Co-existing carpal tunnel syndrome in complex regional pain syndrome after hand trauma

2009 ◽  
Vol 35 (3) ◽  
pp. 228-231 ◽  
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.

scholarly journals The Incidence of Complex Regional Pain Syndrome in Simultaneous Surgical Treatment of Carpal Tunnel Syndrome and Dupuytren Contracture

Hand ◽  
2017 ◽  
Vol 13 (4) ◽  
pp. 391-394 ◽  
Author(s):  
Mitchell Buller ◽  
Steven Schulz ◽  
Morton Kasdan ◽  
Bradon J. Wilhelmi
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Complex Regional Pain Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Group Versus ◽  
Pain Syndrome ◽  
Increased Risk ◽  
Tunnel Syndrome ◽  
Dupuytren Contracture

Background: To determine the incidence of complex regional pain syndrome (CRPS) in the concurrent surgical treatment of Dupuytren contracture (DC) and carpal tunnel syndrome (CTS) through a thorough review of evidence available in the literature. Methods: The indices of 260 hand surgery books and PubMed were searched for concomitant references to DC and CTS. Studies were eligible for inclusion if they evaluated the outcome of patients treated with simultaneous fasciectomy or fasciotomy for DC and carpal tunnel release using CRPS as a complication of treatment. Of the literature reviewed, only 4 studies met the defined criteria for use in the study. Data from the 4 studies were pooled, and the incidence of recurrence and complications, specifically CRPS, was noted. Results: The rate of CRPS was found to be 10.4% in the simultaneous treatment group versus 4.1% in the fasciectomy-only group. This rate is nearly half the 8.3% rate of CRPS found in a randomized trial of patients undergoing carpal tunnel release. Conclusions: Our analysis demonstrates a marginal increase in the occurrence of CRPS by adding the carpal tunnel release to patients in need of fasciectomy, contradicting the original reports demonstrating a much higher rate of CRPS. This indicates that no clear clinical risk is associated with simultaneous surgical treatment of DC and CTS. In some patients, simultaneous surgical management of DC and CTS can be accomplished safely with minimal increased risk of CRPS type 1.

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

2002 ◽  
Vol 82 (10) ◽  
pp. 1009-1016 ◽  
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.

Acute and Nonacute Complications Associated with Interscalene Block and Shoulder Surgery

2001 ◽  
Vol 95 (4) ◽  
pp. 875-880 ◽  
Author(s):  
Alain Borgeat ◽  
Georgios Ekatodramis ◽  
Fabian Kalberer ◽  
Cedric Benz
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Complex Regional Pain Syndrome ◽  
Carpal Tunnel ◽  
Brachial Plexus Block ◽  
Pain Syndrome ◽  
Muscular Weakness ◽  
Interscalene Brachial Plexus Block ◽  
Tunnel Syndrome ◽  
Sulcus Ulnaris ◽  
Plexus Block

Background The incidence, etiology, and evolution of complications after interscalene brachial plexus block (ISB) are not well-known. The authors prospectively monitored 521 patients for complications during the first 9 months after ISB. Methods A total of 521 adults scheduled for elective shoulder surgery performed with an ISB were included in this prospective study. The ISB procedure was standardized for all patients Acute complications were recorded. Patients were observed daily (for 10 days) for paresthesias, dysesthesias, pain not related to surgery, and muscular weakness and were evaluated at 1, 3, 6, and 9 months after surgery. Persistence of paresthesias dysesthesias, pain not related to surgery, or muscular weakness was investigated at 1 or 3 months by means of electroneuromyography. Final evaluation was performed at 9 months. Results A total of 520 patients completed the study; one was excluded after surgical axillary nerve damage. Two hundred thirty-four patients had an interscalene catheter. Acute complications consisted of one pneumothorax (0.2%) and one episode of central nervous system toxicity (incoherent speech; 0.2%). A 10 days, 74 patients (14%) were symptomatic, and none had muscular weakness. At 1 month, 41 patients (7.9%) had symptoms, and none had muscular weakness. Thirty patients under went electroneuromyography; sulcus ulnaris syndrome (n = 8) carpal tunnel syndrome (n = 2), and complex regional pain syndrome (n = 1) were diagnosed. At 3 months 20 patient (3.9%) were symptomatic, and none had muscular weakness All underwent electroneuromyography; carpal tunnel syndrome (n = 2), complex regional pain syndrome (n = 4), plexus neuropathy (n = 1), and plexus damage (n = 1) were diagnosed. At 6 months, 5 patients (0.9%) were symptomatic. At 9 months 1 patient (0.2%) had persistence of dysesthesia. Conclusions Interscalene brachial plexus block performed with a standardized technical approach, material, and drugs is associated with an incidence of short- and severe long-term complications of 0.4%. In case of persistent paresthesia, dysesthesia, or pain not related to surgery after ISB, sulcus ulnaris syndrome, carpal tunnel syndrome, or complex regional pain syndrome should be excluded since specific treatment may be required.

scholarly journals Relationship between clinical outcomes and nerve conduction studies before and after surgery in patients with carpal tunnel syndrome

2021 ◽  
Author(s):  
Masato Ise ◽  
Taichi Saito ◽  
Yoshimi Katayama ◽  
Ryuichi Nakahara ◽  
Yasunori Shimamura ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Carpal Tunnel Release ◽  
Characteristic Curve ◽  
Objective Assessment ◽  
Cutoff Score ◽  
Tunnel Syndrome

Abstract Background:Nerve conduction study (NCS) is the only useful test for objective assessment of carpal tunnel syndrome (CTS). However, the relationship between pre- and postoperative NCS and clinical outcomes was unclear. This study aimed to determine whether pre- and postoperative (6 months) NCS could predict patient-oriented and motor outcomes (6 and 12 months postoperatively) in patients with CTS.Methods:Of the 85 patients with CTS, 107 hands were analyzed from March 2011 to March 2020. All patients underwent open carpal tunnel release and were examined using the disabilities of the arm, shoulder and hand (DASH) questionnaire and grip strength (GS) preoperatively and 6 and 12 months. Moreover, NCS was examined preoperatively and 6 months postoperatively. Distal motor latency (DML) and sensory conduction velocity (SCV) were the parameters used for NCS. The correlation coefficient between NCS and DASH or GS was calculated. A receiver operating characteristic curve was utilized to determine the NCS threshold value to predict DASH and GS improvement.Results:The average scores of GS preoperatively and 6 and 12 months postoperatively were 21.3, 22.3, and 22.8, respectively. On the other hand, the average scores of DASH preoperatively and 6 and 12 months postoperatively were 28.8, 18.3, and 12.2, respectively. The average NCS scores (DML and SCV) preoperatively/6 months postoperatively were 7.3/5.4 and 27.8/36.7, respectively. Preoperative NCS did not correlate with DASH and GS. Postoperative SCV correlated with the change in grip strength (6–12 months, r = 0.67; 0–12 months, r = 0.60) and DASH (0–12 months, r = 0.77). Moreover, postoperative DML correlated with the change in DASH (6–12 months, r = -0.33; 0–12 months, r = -0.59). The prediction for the improvement of GS/DASH achieved a sensitivity of 50.0%/66.7% and a specificity of 100%/100%, at an SCV cutoff score of 38.5/45.0 or above. The prediction for improvement of GS/DASH achieved a sensitivity of 83.3%/66.7% and a specificity of 100%/66.7% at a DML cutoff score of 4.4/4.4 or below.Conclusions:NCS at 6 months postoperatively can be used to predict the improvement of clinical outcome after 6 months postoperatively in patients with CTS.

Treatment of Hand Allodynia Resulting from Wrist Cutting with Radial and Ulnar Artery Perforator Adipofascial Flaps

2018 ◽  
Vol 23 (01) ◽  
pp. 116-120 ◽  
Author(s):  
Hideto Irifune ◽  
Nobuyuki Takahashi ◽  
Suguru Hirayama ◽  
Eichi Narimatsu ◽  
Toshihiko Yamashita
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Complex Regional Pain Syndrome ◽  
Carpal Tunnel ◽  
Perforator Flap ◽  
Pain Syndrome ◽  
Ulnar Artery ◽  
Flap Coverage ◽  
Tunnel Syndrome ◽  
Artery Perforator ◽  
Pedicle Flaps

In this article, we report two cases in which recurrent adhesive hand neuropathy with allodynia were successfully treated with radial and ulnar artery adipofascial perforator flap coverage. Treatment of recurrent neuropathy, such as recurrent carpal tunnel syndrome and re-adhesion after neurolysis using free and pedicle flaps to cover the nerves, has been reported to show good results. However, for severe painful nerve disorders, such as complex regional pain syndrome, the efficacy of this treatment was unclear. We present two cases diagnosed with recurrent adhesive hand neuropathy with allodynia, resulting from wrist cutting; these cases were treated with neurolysis and flap coverage with good results and no recurrence. This suggests that neurolysis and flap coverage are effective methods for treating complex regional pain syndrome.

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

2011 ◽  
Vol 37 (5) ◽  
pp. 427-431 ◽  
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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