scholarly journals Patient’s Perceptions of Carpal Tunnel Surgery

2019 ◽  
Vol 30 (3) ◽  
pp. 197-206
Author(s):  
Raíssa Mansilla ◽  
Marcus André Acioly ◽  
Tayla Taynan Romão ◽  
Alison Mangolin ◽  
Jonadab Dos Santos Silva ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Medical Condition ◽  
Carpal Tunnel Release ◽  
Public Institution ◽  
Structured Interviews ◽  
Carpal Tunnel Surgery ◽  
Returning To Work ◽  
Tunnel Syndrome ◽  
Severity Of The Disease ◽  
Patient’S Perception

Introduction: Carpal tunnel syndrome is a debilitating medical condition to many patients, and in cases refractory to conservative treatment, carpal tunnel decompressive surgery is indicated. In Latin America, however, little is known about the patient’s perception of the surgical procedure and their experience. Objective: In this study, we analyzed patient’s perception and the overall experience about carpal tunnel decompression in a Brazilian public institution and compared the results with literature from other countries. Methods: We conducted a prospective qualitative study with semi-structured interviews with 20 patients who underwent carpal tunnel release. Interviews were audio recorded and transcribed for thematic analysis. Results: Six topics emerged from the analysis: (1) functional restriction and pain are the main reason for seeking surgery; (2) our patients considered CTS as a serious illness, contrarily to previous reports of other countries. (3) patients were satisfied with the overall surgical experience; (4) many patients did not return to work after surgery, despite reporting significant improvement; (5) patients recommend surgical treatment as soon as possible; (6) most patients considered physical therapy important in rehabilitation. Conclusion: perception of CTS surgery is influenced by various socioeconomic and psychocultural variables, and further strategies to improve patient’s outcomes and expectations are still needed. In our community, we need to improve the perception of the severity of the disease and the recovering time before returning to work.

scholarly journals Patient Comprehension of Carpal Tunnel Surgery

Hand ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 175-180 ◽  
Author(s):  
Gregory R. Waryasz ◽  
Joseph A. Gil ◽  
Daniel Chiou ◽  
Paul Ramos ◽  
Jonathan R. Schiller ◽  
...  
Keyword(s):  
Health Literacy ◽  
Carpal Tunnel ◽  
Postoperative Care ◽  
Medical Condition ◽  
Carpal Tunnel Release ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Average Percentage ◽  
Patient Comprehension ◽  
Carpal Tunnel Surgery

Background: Health literacy is the ability of a patient to understand their medical condition. The purpose of this investigation is to determine whether patients are able to obtain an elementary understanding of the fundamental principles of carpal tunnel release and the postoperative instructions after going through the process of informed consent and being provided an additional standardized postoperative instruction document. Our hypothesis is that patients will lack an understanding of these principles and, therefore, will be at risk for being noncompliant in their postoperative care. Methods: Fifty patients with a diagnosis of carpal tunnel surgery who elected to undergo carpal tunnel release alone were enrolled. A standardized education process was performed. Patients completed the questionnaire at their postoperative visit. Results: The average percentage of correct answers was 75.8% (8.34 out of 11 correct). Fisher exact test analysis demonstrated that patients with a lower education level were less likely to know how long it takes for their preoperative symptoms to resolve ( P = .0071), and they were less likely to correctly choose all of the important elements of postoperative care during the first week after surgery ( P = .022). Conclusions: Although we made efforts to help patients achieve health literacy in carpal tunnel surgery, we found that patients continued to lack comprehension of pertinent components of carpal tunnel surgery, particularly understanding the involved anatomy.

scholarly journals Trigger Fingers After Open Carpal Tunnel Release

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.

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 Comparison of open and endoscopic carpal tunnel surgery regarding clinical outcomes, complication and return to daily life: A prospective comparative study

2019 ◽  
Vol 35 (6) ◽  
Author(s):  
Tahsin Gürpınar ◽  
Barış Polat ◽  
Ayşe Esin Polat ◽  
Engin Carkçı ◽  
Ahmet Sinan Kalyenci ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Return To Work ◽  
Carpal Tunnel ◽  
Daily Life ◽  
Carpal Tunnel Release ◽  
Incision Length ◽  
Early Return ◽  
Carpal Tunnel Surgery ◽  
Prospective Comparative Study ◽  
Tunnel Syndrome

Objective: This study aimed to compare the clinical results and complications as well as patient satisfaction in patients with carpal tunnel syndrome operated with open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR) techniques. Methods: This study conducted in Istanbul Training and Research Hospital between August 2016 and January 2018. A total of 54 patients were operated with the ECTR technique and 50 patients were operated with the OCTR technique after failing nonsurgical treatment. Patients functional scores are assessed with the carpal tunnel syndrome-functional status score (CTS-FSS) and carpal tunnel syndrome-symptom severity score (CTS-SSS). Operation time, incision length and complications of the two techniques were noted and compared. Results: The age, sex distribution, distribution of sides, and complaint period were not significant (p > 0.05) between the groups. The preoperative or postoperative CTS-SSS and CTS-FSS values did not differ significantly (p > 0.05). Incision length, time to return to work and return to daily life in the OCTR group was significantly higher than the ECTR group (p < 0.05). Conclusion: ECTR has similar results in terms of symptom relief, severity, functional status, pillar pain and complication rates compared to OCTR. However, it has the advantages of early return to daily life, early return to work and less incision length. doi: https://doi.org/10.12669/pjms.35.6.967 How to cite this:Gurpinar T, Polat B, Polat AE, Carkci E, Kalyenci AS, Ozturkmen Y. Comparison of open and endoscopic carpal tunnel surgery regarding clinical outcomes, complication and return to daily life: A prospective comparative study. Pak J Med Sci. 2019;35(6):1532-1537. doi: https://doi.org/10.12669/pjms.35.6.967 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Neurophysiology not Required Before Surgery for Typical Carpal Tunnel Syndrome

2001 ◽  
Vol 26 (1) ◽  
pp. 61-64 ◽  
Author(s):  
V. FINSEN ◽  
H. RUSSWURM
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Diagnosis ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Neurophysiological Tests ◽  
Carpal Tunnel Surgery ◽  
Neurophysiological Studies ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release

Sixty-eight patients with typical carpal tunnel syndrome underwent neurophysiological investigations preoperatively, but these were not assessed until the end of the study. Open carpal tunnel release was performed and the clinical diagnosis of carpal tunnel syndrome was considered as confirmed when there was a prompt resolution of the preoperative symptoms. Sixty-three of the 68 patients responded well to surgery, three had equivocal outcomes and two did not improve, and thus were considered not to have carpal tunnel syndrome. The neurophysiological tests were normal in these two patients, but were also normal in 14 of the 63 patients who improved with carpal tunnel surgery. Preoperative neurophysiology might therefore have led to up to 14 of the 63 cases of carpal tunnel syndrome being turned down for surgery. We conclude that neurophysiological studies contribute little to the diagnosis in typical cases of carpal tunnel syndrome, and are more often confounding than of assistance.

scholarly journals Pulsed Radiofrequency of the Median Nerve under Ultrasound Guidance

2007 ◽  
Vol 6;10 (6;11) ◽  
pp. 765-770
Author(s):  
Naeem Haider
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Ultrasound Guidance ◽  
Carpal Tunnel Release ◽  
Pulsed Radiofrequency ◽  
Medication Therapy ◽  
Carpal Tunnel Surgery ◽  
Cubital Fossa ◽  
Tunnel Syndrome

Neuropathy of the median nerve within the carpal tunnel (carpal tunnel syndrome) has an age adjusted incidence of 105 cases per 100,000 person years. Treatment of carpal tunnel syndrome ranges from conservative management with medication and exercise to surgical release of the median nerve. Conservative treatment accounts for a significant portion of resources utilized and includes splinting, nerve gliding, ultrasound, and carpal bone mobilization. Recurrent symptoms of carpal tunnel syndrome have been shown to occur in 0% to 19% of patients following carpal tunnel release, with up to 12% requiring re-exploration. Prognosis for re-exploration is not as good as for primary carpal tunnel release, with a high recurrence rate in some populations. Ultrasound has seen increasing use in regional anesthesia and has been shown to improve the quality of regional anesthetic blocks. Pulsed radiofrequency was developed with the goal of providing reduction in pain from the use of electrical fields in the absence of neural injury. The use of ultrasound guidance for positioning radiofrequency probes over peripheral nerves has not been reported. This case report describes the use of ultrasound guided pulsed radiofrequency in the treatment of recurrent carpal tunnel syndrome. Following revision carpal tunnel surgery, the patient in this report was unable to obtain relief of pain in either hand with medication therapy alone. After a successful diagnostic median nerve block at the cubital fossa, pulsed radiofrequency of the median nerve was performed on the left side at the cubital fossa, under ultrasound guidance. Radiofrequency probe adjustment around the nerve was conducted under live ultrasound guidance and multiple pulsed treatments were applied at anatomically distinct sites over the nerve. A 70% reduction in pain was reported over the follow up period of 12 weeks. Key words: Pulsed radiofrequency, carpal tunnel, ultrasound, median nerve.

Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

2003 ◽  
Vol 8 (4) ◽  
pp. 4-5
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Proper Time ◽  
Carpal Tunnel Release ◽  
Hand Function ◽  
Factors Affecting ◽  
Early Results ◽  
Medical Evaluation ◽  
Nerve Recovery ◽  
Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

The association between surgery for carpal and cubital tunnel syndrome: analysis of incidence and risk factors within a geographical area

2021 ◽  
Vol 46 (3) ◽  
pp. 260-264
Author(s):  
Nick A. Johnson ◽  
Oliver Darwin ◽  
Dimitrious Chasiouras ◽  
Anna Selby ◽  
Chris Bainbridge
Keyword(s):  
Relative Risk ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Geographical Area ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Level Of Evidence ◽  
Tunnel Syndrome ◽  
The Relationship ◽  
Syndrome Analysis

The relationship between surgery for cubital tunnel and carpal tunnel syndrome was examined in this retrospective study. Between 1997 and 2018, data from consecutive patients who underwent carpal tunnel release (8352 patients), cubital tunnel release (1681 patients) or both procedures (692 patients) were analysed. The relative risk of undergoing cubital tunnel release in the population who had carpal tunnel release compared with those with no carpal tunnel release was 15.3 (male 20.3; female 12.5). The relative risk of undergoing carpal tunnel release in the population who had cubital tunnel release compared with those who did not undergo carpal tunnel release was 11.5 (male 16.5; female 9.1). Our study showed that men and women who undergo carpal tunnel release are over 20 times and 10 times more likely to have cubital tunnel release than those who did not undergo carpal tunnel release, respectively. These findings suggest that the two conditions may share a similar aetiology. Level of evidence: IV

Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

2021 ◽  
pp. 175319342110017
Author(s):  
Saskia F. de Roo ◽  
Philippe N. Sprangers ◽  
Erik T. Walbeehm ◽  
Brigitte van der Heijden
Keyword(s):  
Systematic Review ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Open Release ◽  
Flap Coverage ◽  
Tunnel Syndrome

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

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