Arm sling after carpal tunnel surgery: myth or evidence based?

2019 ◽  
Vol 45 (3) ◽  
pp. 255-259
Author(s):  
Maartje Kroeze ◽  
Hinne Rakhorst ◽  
Peter Houpt
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Symptom Relief ◽  
Hand Surgery ◽  
Volumetric Analysis ◽  
Level Of Evidence ◽  
Pain Scores ◽  
Carpal Tunnel Surgery ◽  
Significant Difference ◽  
Carpal Tunnel Release Surgery

Arm sling elevation is widely used after hand surgery to prevent swelling and pain. This prospective cohort study investigated whether arm sling elevation has any value after carpal tunnel release surgery. Patients were assigned to one of two groups after carpal tunnel release: with or without arm sling elevation. The primary outcome was postoperative swelling. Secondary outcomes were pain and symptom relief and functional outcome. Volumetric analysis showed no significant difference between the sling and non-sling group. Pain scores and improvement of symptom severity and functional status scores were similar for both groups. Thirty-eight per cent found the sling uncomfortable. These results do not support routine use of arm sling elevation after carpal tunnel release. Level of evidence: III

SHORT VERSUS LONG-ACTING LOCAL ANAESTHETIC IN OPEN CARPAL TUNNEL RELEASE: WHICH PROVIDES BETTER PREEMPTIVE ANALGESIA IN THE FIRST 24 HOURS?

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 45-47 ◽  
Author(s):  
Z. H. Chan ◽  
V. Balakrishnan ◽  
A. McDonald
Keyword(s):  
Carpal Tunnel ◽  
Local Anaesthetic ◽  
Carpal Tunnel Release ◽  
Local Anaesthetics ◽  
Pain Scores ◽  
Carpal Tunnel Surgery ◽  
Significant Difference ◽  
Long Acting ◽  
Open Carpal Tunnel Release

Open carpal tunnel release is commonly performed under local anaesthesia. No study has compared intra-operative short- versus long-acting local anaesthetics as preemptive analgesics in carpal tunnel surgery. In this single-blinded prospective study, 100 consecutive carpal tunnel releases were performed by a single surgeon at one institution with either lignocaine (n = 50) or ropivacaine (n = 50). Allocation was performed via the method of alternation. Subjects were given a questionnaire to answer the following: (1) time to first incidence of pain, (2) quality of first night's sleep, and (3) mean numerical pain scores in the first 24 hours. The time to the first postoperative pain was significantly shorter in the lignocaine group (5.58 vs. 9.17 hours, p < 0.035). There were no significant difference in the incidence of poor first night's sleep (16% vs. 26%, p = 0.28) or mean pain scores in the first day (3.6 vs. 2.9, p = 0.16). Existing evidence advocates for long-acting intraoperative local anaesthetic because it results in a longer duration of postoperative analgesia, however, our study suggests that it may also result in a poorer first night's sleep.

Endoscopic Carpal Tunnel Release

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.

scholarly journals Return to work recommendations after carpal tunnel release: a survey of UK hand surgeons and hand therapists

2018 ◽  
Vol 43 (8) ◽  
pp. 875-878 ◽  
Author(s):  
Lisa Newington ◽  
Kristin Francis ◽  
Georgia Ntani ◽  
David Warwick ◽  
Jo Adams ◽  
...  
Keyword(s):  
Return To Work ◽  
Carpal Tunnel ◽  
Current Practice ◽  
Carpal Tunnel Release ◽  
Evidence Base ◽  
British Society ◽  
Level Of Evidence ◽  
Functional Activities ◽  
Different Types ◽  
Carpal Tunnel Release Surgery

There is a limited evidence base from which to derive recommendations for safe and effective return to different types of occupation after carpal tunnel release surgery. The current practice of members of the British Society for Surgery of the Hand and the British Association of Hand Therapists was investigated with a questionnaire. In total, 173 surgeons and 137 therapists responded from an estimated sample of 1959. Median recommended return-to-work times were 7 days for desk-based duties, 15 days for repetitive light manual duties and 30 days for heavy manual duties. However, the responses were wide-ranging: 0–30 days for desk-based; 1–56 days for repetitive light manual; and 1–90 days for heavy manual. Variation in the recommended timescales for return to work and other functional activities after carpal tunnel release suggests that patients are receiving different and possibly even conflicting advice. Level of evidence: V

Topical Anaesthesia to Reduce Pain Associated with Carpal Tunnel Surgery

2002 ◽  
Vol 27 (5) ◽  
pp. 462-464 ◽  
Author(s):  
T. M. LAWRENCE ◽  
V. V. DESAI
Keyword(s):  
Carpal Tunnel ◽  
Local Anaesthetic ◽  
Carpal Tunnel Release ◽  
Statistical Significance ◽  
Eutectic Mixture ◽  
Local Anaesthetics ◽  
Needle Insertion ◽  
Visual Analogue Pain ◽  
Pain Scores ◽  
Carpal Tunnel Surgery

This randomized, double-blinded study assessed the effectiveness of a topical anaesthetic, eutectic mixture of local anaesthetics (EMLA), in reducing pain associated with carpal tunnel release performed under local anaesthetic. Fifty-six patients undergoing carpal tunnel release under local anaesthetic were randomized into either EMLA ( n=29) or placebo ( n=27) groups. Visual analogue pain scores were obtained for needle insertion, injection of anaesthetic and surgery itself. Pain scores were significantly less for needle insertion ( P=0.001) and injection of anaesthetic ( P=0.0005). Scores related to surgery were also lower in the EMLA group, but this did not reach statistical significance.

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.

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

Comparison of Patient-Reported Outcomes between Two Different Techniques of Carpal Tunnel Release: Classical Incision versus Minimal Incision

2020 ◽  
Author(s):  
Sajad Heidari ◽  
Alireza Taabbod ◽  
Mahmoud Farzan ◽  
Sadegh Saberi ◽  
Mitra Ashrafi
Keyword(s):  
Patient Satisfaction ◽  
Carpal Tunnel ◽  
Patient Reported Outcomes ◽  
Carpal Tunnel Release ◽  
Symptom Relief ◽  
Visual Analogue Score ◽  
Minimal Incision ◽  
Significant Difference ◽  
Patient Reported ◽  
One Year

Background: Carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper limb which needs surgery in many cases. Two common surgical incisions for carpal tunnel release (CTR) are classical incision and minimal incision. In this survey, the aim is to compare patient-reported outcomes of these two types of incisions. Methods: In this retrospective study, patients with CTS who underwent two different approaches for CTR (classical or minimal) during one year were included. The diagnosis was confirmed clinically and by electrodiagnostic studies. The patients were categorized into two groups regarding the type of surgery. At the 12-month visit, the patients were assessed for functional outcome, level of the pain, and satisfaction with Quick Disability of Arm, Hand and Shoulder score (QuickDASH), the visual analogue score (VAS) scale, and the scar appearance and symptom relief, respectively. Results: 39 patients were entered in this study, 3 of who had bilateral symptoms. The 42 operated hands were divided into two groups: classical incision group (n = 21) and minimal incision group (n = 21). No significant difference was discovered between the two groups considering age and sex. In addition, no significant difference was found in the variables evaluated between the two groups, except for the higher patient satisfaction with the scar appearance in minimal incision group after 12 months. Conclusion: After a one-year period, the minimal incision procedure had no priority to classical incision procedure, except for higher patient satisfaction considering the scar appearance.

scholarly journals Early Postoperative Improvement in Sleep and Pain After Carpal Tunnel Release

Hand ◽  
2018 ◽  
Vol 15 (3) ◽  
pp. 311-314 ◽  
Author(s):  
Steven R. Niedermeier ◽  
Robert J. Pettit ◽  
Travis L. Frantz ◽  
Kara Colvell ◽  
Hisham M. Awan
Keyword(s):  
Sleep Quality ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Hand Surgery ◽  
Outpatient Setting ◽  
Compressive Neuropathy ◽  
Carpal Tunnel Surgery ◽  
Tunnel Syndrome ◽  
And Function

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.

Early Outcome and Cost-Effectiveness of Endoscopic Versus Open Carpal Tunnel Release: A Randomized Prospective Trial

2003 ◽  
Vol 28 (5) ◽  
pp. 444-449 ◽  
Author(s):  
N. L. B. SAW ◽  
S. JONES ◽  
L. SHEPSTONE ◽  
M. MEYER ◽  
P. G. CHAPMAN ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Prospective Trial ◽  
Cost Effective ◽  
Early Outcome ◽  
Endoscopic Carpal Tunnel Release ◽  
Carpal Tunnel Surgery ◽  
Significant Difference ◽  
Open Carpal Tunnel Release

Proponents of endoscopic carpal tunnel release have been advocating the technique for more than 10 years but there is still debate about its efficacy, safety and cost-effectiveness. We have performed a randomized, prospective, blind trial to compare early outcome after single portal endoscopic or open carpal tunnel surgery and to assess the cost-effectiveness of the procedures. There were no significant differences in symptom and functional activity scores, grip strength or anterior carpal pain in the first 3 months. For those in employment, we found a statistically significant difference between the two treatment groups with the endoscopic group returning to work, on average, 8 (95% CI, 2–13 days) days sooner than the open group. This translates into a cost saving to industry. There were no major neurovascular complications in either group. On the basis of these findings, we recommend that endoscopic carpal tunnel release should be considered in the employed as a cost-effective procedure, but perhaps not in the general population as a whole.

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.

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