Median Nerve Injury After Carpal Tunnel Injection Serially Followed by Ultrasonographic, Sonoelastographic, and Electrodiagnostic Studies

2011 ◽  
Vol 90 (4) ◽  
pp. 336-341 ◽  
Author(s):  
Gi-Young Park ◽  
Seong-Kyu Kim ◽  
Jung Hyun Park
Keyword(s):  
Median Nerve ◽  
Nerve Injury ◽  
Carpal Tunnel ◽  
Tunnel Injection ◽  
Median Nerve Injury

scholarly journals Litigation Following Carpal Tunnel Release

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 466-470 ◽  
Author(s):  
Nishant Ganesh Kumar ◽  
Nicholas Hricz ◽  
Brian C. Drolet
Keyword(s):  
Median Nerve ◽  
Nerve Injury ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Hand Surgery ◽  
The United States ◽  
Fellowship Training ◽  
Malpractice Claims ◽  
Predominantly Female ◽  
Median Nerve Injury

Background: Carpal tunnel release (CTR) is the most common hand surgery operation performed in the United States. While serious complications are rare, they can be life-altering to patients. In some cases, patients will pursue malpractice claims against the surgeon. This study aimed to understand the patient, procedure, and surgeon factors involved in CTR malpractice litigation. Methods: The Westlaw legal database was queried for all recorded CTR malpractice cases resulting in jury verdicts and settlements. Only cases directly related to injury after CTR were included in this study. Cases were reviewed to determine plaintiff demographics, defendant training, liability, injury, outcomes, and monetary awards. Results: Ninety-two unique cases were identified. Plaintiffs were predominantly female (n = 65, 71%). Most surgeons were orthopedic-trained (n = 37, 52%). Only 27% of defendants (n = 19) were hand fellowship-trained. Only 19% of cases resulting in a monetary award were against surgeons who had hand fellowship training. The majority of cases (n = 61, 66%) were found in favor of the defendant. Monetary awards averaged $305 923 (range = $12 000-1 338 147), while settlements averaged $266 250. Alleged liability was most for surgeon negligence (n = 69, 75%) with a third of cases resulting in monetary awards. Median nerve injury was claimed in 41 cases (45%), with 17 (41%) resulting in monetary awards. Conclusion: Although CTR is generally safe and effective, some patients will experience complications. Median nerve injury was the most common reason for successful litigation in this study. Adequate training and experience in hand surgery may lower the risk of injuries resulting in successful malpractice suits.

The Modified Ultrasound-Guided Distal-to-Proximal Carpal Tunnel Injection With Median Nerve Hydrodissection: A Retrospective Safety Review of 827 Procedures

Hand ◽  
2019 ◽  
pp. 155894471986171
Author(s):  
Kathy Guo ◽  
Logan McCool ◽  
Hao Wang ◽  
Danzhu Guo ◽  
Danqing Guo
Keyword(s):  
Soft Tissue ◽  
Median Nerve ◽  
Nerve Injury ◽  
Vascular Injury ◽  
Carpal Tunnel ◽  
Side Effect ◽  
Ultrasound Guided ◽  
Surrounding Soft Tissue ◽  
Safety Review ◽  
Tunnel Injection

Objective: The aim of this report is to describe a new ultrasound guided technique for carpal tunnel injection and median nerve hydrodissection using distal to proximal approach. Methods: From 2015 to 2019, 827 consecutive injections by distal-to-proximal approach were included using coding information to check for post-procedural skin hypopigmentation, hematoma, seroma, nerve injury, or vascular injury. Results: There were no occurrences of post-procedural skin-hypopigmentation, hematoma or seroma formation, or neurovascular injury. Conclusions: The distal approach carpal tunnel injection is a safe and effective method. It may directly inject the medication into carpal tunnel to avoid skin hypopigmentation from steroid side effect with previous report method, also it may release adhesion of median nerve with surrounding soft tissue by hydrodissection. It helps median nerve compression at outlet of carpal tunnel.

CARPAL TUNNEL RELEASE IN PATIENTS WITH NEGATIVE NEUROPHYSIOLOGICAL EXAMINATIONS

Neurosurgery ◽  
2009 ◽  
Vol 65 (suppl_4) ◽  
pp. A171-A173 ◽  
Author(s):  
Massimo Lama
Keyword(s):  
Median Nerve ◽  
Nerve Injury ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Cervical Radiculopathy ◽  
Clinical Findings ◽  
Work Related ◽  
Persistent Symptoms ◽  
Operative Findings ◽  
Median Nerve Injury

Abstract OBJECTIVE In 16% to 34% of patients with classic symptoms of carpal tunnel syndrome (CTS), neurophysiology is negative. Few studies have concentrated on patients with symptoms compatible with CTS with normal examinations. The purpose of our study was to examine the clinical and surgical characteristics of this subtype of CTS in order to clarify a correct approach toward these patients. METHODS We studied a subpopulation of 25 patients (31 hands) with typical CTS symptoms despite normal neurophysiological examinations. All of the patients were initially treated with conservative therapy, and patients with work-related symptoms were advised to change their duties. In patients with persistent symptoms, wrist ultrasound and radiographic and blood examinations with rheumatic screenings were performed. Cervical magnetic resonance imaging was performed in some cases to exclude cervical radiculopathy. Other pathologies were found in 5 cases. Nine patients improved with nonsurgical therapy. Six months later, electric examinations were repeated and 3 patients with a confirmed median nerve injury underwent surgery. Eight patients with negative examinations underwent surgery (10 hands). All patients were advised of the possibility of incomplete pain remission after surgery. RESULTS All patients improved after surgery. Median nerve injury was confirmed by operative findings according to Tuncali grading. CONCLUSION A combination of clinical findings and instrumental procedures is required when selecting patients for successful surgery.

scholarly journals Trends and Complications in Open Versus Endoscopic Carpal Tunnel Release in Private Payer and Medicare Patient Populations

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 455-461 ◽  
Author(s):  
Sai K. Devana ◽  
Andrew R. Jensen ◽  
Kent T. Yamaguchi ◽  
Anthony D’Oro ◽  
Zorica Buser ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Median Nerve ◽  
Nerve Injury ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Wound Dehiscence ◽  
Endoscopic Carpal Tunnel Release ◽  
Open Versus ◽  
Median Nerve Injury ◽  
Private Payer

Purpose: The purpose of this study was to report trends, complications, and costs associated with endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR). Methods: Using Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision (ICD-9) codes, patients who had open versus endoscopic carpal tunnel release (CTR) were identified retrospectively in the PearlDiver database from both the Medicare and Humana (a private payer health insurance) populations from 2005 to 2014. These groups were then evaluated for postoperative complications, including wound infection within 90 days, wound dehiscence within 90 days, and intraoperative median nerve injury. We also used the data output for each group to compare the cost of the 2 procedure types. Data were analyzed via the Student t test. Statistical significance was set at P < .05. Results: A significantly lower percentage of patients in the endoscopic CTR group had a postoperative infection (5.21 vs 7.97 per 1000 patients per year, P < .001; 7.36 vs 11.23 per 1000 patients per year, P < .001) and wound dehiscence (1.58 vs 2.87 per 1000 patients per year, P < .001; 2.14 vs 3.73 per 1000 patients per year, P < .05) than open CTR group in the Medicare and Humana populations, respectively. Median nerve injury occurred 0.59/1000 ECTRs versus 1.69/1000 OCTRs (Medicare) and 1.96/1000 ECTRs versus 3.72/1000 OCTRs (Humana). Endoscopic CTR cost was more than open CTR for both the Medicare population ($1643 vs $1015 per procedure, P < .001) and Humana population ($1928 vs $1191 per procedure, P < .001). Conclusions: In both the Medicare and private insurance patient populations, endoscopic CTR is associated with fewer postoperative complications than open CTR, but is associated with greater expenses.

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