Carpal Tunnel Release Surgery Plus Intraoperative Corticosteroid Injection versus Carpal Tunnel Release Surgery Alone: A Double Blinded Clinical Trial

2019 ◽  
Vol 24 (03) ◽  
pp. 371-377
Author(s):  
Mohammad Mottaghi ◽  
Mostafa Zare ◽  
Hamid Pahlavanhosseini ◽  
Mina Mottaghi
Keyword(s):  
Carpal Tunnel ◽  
Corticosteroid Injection ◽  
Carpal Tunnel Release ◽  
Mean Values ◽  
Before And After ◽  
The Mean ◽  
Carpal Tunnel Release Surgery ◽  
Group 2 ◽  
Double Blinded ◽  
Local Corticosteroid Injection

Background: Carpal tunnel syndrome is a prevalent disease with significant morbidity. The current treatments range from oral medication and local corticosteroid injection to surgical carpal tunnel release (CTR). In this study, we tried to assess the results of Carpal Tunnel Release surgery in combination with the anti-inflammatory effect of local corticosteroid injection. Methods: 65 patients were enrolled by clinical and electrodiagnostic tests and randomly divided into two groups, 32 in group one which underwent surgery with Dexamethasone injection and 33 in group 2 which intervened with carpal tunnel release surgery alone. Data on Boston questionnaire of patients were conducted before and two weeks after surgery. Distal motor and sensory latencies of patients were recorded before and two months after surgery. Mean values were compared between groups before and after surgery. Results: The mean preoperative Boston index was 35.83 in group one and 37.7 in group two, these data postoperative were 15.83 and 19.15 respectively. The mean preoperative distal sensory latency was 54.8 in group one and 47.6 in group two, these data postoperative were 34.1 and 35.1 respectively. The mean preoperative distal motor latency was 63.2 in group one and 62.3 in group two, these data postoperative were 44.5 and 46.55 respectively. Conclusions: CTR surgery plus local corticosteroid injection did not significantly change in results of Electrodiagnostic test or Boston index compared to the non-injection group.

INVESTIGATION OF SEGMENTAL CARPAL TUNNEL PRESSURE IN PATIENTS WITH IDIOPATHIC CARPAL TUNNEL SYNDROME — IS IT NECESSARY TO RELEASE THE DISTAL APONEUROTIC PORTION OF THE FLEXOR RETINACULUM IN ENDOSCOPIC CARPAL TUNNEL RELEASE SURGERY?

Hand Surgery ◽  
2007 ◽  
Vol 12 (03) ◽  
pp. 205-209 ◽  
Author(s):  
Keiichi Murata ◽  
Hiroshi Yajima ◽  
Naoki Maegawa ◽  
Koji Hattori ◽  
Yoshinori Takakura
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Guide Wire ◽  
Carpal Tunnel Release ◽  
Endoscopic Carpal Tunnel Release ◽  
Flexor Retinaculum ◽  
Before And After ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery

Segmental carpal tunnel pressure was measured in 12 hands of 11 idiopathic carpal tunnel syndrome patients before and after two-portal endoscopic carpal tunnel release. We aimed to determine at which part of the carpal tunnel the median nerve could be compressed, and to evaluate whether carpal tunnel pressure could be reduced sufficiently at all segments of the carpal tunnel after the surgery. Pressure measurements were performed using a pressure guide wire. The site with the highest pressure corresponded to the area around the hamate hook; the pressure in the area distal to the flexor retinaculum could be pathogenically high (more than 30 mmHg) before the surgery. The two-portal endoscopic carpal tunnel release achieved sufficient pressure reduction in all segments of the carpal tunnel when the flexor retinaculum and the fibrous structure between the flexor retinaculum and the palmar aponeurosis were completely released.

scholarly journals Use of conservative therapy before and after surgery for carpal tunnel syndrome

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Juhani Multanen ◽  
Mikko M. Uimonen ◽  
Jussi P. Repo ◽  
Arja Häkkinen ◽  
Jari Ylinen
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Level Of Evidence ◽  
Post Surgery ◽  
High Satisfaction ◽  
Before And After ◽  
Satisfaction With Treatment ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery

Abstract Background Conservative therapies are typically offered to individuals who experience mild or intermittent symptoms of carpal tunnel syndrome (CTS) or postoperatively to subjects who have undergone carpal tunnel release. Although long-term studies report mostly positive results for carpal tunnel release, knowledge on the need for conservative treatments following surgery is scarce. The aim of this retrospective cohort study was to examine the use of conservative therapies before and after carpal tunnel releasing surgery. Methods Of 528 patients who underwent carpal tunnel release surgery in the study hospital during the study period, 259 provided sufficiently completed questionnaires (response rate 49 %). The patients completed a questionnaire battery including a sociodemographic, medical history and symptom questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire, 6-item CTS symptoms scale and EuroQoL 5D. Frequencies of conservative therapies pre- and postoperatively were calculated. Association between Pain VAS and satisfaction with treatment were examined in patient groups according to the use of conservative therapies. Results Of all patients, 41 (16 %) reported receiving only preoperative, 18 (7 %) reported receiving only postoperative, 157 (60 %) reported receiving both pre- and postoperative conservative therapies and 43 (17 %) did not receive any therapies. Preoperative use of conservative therapies was more common in females than males (82 % vs. 64 %; p = 0.002), but postoperatively no significant gender difference was observed. The patients who received conservative therapies were younger than non-users in both the preoperative (median age 59 vs. 66; p < 0.001) and postoperative (59 vs. 66; p = 0.04) phases. The patients reported high satisfaction with their treatment and simultaneous improvement in Pain VAS scores. Those receiving conservative therapies only preoperatively reported the highest satisfaction. Conclusions While the use of conservative therapies decreased after surgery, a large proportion of the patients received these adjunct interventions. Patients reported high satisfaction with their treatment one year post surgery. Pain outcome seems to be closely related to satisfaction with treatment. Level of Evidence Level III.

Quantitative analysis of the variation in angles of the carpal arch after open and endoscopic carpal tunnel release

2009 ◽  
Vol 111 (2) ◽  
pp. 311-316 ◽  
Author(s):  
Leandro Pretto Flores ◽  
Thiago F. P. Cavalcante ◽  
Oswaldo R. M. Neto ◽  
Fabiano S. Alcântara
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Open Surgery ◽  
Carpal Tunnel Release ◽  
Statistical Significance ◽  
Mean Values ◽  
Endoscopic Carpal Tunnel Release ◽  
Tunnel Syndrome ◽  
The Mean ◽  
The Difference

Object Previous studies have demonstrated that the volume of the carpal canal increases after open and endoscopic surgery in patients with carpal tunnel syndrome. There is some controversy regarding the contribution of the postoperative widening of the carpal arch to the increment in carpal canal volume. The objectives of this study were to: 1) evaluate the degree of variation in the angles formed by the borders of the carpal arch following the surgical division of the transverse carpal ligament; and 2) determine if there are differences in the variation of these angles after the classical open surgery versus endoscopic carpal tunnel release. Methods The authors prospectively studied 20 patients undergoing carpal tunnel syndrome surgery: 10 patients were treated via the standard open technique, and 10 underwent endoscopic carpal tunnel release. The angles of the carpal arch were measured on CT scans of the affected hand obtained before and immediately after the surgical procedures. Measurements were performed at the level of the pisiform-scaphoid hiatus and at the level of the hook of the hamate-trapezium hiatus. Results There was widening of the postoperative angles of the carpal arch after open and endoscopic division of the flexor retinaculum; however, the difference between pre- and postoperative angulations reached statistical significance only in those patients treated by means of the open procedure. The mean (± SD) values for the postoperative increase in the angles at the level of the pisiform-scaphoid hiatus were 5.1 ± 0.4° after open surgery and 2.5 ± 0.3° after the endoscopically assisted procedure (p < 0.05). At the level of the hook of the hamate-trapezium hiatus, the mean values for the widening of the angles were 6.2 ± 0.6° for the open surgery group and 1.2 ± 0.4° for those patients treated by means of the endoscopic technique (p < 0.05). Conclusions The widening of the postoperative angles of the carpal arch is a phenomenon observed at the proximal and distal levels of the carpal canal, and it can be noted after both open and endoscopically assisted carpal tunnel release. The endoscopic procedure yielded less increase in these angles than the open surgery.

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.

Comparison of phaco time parameters in eyes with and without glaucoma filtration surgery due to pseudoexfoliation glaucoma

2021 ◽  
pp. 112067212110177
Author(s):  
Ayse Gul Kocak Altintas ◽  
Cagri Ilhan
Keyword(s):  
Clinical Characteristics ◽  
Pseudoexfoliation Glaucoma ◽  
Filtration Surgery ◽  
Glaucoma Filtration Surgery ◽  
Mean Values ◽  
Time Parameters ◽  
The Mean ◽  
Group 2 ◽  
Surgical Manipulations ◽  
Phaco Time

Purpose: To compare the phaco time parameters including ultrasound time (UST), effective phaco time (EPT), and average phaco power (APP) in eyes with pseudoexfoliation glaucoma (PEG) and had or had not glaucoma filtration surgery. Methods: In this retrospective comparative study, Group 1 was constructed with 84 PEG patients who had not operated previously, and Group 2 was constructed with 49 PEG patients who had glaucoma filtration surgery. The mean values of UST, EPT, and APP were compared. The preoperative clinical characteristics and surgical manipulations were also compared. Results: The mean ages and male-to-female ratios of the groups were similar ( p > 0.05, for both). There was no difference in the preoperative clinical characteristics, including biometric values between the groups ( p > 0.05, for all). Some surgical manipulations, including pupillary stretching ( p = 0.004), pupillary membrane peeling ( p = 0.021), iris hook using ( p = 0.041), and capsular tension ring implantation ( p = 0.041), were significantly performed more commonly in Group 2. Although the mean UST and EPT values were similar ( p > 0.05, for both), the mean APP value was significantly lower in Group 2 ( p = 0.011). Conclusion: The lower APP parameter was observed in PEG patients having had glaucoma filtration surgery. Needing more surgical manipulation to overcome poor pupillary dilation and weak zonular instability can be a reason for this result.

SURGICAL PROCESS RE-ENGINEERING: CARPAL TUNNEL DECOMPRESSION — A MODEL

Hand Surgery ◽  
2004 ◽  
Vol 09 (01) ◽  
pp. 19-27 ◽  
Author(s):  
J. A. Casaletto ◽  
V. Rajaratnam
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Procedure Time ◽  
Original Process ◽  
Depth Analysis ◽  
New Process ◽  
Common Operation ◽  
The Mean ◽  
Operative Findings ◽  
Made In

Surgical process re-engineering is a methodology where the entire surgical process is systematically analysed and re-designed. The process starts with mapping of the current process followed by in-depth analysis of the existing process. A new process is drafted with the aim of making the whole procedure more efficient. The new process is then discussed with all the staff involved in the operating room. Following implementation of the process, surgical process re-engineering should ideally be routinely carried out to continuously improve the procedure. We present an example of surgical process re-engineering which we carried out on the procedure of carpal tunnel release. We used carpal tunnel release as a model as it is a very common operation, with predictable intra-operative findings, and the patient is likely to benefit directly from procedure time reduction. A preliminary mapping of three procedures was done followed by a detailed timed mapping of five routine carpal tunnel decompression procedures. The mapped process was analysed in detail and a number of changes were made in the process. After implementing the new process, a further five procedures were mapped and timed again. In comparison to the original process, we achieved a reduction of 20% in the mean procedure time and a reduction of 42% in the number of steps from 66 to 37.

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