Early Postoperative Improvement in Sleep and Pain After Carpal Tunnel Release

Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy of the upper extremity. We sought to assess the subjective improvement in preoperative symptoms related to CTS, particularly those affecting sleep, and describe opioid consumption postoperatively. Methods: All patients undergoing primary carpal tunnel release (CTR) for electromyographically proven CTS were studied prospectively. All procedures were performed by hand surgery fellowship–trained adult orthopedic and plastic surgeons in the outpatient setting. Patients underwent either endoscopic or open CTR from June 2017 to December 2017. Outcomes assessed were pre- and postoperative Quick Disabilities of Arm, Shoulder and Hand (QuickDASH), visual analog scale (VAS), and Pittsburgh Sleep Quality Index (PSQI) scores as well as postoperative pain control. Results: Sixty-one patients were enrolled. At 2 weeks, all showed significant ( P < .05) improvement in QuickDASH scores. At 6 weeks, 40 patients were available for follow-up. When compared with preoperative scores, QuickDASH (51 vs 24.5; P < .05), VAS (6.7 vs 2.9; P < .05), and PSQI (10.4 vs 6.4; P < .05) scores continued to improve when compared with preoperative scores. At 2-week follow-up, 39 patients responded to the question, “How soon after your carpal tunnel surgery did you notice an improvement in your sleep?” Seventeen patients (43.6%) reported they had improvement in sleep within 24 hours, 12 patients (30.8%) reported improvement between 2 and 3 days postoperatively, 8 patients (20.5%) reported improvement between 4 and 5 days postoperatively, and 2 patients (5.1%) reported improvement between 6 and 7 days postoperatively. Conclusions: The present study demonstrates rapid and sustained improvement in sleep quality and function following CTR.

Download Full-text

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.

Download Full-text

Improvement of Sleep Quality after Surgical Decompression in Carpal Tunnel Syndrome

Indian Journal of Neurosurgery ◽

10.1055/s-0041-1741406 ◽

2021 ◽

Author(s):

Nguyen Le Trung Hieu ◽

Nguyen Anh Sang ◽

Nguyen Lam Vuong

Keyword(s):

Carpal Tunnel Syndrome ◽

Sleep Quality ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Surgical Decompression ◽

Poor Sleep ◽

Tunnel Syndrome ◽

And Function ◽

Hand Symptoms ◽

The Impact

Abstract Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy which can cause severe sleep disturbance. Carpal tunnel release (CTR) is a choice for severe cases, which has shown to improve sleep quality, but the available evidence is limited. This study aimed to investigate the impact of CTR on sleep quality and hand symptoms and functions in patients with CTS. Methods This was a prospective study in 2019–2020 on patients with CTS and poor sleep quality undergoing CTR. Patients were evaluated before and at 1, 3, and 12 months after CTR by the Pittsburgh sleep quality index (PSQI) and Boston carpal tunnel syndrome questionnaires. Results There were 33 patients with 27 females (82%) and a median age of 51 years. The median time of CTS diagnosis and having sleep disorder before CTR were 12 and 6 months, respectively. The outcomes significantly improved after CTR, with the median PSQI and Boston symptom and function scores reduced from 12, 33, and 23 before CTR to 9, 14, and 11 at 1 month; 7, 13, and 9 at 3 months; and 1, 11, and 8 at 12 months postoperatively, respectively. The correlations between the PSQI and Boston symptom and function scores were > 0.6 at all time-points. Conclusions Surgical decompression significantly improves sleep quality and the hand symptoms and functions in patients with CTS. Long-term evaluations are lacking and thus are required in future studies.

Download Full-text

Trigger Fingers After Open Carpal Tunnel Release

Plastic Surgery ◽

10.1177/2292550320928554 ◽

2020 ◽

Vol 28 (4) ◽

pp. 192-195

Author(s):

Duffield Ashmead ◽

Haruko Okada ◽

Jonathan Macknin ◽

Steven Vander Naalt ◽

Ilene Staff ◽

...

Keyword(s):

Risk Factors ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Specific Treatment ◽

Trigger Thumb ◽

Carpal Tunnel Surgery ◽

Tunnel Syndrome ◽

Compensation Status ◽

Open Carpal Tunnel Release

Trigger finger (TF) and carpal tunnel syndrome (CTS) are common conditions often occurring together with an unclear relationship. While some studies conclude that TFs occur as a result of carpal tunnel release (CTR), others have not established a causal relationship. Our purpose was to evaluate the prevalence and timing of TF development in the same hand after open CTR in our population. This was a retrospective review of 497 patients undergoing open CTR by a single surgeon. Two hundred twenty-nine charts were analysed for age, gender, handedness, BMI, workers’ compensation status, and background disease. We analysed the specific digit involved and timing to development of triggering after CTR. Thirty-one patients developed triggering after CTR (13.5%). Mean age was 52.5 (14.0) years. Follow-up ranged from 1 to 53 months with a median follow-up of 6 months (interquartile range = 2-13). The thumb was the most common to trigger (42.22%), followed by the ring 24.44%, middle 22.22%, little 8.89%, and index fingers 2.22%. Trigger thumb occurred at 3.5 months (3.6) post-operatively, while other digits triggered at 7.5 months (4-10.25) after surgery ( P = .022). No risk factors were associated with TF development. Our results suggest that a trigger thumb develops more frequently and earlier than other trigger digits after an open CTR. Further study is needed to clarify the mechanisms involved and may enable specific treatment such as local anti-inflammatory medication following CTR. We suggest educating prospective carpal tunnel surgery patients to high risk of triggering following CTR.

Download Full-text

Endoscopic Carpal Tunnel Release

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0098 ◽

2019 ◽

pp. 989-994

Author(s):

Antony Hazel ◽

Neil F. Jones

Keyword(s):

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Hand Surgery ◽

Anatomical Landmarks ◽

Transverse Carpal Ligament ◽

Palmar Arch ◽

Endoscopic Carpal Tunnel Release ◽

Tunnel Syndrome ◽

Carpal Tunnel Release Surgery ◽

Open Carpal Tunnel Release

Conventional open carpal tunnel release surgery is one of most successful procedures in hand surgery and has been demonstrated to be an effective treatment for carpal tunnel syndrome. However, a known sequelae in some individuals who undergo the procedure is “pillar” pain. In an effort to avoid this condition and help people return to work more quickly, the endoscopic technique was developed. Endoscopic carpal tunnel release offers a minimally invasive alternative to other traditional techniques with similar outcomes. By placing the incision proximal to the transverse carpal ligament there is potential for decreased scar sensitivity and pillar pain. The technique is technically demanding. The superficial palmar arch and common digital nerve to the ring and middle fingers are at risk for injury during the procedure. With adherence to anatomical landmarks and the proper visualization, the surgery may be safely performed.

Download Full-text

Physical Therapy Intervention Following Surgical Treatment of Carpal Tunnel Syndrome in an Individual With a History of Postmastectomy Lymphedema

Physical Therapy ◽

10.1093/ptj/82.10.1009 ◽

2002 ◽

Vol 82 (10) ◽

pp. 1009-1016 ◽

Cited By ~ 15

Author(s):

Julie E Donachy ◽

Emily L Christian

Keyword(s):

Physical Therapy ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Hand Surgery ◽

Tourniquet Time ◽

Compression Bandaging ◽

Right Hand ◽

Tunnel Syndrome ◽

Chronic Lymphedema

Abstract Background and Purpose. This case report describes the physical therapy examination, intervention, and outcomes for a patient with lymphedema following breast cancer treatment who underwent carpal tunnel release. Case Description. The patient was a 53-year-old woman with right upper-limb lymphedema and symptoms of carpal tunnel syndrome (CTS) in her right hand who underwent a carpal tunnel release. Management of her lymphedema included the use of general anesthesia with reduced tourniquet time in conjunction with physical therapy, which included use of compression bandaging, limb positioning, and exercise. Outcomes. Following surgical release, the patient' s numbness and pain were alleviated. Right-hand grip strength increased following active exercise. Girth of the forearm decreased 1 to 1.5 cm at the 2 most distal measurement sites, and girth of the arm increased 1.5 to 2 cm 6 months after surgery. Discussion. This case supports the option of elective hand surgery for CTS in an individual with chronic lymphedema.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Function of Microscopic Carpal Tunnel Release in Cases Resistant to Conservative Therapy

American Journal of Health, Medicine and Nursing Practice ◽

10.47672/ajhmn.837 ◽

2021 ◽

Vol 6 (4) ◽

pp. 89-96

Author(s):

Jehan Zeb ◽

Muhammad Ullah ◽

Muhammad Shoaib ◽

Syed Shah ◽

Walayat Shah ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Conservative Treatment ◽

Carpal Tunnel ◽

Symptom Severity ◽

Carpal Tunnel Release ◽

P Value ◽

Symptom Severity Score ◽

Tunnel Syndrome ◽

The Mean ◽

And Function

Purpose: To determine the outcome of microscopic carpal tunnel release in patients with carpal tunnel syndrome who failed to respond to conservative treatment. Methodology: This descriptive case series was carried at Department of Neurosurgery, D.H.Q Hosptial Charsadda over 1 year from Jan 2019 to Dec 2020, indicate the sampling method used to select the study participants involving 94 patients; both men and women with ages in the range 30-70 years diagnosed of carpal tunnel syndrome who failed to respond to conservative treatment and were planned for surgical release. Microscopic CTS release was performed and outcomes were assessed in terms of improvement in VAS score for wrist pain, symptom severity score and function status scale 3 and 6 months after the surgery. Recurrence of symptoms was also noted. A written informed consent was obtained from every patient. Indicate the method of data collection and data analysis Findings: The mean age of the patients with carpal tunnel syndrome was 41.6±7.9 years. There was slight female predominance with male to female ratio of 1:2.1. History of diabetes was recorded in 29 (31.0%) patients while 34 (37.0%) patients were obese. Right hand was more frequently involved (53.0%) than the left hand (47.0%). The mean VAS score for wrist pain reduced from 7.9±1.2 at baseline to 1.8±0.7 3 months after the surgery (p- value<0.001). Similar improvements were also noted in symptom severity score (3.8±0.8 to 1.6±0.8; p- value<0.001) and function status scale (2.7±0.8 to 1.5±0.8; p-value<0.001) at the end of 3 months after the surgery. Recurrence was not observed in any patient at the end of 6 months follow-up. Recommendation: Microscopic carpal tunnel release was found to relieve patient’s symptoms and improve wrist function yet with minimal scarring and without recurrence which advocates its preferred use in future practice provided necessary surgical skills and hardware are available.

Download Full-text

Does the Duration and Severity of Symptoms Have an Impact on Relief of Symptoms after Carpal Tunnel Release?

Journal of Brachial Plexus and Peripheral Nerve Injury ◽

10.1055/s-0038-1668552 ◽

2019 ◽

Vol 14 (01) ◽

pp. e1-e8

Author(s):

Mehreen Masud ◽

Mamoon Rashid ◽

Saleem Malik ◽

Muhommad Ibrahim Khan ◽

Saad-ur-Rehman Sarwar

Keyword(s):

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Hand Function ◽

Normal Function ◽

Duration Of Symptoms ◽

Compressive Neuropathy ◽

Carpal Tunnel Surgery ◽

Short Period ◽

Group 2 ◽

Open Carpal Tunnel Release

Rationale Carpal tunnel syndrome (CTS) is the most frequently encountered compressive neuropathy of the upper limb. The treatment of CTS ranges from conservative management to carpal tunnel release. Many patients with misconception about the potential morbidity and with the hope of successful conservative treatment delay the surgical release of carpal tunnel. This delay results in reduced recovery of sensory and motor median nerve function. Objective The aim of this study was to evaluate the influence of preoperative duration and severity of symptom on the outcome of carpal tunnel surgery. Method It included 45 cases of CTS, all treated with limited access open carpal tunnel release. The duration of symptoms (i.e., pain, numbness, tingling, waking up at night because of pain/numbness, difficulty in grasping small objects, and their preoperative severity) was noted using Boston CTS questionnaire. To investigate the outcome, patients were divided into three groups based on their duration of symptoms. Result Group1: The severity of symptoms was reduced to normal in a short period of time in patients who presented with duration of symptoms less than 6 months. Group 2: Patients in whom symptoms lasted for 6 to 12 months had reduced or delayed recovery of hand function as compared with first group. Group 3: Patients who had symptoms for more than 12 months had incomplete recovery of grip strength. Return to normal function took the longest time (median: 16 weeks) in this group. Conclusion This study suggests that patients who present late have delayed/incomplete relief of symptoms after carpal tunnel release.

Download Full-text