scholarly journals The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Donna L. Kennedy ◽  
Deborah Ridout ◽  
Ladislava Lysakova ◽  
Jan Vollert ◽  
Caroline M. Alexander ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Surgical Outcome ◽  
Quantitative Sensory Testing ◽  
Sensory Loss ◽  
Sensory Testing ◽  
Post Surgery ◽  
Carpal Tunnel Surgery ◽  
Functional Interference ◽  
Patient Reported ◽  
And Function

Abstract Background Up to 25% of people who have had carpal tunnel release surgery (CTR) fail to report improvement; however, evidence for prognostic indicators in this surgical cohort is limited. To identify candidate prognostic factors, this study investigated the association of quantitative sensory testing (QST) derived sensory phenotype and attendant impairment with patient-reported surgical outcome. Methods With ethical approval and informed consent, this prospective observational longitudinal study recruited patients from two London hospitals. Multimodal phenotyping measures including quantitative sensory testing (QST), pain parameters, insomnia, pain-related worry, mood and function, were evaluated prior to; and at 3- and 6-months post-surgery. Pain in median nerve distribution with electrophysiologically confirmed conduction delay and DN4 score ≥ 4 was defined as neuropathic. Primary outcome was patient-rated change at 6 months, dichotomised as poor outcome; “worse” or “no change” and good outcome; “slightly better”, “much better” or “completely cured”. Results Seventy-six patients participated. Prior to surgery, substantial heterogeneity in established categories of somatosensory function was observed with 21% of participants categorised as having a healthy sensory phenotype; 29% with thermal hyperalgesia; 32% mechanical hyperalgesia and 18% sensory loss. Seventy six percent of participants were classified as having neuropathic pain, 33% with high levels of pain related worry and 64% with clinical insomnia. Observed differences in pain, sleep impairment, psychological factors and function, between sensory phenotypic groups, was not significant. At 3- and 6-months post-surgery there was significant improvement in all phenotyping measures with a moderate to large effect size. Thermal and mechanical measures of somatosensation improved (p < 0.001), as did functional ability (p < 0.001). Symptom severity diminished (p < 0.001), as did pain-related worry (p < 0.001), anxiety (p = 0.02) and insomnia (p < 0.001). Patient-rated surgical outcome was good in 92% of the cohort, poor in 8%. Baseline sensory phenotype category was not associated with surgical outcome however pain-related worry, anxiety and functional interference were significantly associated with outcome (p ≤ 0.05). Conclusion In patients undergoing carpal tunnel surgery, pain-related worry, anxiety and pain functional interference are candidate prognostic outcome factors and require further elucidation.

Quantitative Sensory Testing in Patients with Multisomatoform Disorder with Chronic Pain as the Leading Bodily Symptom—a Matched Case–Control Study

Pain Medicine ◽  
2019 ◽  
Author(s):  
Johannes Achenbach ◽  
Anh-Thu Tran ◽  
Burkhardt Jaeger ◽  
Karl Kapitza ◽  
Michael Bernateck ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Quantitative Sensory Testing ◽  
Pain Threshold ◽  
Somatoform Disorders ◽  
Detection Threshold ◽  
Pressure Pain Threshold ◽  
Sensory Profile ◽  
Sensory Loss ◽  
Sensory Testing ◽  
Presenting Symptoms

Abstract Objective Chronic pain is a debilitating condition of multifactorial origin, often without physical findings to explain the presenting symptoms. Of the possible etiologies of persisting painful symptoms, somatoform disorders and functional somatic syndromes (FSS) are among the most challenging, with a prevalence of 8–20%. Many different somatoform disorders and FSS have overlapping symptoms, with pain being the most prevalent one. The concept of multisomatoform disorder (MSD) has been developed to acknowledge that fact. We hypothesized that the concept of MSD will be reflected in a distinct sensory profile of patients compared with healthy controls and possibly provide insight into the type and pathophysiology of the pain commonly experienced by patients. Design We performed comprehensive quantitative sensory testing (QST) in 151 patients and 149 matched controls. Results There were significant differences in the sensory profiles of patients compared with controls. Patients with MSD showed a combination of tactile and thermal hypesthesia combined with mechanical and cold hyperalgesia. This was true for measurements at test and control sites, with the exception of vibration detection threshold and mechanical pain threshold. Among the observed changes, a marked sensory loss of function, as evidenced by an increase in cold detection threshold, and a marked gain of function, as evidenced by a decrease of pressure pain threshold, were most notable. There was no evidence of concurrent medication influencing QST results. Conclusions The observed somatosensory profile of patients with MSD resembles that of patients suffering from neuropathic pain with evidence of central sensitization.

Median Nerve Small- and Large-Fiber Damage in Carpal Tunnel Syndrome: A Quantitative Sensory Testing Study

2011 ◽  
Vol 12 (2) ◽  
pp. 205-212 ◽  
Author(s):  
Stefano Tamburin ◽  
Carlo Cacciatori ◽  
Maria Luigia Praitano ◽  
Clizia Cazzarolli ◽  
Cristina Foscato ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Quantitative Sensory Testing ◽  
Sensory Testing ◽  
Fiber Damage ◽  
Tunnel Syndrome ◽  
Large Fiber

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.

scholarly journals One and Two Year Postoperative Patient Reported Outcomes of Robotic-Assisted Total Knee Arthroplasty

10.29007/n4qv ◽  
2019 ◽  
Author(s):  
Christopher Blum ◽  
Christopher Plaskos ◽  
Adil Hussein ◽  
Jan A Koenig
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Computer Assisted ◽  
Robotic Assisted ◽  
Post Surgery ◽  
Patient Reported ◽  
National Cohort ◽  
Total Knee ◽  
And Function

Total knee arthroplasty is a successful procedure. However, there is still area for improvement as up to 15-20% of patients remain unsatisfied. Robotic-assisted surgery (RAS) may improve patient outcomes by providing a reproducible way of obtaining neutral mechanical alignment of the limb, which has been shown to reduce early revisions and correlate with patient reported outcomes after surgery.We prospectively enrolled 106 patients undergoing robotic-assisted TKA by a single surgeon performing a measured-resection femur-first technique using the OMNIBotic system. Patients completed a KOOS and New Knee Society Score (KSS) pre-operatively and at 3, 6, 12, and 24 months (M) postoperatively. Changes in the five KOOS sub-scales were compared to available literature data from the FORCE – TJR cohort, as well as to individual studies reporting on conventional and computer-assisted TKA.When compared to FORCE-TJR 6-month (M) and 2-year (Y) data, the RAS cohort had significantly higher improvements at 6M for pain (40.5 vs. 31.1, p&lt;.001) and at 2Y for all five KOOS sub-scores. The larger improvement was due to the RAS cohort having lower baseline KOOS scores than the FORCE-TJR cohort, except for the Sports-Recreation sub-score, which was similar pre- operatively but significantly higher post-operatively for the robotic cohort. Rates of dissatisfaction with knee pain level and function using the KSS after RAS were 3.0%, 1.0%, and 2.7% at 6, 12, and 24M postoperatively, respectively.Despite having poorer joint function and higher pain pre-operatively, robotic-assisted TKA patients achieved excellent self-reported outcomes, with significantly higher levels of improvement through two years post-surgery when compared with large national cohort studies. Further controlled clinical studies are warranted to determine if these results translate to other groups of surgeons, centers and patients.

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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