scholarly journals A study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome, their correlation with post-operative recovery

2017 ◽  
Vol 50 (03) ◽  
pp. 260-265
Author(s):  
Sushil Ramesh Nehete ◽  
Binita B. Raut ◽  
Amita S. Hiremath ◽  
R. Mukund Thatte
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Statistical Correlation ◽  
Clinical Severity ◽  
Thenar Muscle ◽  
Severity Scores ◽  
Tunnel Syndrome ◽  
Operative Recovery ◽  
A Prospective Study

ABSTRACT Objective: We aimed to study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome (CTS) and to see if the severity of CTS affects recovery after surgery. Patients and Methods: A prospective study of 35 patients suffering from CTS. Clinical severity was assessed using visual analogue scale and standard questionnaires such as Levine and Disabilities of Arm, Shoulder and Hand questionnaires. All the patients underwent electrophysiological evaluation to assess electrophysiological severity of CTS. According to modified Padua classification, they were classified into three groups, namely, minimal to mild, moderate and severe to extreme. All patients underwent Carpal tunnel release in our unit. The clinical assessment was repeated 3 months post-operatively. Results: Out of 33 patients, majority (65.7%) of the patients were suffering from moderately severe CTS. The clinical provocative tests were positive in majority of patients. Clinically and statistically significant (P < 0.001) improvement was seen in all clinical severity scores. However, it did not show any statistical correlation with electrophysiological severity of the disease when compared among the groups. There was no association of age, gender of the patient, body mass index, hand dominance, affected side of the patient, results of provocative tests and the presence or absence of thenar muscle atrophy when compared among the three severity groups (P > 0.05). Conclusions: Although pre-operative clinical scores of severity and electrophysiology have a diagnostic role in CTS, they do not correlate with post-operative recovery and in turn fail to predict the extent of post-operative recovery before surgery.

A Prospective Study of Outcome Following Mini-open Carpal Tunnel Release

Hand Surgery ◽  
2003 ◽  
Vol 08 (01) ◽  
pp. 59-63 ◽  
Author(s):  
Michael P. Bradley ◽  
Edward P. Hayes ◽  
Arnold-Peter C. Weiss ◽  
Edward Akelman
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Historical Cohort ◽  
Endoscopic Release ◽  
Severity Scores ◽  
Tunnel Syndrome ◽  
A Prospective Study ◽  
Open Carpal Tunnel Release ◽  
Mini Open

Mini-open carpal tunnel release has been the focus of recent attention for surgical decompression of carpal tunnel syndrome. Other techniques such as standard open carpal tunnel release and endoscopic release have been well established, and outcomes, complications and results for these operations have been published widely. Our study uses the validated Levine Katz questionnaire for carpal tunnel syndrome to measure patient subjective outcomes at one year follow-up after mini-open carpal tunnel release. Thirty-four consecutive hands were enrolled prospectively with preoperative and postoperative questionnaires. Mean symptom severity scores per question improved from 2.8 to 1.3 and mean function severity scores per question improved from 2.6 to 1.3. Comparing our data to the historical cohort of Levine et al., there was a statistically significant improvement in postoperative outcomes in our population (p < 0.0001).

An analysis of patient’s and disease related factors predictive of the outcomes of surgery for carpal tunnel syndrome

2020 ◽  
Vol 52 (01) ◽  
pp. 11-17
Author(s):  
Andrzej Zyluk ◽  
Paulina Zyluk-Gadowska ◽  
Lukasz Kolodziej ◽  
Zbigniew Szlosser
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Clinical Severity ◽  
Related Factors ◽  
Minimally Clinically Important Difference ◽  
Duration Of Symptoms ◽  
Younger Age ◽  
Severity Scores ◽  
Tunnel Syndrome

Abstract Purpose Outcomes of surgery for carpal tunnel syndrome may differ in relation to certain factors like age, duration of symptoms, clinical and electrophysiological severity. The objective of this study was an investigation into the hypothesis that several factors are predictive of results of surgical treatment of the condition. Methods The pre- and postoperative records of 1,117 patients: 909 women (81 %) and 208 men (19 %) with a mean age of 63 years were analysed. Outcomes recorded in the sensory and functional severity scores of the Levine questionnaire were dichotomized into achieving or not-achieving a minimally clinically important difference. The effect of selected variables: sex, age, duration of symptoms, clinical and electrophysiological severity of and presence of comorbidities on outcomes of surgery at 6 months was investigated. Results Univariate and multivariate analysis of covariates based on sex, age, duration of the disease and its clinical severity showed female gender and worse baseline symptom severity scores to be significant predictors for an improvement following carpal tunnel syndrome surgery. It showed also younger age, shorter duration of symptoms and higher baseline symptom severity scores to be predictive of a greater improvement of total grip strength, and younger age to be predictive of a greater pain cessation following surgery. Conclusion Of all considered patient’s and disease related factors, the baseline clinical severity expressed in the Levine symptom severity scores had appeared to be the strongest predictor of better outcomes of surgery for carpal tunnel syndrome.

The Anatomical Site of Constriction of the Median Nerve in Patients with Severe Idiopathic Carpal Tunnel Syndrome

2006 ◽  
Vol 31 (6) ◽  
pp. 608-610 ◽  
Author(s):  
M. M AL-QATTAN
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Anatomical Site ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
A Prospective Study ◽  
Open Carpal Tunnel Release ◽  
Radiological Studies

During open carpal tunnel release in patients with severe idiopathic carpal tunnel syndrome, an area of constriction in the substance of the median nerve is frequently noted. In a prospective study of 30 patients, the central point of the constricted part of the nerve was determined intraoperatively and found to be, on average, 2.5 (range 2.2–2.8) cm from the distal wrist crease. This point always corresponded to the location of the hook of the hamate bone. These intraoperative findings were compared with the “narrowest” point of the carpal canal as determined by anatomical and radiological studies in the literature.

scholarly journals A Prospective, Randomized Trial Comparing Open and Endoscopic Carpal Tunnel Release Within the Same Patient

Hand ◽  
2018 ◽  
Vol 15 (3) ◽  
pp. 322-326 ◽  
Author(s):  
Brett M. Michelotti ◽  
Kavita T. Vakharia ◽  
Diane Romanowsky ◽  
Randy M. Hauck
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Functional Status ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Carpal Tunnel Release ◽  
Demographic Data ◽  
Pinch Strength ◽  
Postoperative Time ◽  
Tunnel Syndrome ◽  
A Prospective Study

Background: Surgical management of carpal tunnel syndrome includes performing an endoscopic (ECTR) or open (OCTR) carpal tunnel release. Several studies have shown less postoperative pain and improvement in grip and pinch strength with the endoscopic technique. The goal of this study was to prospectively examine outcomes, patient satisfaction, and complications after both ECTR and OCTR in the opposite hands of the same patient. Methods: This was a prospective study in which patients with bilateral carpal tunnel syndrome underwent surgical release with both techniques, with initial operative approach randomized in the more symptomatic hand. Demographic data and functional outcomes were recorded, including the pain score, 2-point discrimination, Semmes-Weinstein monofilament testing, thenar strength testing, grip strength, carpal tunnel syndrome functional status score, carpal tunnel syndrome symptom severity score, and overall satisfaction. Results: Thirty patients completed the study; there were no significant differences in any measure at any of the postoperative time points. Symptom severity and functional status scores were not significantly different between groups at any evaluation. Subjectively, 24 of 30 patients did state they preferred the ECTR, mostly citing less pain as their primary reason, although pain scores were not significantly different. Differences in overall satisfaction were also not significant. Conclusions: Both techniques are well tolerated with no differences in outcomes. With the added cost and equipment associated with ECTR, and no added benefit, the usefulness of ECTR is questionable.

Outcomes of Patients with and without Nighttime Awakening Symptoms After Carpal Tunnel Release

Hand ◽  
2020 ◽  
pp. 155894471989562
Author(s):  
Sarah Lander ◽  
Alex Lander ◽  
Warren C. Hammert
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Functional Results ◽  
Common Symptom ◽  
Outcome Questionnaire ◽  
Early Improvement ◽  
Severity Scores ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Questionnaire ◽  
A Prospective Study

Background: A common symptom associated with carpal tunnel syndrome (CTS) is nighttime awakening (NTA), which typically resolves quickly following carpal tunnel release (CTR). The early improvement in those who do not wake-up at night is less clear. This study investigates outcomes following CTR in patients with preoperative NTA symptoms compared to those without at 6 weeks and 3 months. Methods: Patients diagnosed with CTS who proceeded with CTR and agreed to participate in a prospective study completed the Boston Carpal Tunnel Questionnaire (BCTQ) and Michigan Hand Outcome Questionnaire (MHQ) at their preoperative appointment and 6-week and 3-month follow-ups. We compared outcomes between time points for improvement. Results: Of 45 patients, 37 patients with NTA had BCTQ scores of 3.09, 1.86, and 1.50 at preoperative, 6-week, and 3-month follow-up, respectively, and MHQ scores of 56.68, 74.91, and 81.01. NTA patients had improvement of both BCTQ and MHQ at 6 weeks and 3 months. Nonawakening patients had BCTQ scores of 2.58, 2.15, and 1.86 and MHQ scores of 57.94, 62.71, and 72.16, respectively. This cohort did not have significant improvement of MHQ at 6 weeks, but did at 3 months. The BCTQ severity scores in the nonawakening patients had significant improvement at both 6 weeks and 3 months, but did not at either time point for the BCTQ functionality scores. At 6 weeks, 2/37 patients continued to have NTA and no patients had NTA at 3 months. Conclusion: Patients with CTS and NTA symptoms had significant improvements in BCTQ and MHQ at 6 weeks and 3 months. Patients who did not awaken at night did not have significant improvements when evaluating BCTQ functional results, although they did improve when analyzing for BCTQ for symptom severity and MHQ, but not to the same level as those that do awaken and improvement was slower based on MHQ scores.

scholarly journals Outcome of Carpal Tunnel Release: a prospective study

2013 ◽  
Vol 1 (1) ◽  
Author(s):  
NMS Pradhan ◽  
JA Khan ◽  
BM Acharya ◽  
P Devkota ◽  
A Rajbhandari
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Prospective Study ◽  
Carpal Tunnel ◽  
Outcome Measurement ◽  
Carpal Tunnel Release ◽  
Signs And Symptoms ◽  
Tunnel Syndrome ◽  
A Prospective Study ◽  
Open Carpal Tunnel Release

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy and is manifested by characteristic signs and symptoms resulting from median nerve compression at the carpal tunnel. The diagnosis is essentially clinical, which is further confirmed by nerve conduction studies. Surgical release of the transverse carpal ligament is advised when conservative treatment fails.  METHODS: This prospective study evaluates the outcome of standard open carpal tunnel release performed at our center* from June 2004 to July 2007. Thirty two patients with idiopathic carpal tunnel syndrome, with failed conservative treatments, either with NSAIDs and/or local infiltration with corticosteroid injections plus night splint, or recurrence after conservative treatment were subjected to open carpal tunnel release after getting approval from the local ethical committee and getting a written and informed consent from the patient. Clinical assessment was done preoperatively and at 6 weeks, 3 months and 6 months following the procedure and included the two-point discrimination test at the tip of the index finger and Boston questionnaires as an outcome measurement of symptoms severity. All the patients were followed up for a period of six months. RESULTS: All the patients presented improvement in the postoperative evaluations in all the analyzed parameters. CONCLUSION: Open carpal tunnel release is a safe and effective method for the treatment of CTS and can be carried out when the conservative means fail to relieve the symptoms. DOI: http://dx.doi.org/10.3126/noaj.v1i1.8129 Nepal Orthopaedic Association Journal Vol.1(1) 2010

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.

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.

Hand-held nerve conduction device in carpal tunnel syndrome: A prospective study

2012 ◽  
Vol 45 (5) ◽  
pp. 635-641
Author(s):  
S. Veronica Tan ◽  
Fiona Sandford ◽  
Mark Stevenson ◽  
Sara Probert ◽  
Sue Sanders ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Prospective Study ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Tunnel Syndrome ◽  
A Prospective Study
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