Identification of Clinical and Demographic Predictors for Treatment Modality in Patients With Carpal Tunnel Syndrome

Hand ◽  
2021 ◽  
pp. 155894472110604
Author(s):  
Richard D. Lander ◽  
Courtney Marie Cora Jones ◽  
Warren C. Hammert
Keyword(s):  
Treatment Group ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Treatment Modality ◽  
Pain Interference ◽  
Treatment Modalities ◽  
Demographic Predictors ◽  
Patient Reported ◽  
Tunnel Syndrome ◽  
To Receive

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. There are multiple treatment modalities for CTS. This study examines both clinical and demographic predictors for initial treatment modality of CTS. Methods: Patients diagnosed with CTS between February 2015 and October 2020 with a hand clinic visit within 6 weeks before treatment were included in our study. Patients completed Patient-Reported Outcomes Measurement Information System Pain Interference, Physical Function, and Depression and had complete data on relevant predictor variables. Primary outcomes were treatment group: (1) injection only; (2) release only; and (3) injection followed by release. Bivariate analyses and multinomial logistic regression was used to identify statistically significant variables and independent predictors associated with the treatment groups, respectively. Results: A total of 1409 patients fit our inclusion criteria. Sex, age, body mass index (BMI), race, ethnicity, Pain Interference, and Depression were statistically significant predictors for treatment group in bivariate analysis ( P < .05). In multivariable analysis, adults older than 65 years were less likely to receive either injection only or injection followed by release (odds ratio [OR]: 0.56 and OR: 0.52, respectively; P < .01). Overweight (BMI: ≥25) individuals were less likely to receive injection only (OR: 0.45; P < .01). Women were more likely to have either injection only or injection followed by released (OR: 1.50 and 1.55; P < .01). Similarly, black, Indigenous, or Persons of Color had an increased odds of injection only and injection followed by release (OR: 1.61 and OR: 1.69, respectively; P < .05). Conclusions: Sex, age, BMI, race, and ethnicity were found to be independent predictors of treatment modality for CTS.

scholarly journals A Comparison of PROMIS Physical Function and Pain Interference Scores in Patients With Carpal Tunnel Syndrome: Research Collection Versus Routine Clinical Collection

Hand ◽  
2019 ◽  
Vol 15 (6) ◽  
pp. 771-775 ◽  
Author(s):  
David N. Bernstein ◽  
Bilal Mahmood ◽  
Constantinos Ketonis ◽  
Warren C. Hammert
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Physical Function ◽  
Carpal Tunnel ◽  
Medical Center ◽  
Clinical Care ◽  
Pearson Correlation ◽  
Academic Medical Center ◽  
Pain Interference ◽  
Patient Reported ◽  
Tunnel Syndrome

Background: There is a concern that patients may answer patient-reported outcome (PRO) questionnaires differently depending on the purpose—clinical care or research (eg, “Hawthorne effect”). We sought to determine whether Patient-Reported Outcomes Management Information System (PROMIS) scores differ at the same clinic visit based on whether a patient was completing the PRO tool for study or clinical care purposes. Methods: Patients presenting to one surgeon at an academic medical center hand clinic were asked to complete PROMIS Physical Function (PF) and Pain Interference (PI) questionnaires as part of routine care. Those diagnosed with carpal tunnel syndrome from February 2015 to April 2017 were then asked to participate in a clinical research project, which had them complete PROMIS PF and PROMIS PI again. Data from those who completed both routine and research PROs at each visit were compared. Between the 2 settings, test-retest reliability was determined using Pearson correlation coefficients ( r), and internal consistency was evaluated using Cronbach α. Results: A total of 128 unique office visits representing 67 patients fit our inclusion criteria. There was a strong correlation between PROMIS PF and PI in the research and patient care setting (PF: r = 0.82, P < .01; PI: r = 0.83, P < .01). Both domains had a Cronbach α of 0.90. The PROMIS PF scores were not different between the 2 groups ( P = .19), but the PROMIS PI scores were slightly different ( P < .01). Conclusions: Patients appear to be consistent when completing PROMIS for both clinical care and research, supporting the idea that data obtained in either setting are generalizable and appropriate for research purposes.

Evaluation of PROMIS Outcomes for Surgical Treatment of Cubital Tunnel Syndrome With and Without Carpal Tunnel Syndrome

Hand ◽  
2021 ◽  
pp. 155894472110289
Author(s):  
Amy Phan ◽  
Warren Hammert
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Postoperative Period ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Measurement Information ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Tunnel Syndrome ◽  
Measurement Information System

Background: Assessment of outcomes for cubital tunnel syndrome (CuTS) surgeries has been difficult due to heterogeneity in outcome reporting. Our objective was to evaluate the outcomes for 2 cohorts treated surgically for isolated CuTS and for combined CuTS and carpal tunnel syndrome (CTS) using Patient Reported Outcomes Measurement Information System (PROMIS). Methods: There were 29 patients in the isolated CuTS cohort and 30 patients in the combined CuTS and CTS cohort. PROMIS Physical Function (PF), Pain Interference (PI), Depression, and Upper Extremity (UE) were completed preoperatively and 1-week, 6-weeks, and 3-months postoperatively. Responsiveness was evaluated by standardized response means (SRM). Results: Significant improvements from the 1-week to 6-week postoperative period are shown in the isolated CuTS cohort for PROMIS PF ( P = .002), PI ( P = .0002), and UE ( P = .02), but scores plateau after 6-weeks postoperatively. A similar pattern for the same time points was seen for the combined CuTS and CTS group for PROMIS PF ( P = .001), PI ( P = .02), and UE ( P = .04), with a plateau of scores beyond 6 weeks postoperatively. PROMIS UE was more responsive (SRM range: 0.11-1.03) than the PF (SRM range: 0.02-0.52) and PI (SRM range: 0.11-0.40), which were both mildly responsive for both cohorts. Conclusions: PROMIS lacks the sensitivity to show improvement beyond 6-weeks postoperatively for both isolated CuTS and combined CuTS and CTS. Patients with combined nerve compressions follow similar trajectories in the postoperative period as those with isolated CuTS. Level of Evidence: Level IV.

A prognostic model for the patient-reported outcome of surgical treatment of carpal tunnel syndrome

2018 ◽  
Vol 58 (6) ◽  
pp. 784-789 ◽  
Author(s):  
Angela Bowman ◽  
Stephan Rudolfer ◽  
Peter Weller ◽  
Jeremy D. P. Bland
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Prognostic Model ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Tunnel Syndrome

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

2012 ◽  
Vol 38 (1) ◽  
pp. 44-49 ◽  
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.

Patient-reported outcomes of carpal tunnel release surgery in patients with bilateral severe carpal tunnel syndrome

2017 ◽  
Vol 42 (9) ◽  
pp. 932-936 ◽  
Author(s):  
C. Q. Y. Tang ◽  
S. W. H. Lai ◽  
S. C. Tay
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Complete Resolution ◽  
Patient Reported Outcomes ◽  
Operative Time ◽  
Carpal Tunnel Release ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery

This retrospective study examined whether the presenting complaint of numbness is relieved post-operatively in severe carpal tunnel syndrome and also assessed any correlation between outcomes of the first and second procedures in staged bilateral carpal tunnel releases. Carpal tunnel release (60 open and 38 endoscopic) was done in 49 patients with bilateral severe carpal tunnel syndrome. There was complete resolution of numbness post-operatively in 77% ( n = 75) of hands. The median post-operative time before complete resolution of numbness was 21 days (IQR 8 to 21; range 3 to 482). The likelihood of complete resolution of symptoms after the second carpal tunnel release in patients with complete resolution of symptoms after the first carpal tunnel release was 22 (95% CI: 4 to 131) times that of the likelihood of improvement in patients with incomplete resolution of symptoms after the first carpal tunnel release. Level of evidence: IV

Histoplasmosis of the Upper Extremities: Clinical Case, Treatment Algorithm, and Systematic Review

Hand ◽  
2020 ◽  
pp. 155894472091121
Author(s):  
Maria T. Huayllani ◽  
David J. Restrepo ◽  
Daniel Boczar ◽  
Andrea Sisti ◽  
Brian D. Rinker ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Treatment Algorithm ◽  
Clinical Signs ◽  
Upper Extremities ◽  
Treatment Modalities ◽  
Treatment Recommendation ◽  
Persistent Symptoms ◽  
Tunnel Syndrome

Background: Histoplasmosis of the upper extremities is extremely rare, and there is no consensus in its management. The aim of this study was to present a case report and literature review of histoplasmosis in the upper extremities to provide the best treatment recommendation and to increase awareness of this disease. Methods: A systematic review of the literature was performed in PubMed, MEDLINE, and EMBASE databases with the search terms “(Tenosynovitis AND histoplasmosis)” OR “(Upper limbs AND histoplasmosis)” OR “(Upper extremities AND histoplasmosis)” OR “((finger OR arm OR hand OR forearm OR wrist) AND histoplasmosis).” Manuscripts were included in the study if they described diagnosis of histoplasmosis in the bone, joint, synovia, or tendons of the upper extremities. Results: In all, 14 manuscripts and 15 cases of histoplasmosis of the upper extremities from 1992 to 2015 met the inclusion criteria. Eight (53.3%) patients were diagnosed with tenosynovitis, 5 (33.3%) with osteomyelitis, 1 (6.7%) with carpal tunnel syndrome, and 1 (6.7%) with joint wrist abscess. Immunosuppression, travel history, previous diagnosis with histoplasmosis, and persistent symptoms may suggest infectious causes. Surgery and medical treatment together are recommended to optimize outcomes compared with single treatment alone. Conclusions: Histoplasmosis of the upper extremities may have various clinical presentations, including tenosynovitis, osteomyelitis, carpal tunnel syndrome, and joint wrist abscess. The type of surgical approach may depend on the etiology of disease. Increased awareness and knowledge of the clinical signs, symptoms, and effective treatment modalities will help decrease possible complications, such as tendon rupture and functional impairment of the upper extremities.

scholarly journals The effectiveness of therapeutic massage in carpal tunnel syndrome

2015 ◽  
Vol 9 (1) ◽  
pp. 21-23
Author(s):  
Iwona Wilk
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Lymphatic Drainage ◽  
Therapeutic Massage ◽  
Post Surgery ◽  
Treat Ment ◽  
Patient Reported ◽  
Tunnel Syndrome ◽  
Surgical Treatments

Background: The carpal tunnel syndrome is a neuralgia of the median nerve of the hand caused by permanent pressure which results in sensation and motion disturbances in the area. Principal symptoms include pain in the hand and wrist, numbness and tingling of the fingers, sensation dysfunctions, and finally, the limitation of mobility and manual flexibility of the hand. The discomfort leads to a significant decrease in the patient’s quality of life. In case of carpal tunnel syndrome surgical and non-surgical treatments with selected elements of physiotherapy are applied. Aim of the study: The aim of this study was to present and evaluate possible methods of treatment such as massage therapy and lymphatic drainage as the form of post-surgery treat-ment in carpal tunnel syndrome.Material and methods: The young woman with the carpal tunnel syndrome after the surgical treatment received 50-minute lymphatic drainage (three sessions) and 30-minute therapeutic massage (four sessions). The procedures were performed every two days.Results: After the application of both kinds of massage in appropriate sequence, the following changes have been notified. The swelling in the area of the hand was reduced and the patient reported definite decrease of pain.Conclusions: The massage might be one of the forms of therapy used after surgical treatment in carpal tunnel syndrome, especially when the symptoms occur. It is also often effective with other components of physiotherapy as non-surgical treatment.

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