ◽

Age And Sex

GA Taylor. Carpal tunnel syndrome and hand function. Can J Plast Surg 1993; 1 (1):44-46. A prospective review of 78 hands in 58 patients with carpal tunnel syndrome is presented. The author's technique for carpal tunnel release under local anesthesia is described. Comparison of the patients in the series with age- and sex-matched controls revealed a high incidence of preoperative weakness of grip and pinch strength. Postoperatively, many patients experienced further loss of strength persisting six months or more. Some had not regained preoperative strength by six months. Explanations for diminished hand strength in patients with carpal tunnel syndrome both pre- and postoperatively are advanced and recommendations made for improved informed consent for patients undergoing carpal tunnel release.

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Functional outcome of surgery done for carpal tunnel syndrome

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164827 ◽

2016 ◽

Vol 3 (1) ◽

pp. 71

Author(s):

Mathew P. Thomas

Keyword(s):

Carpal Tunnel Syndrome ◽

Functional Outcome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Symptomatic Relief ◽

Age At Onset ◽

Clinical Findings ◽

Medical College ◽

Tunnel Syndrome ◽

Carpal Tunnel Release Surgery

Background: Carpal tunnel syndrome is a common, chronic and disabling condition afflicting many people. The common age at onset is 40 to 50, although a person of any age may be affected. The diagnosis of carpal tunnel syndrome is often based on clinical findings alone. Electro-diagnostic studies of carpal tunnel syndrome were first established in 1956 by demonstrating focal slowing of median nerve conduction at wrist. This study is meant to evaluate the functional outcome of carpal tunnel release surgery done in Al Azhar Medical College from 2012-2014.Methods: 50 cases (5 cases being bilateral) of carpal tunnel syndrome were operated between 2012 to 2014. All cases were done under local anesthesia. Patients were retrospectively evaluated and interviewed for 2 months follow up after the surgery.Results: Out of the 50 patients who had undergone surgery, 44 patients (88%) had symptomatic relief in the first 10 days. Remaining patients had symptomatic relief in 2 months time.Conclusions: Surgery is always the preferred treatment for carpal tunnel syndrome. In my study, 6 patients (12%) had long standing carpal tunnel syndrome, hence it took 2 months for symptomatic relief. Remaining patients had symptomatic relief in the first 10 days.

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