scholarly journals National Trends in Carpal Tunnel Release and Hand Fracture Procedures Performed During Orthopaedic Residency: An Analysis of ACGME Case Logs

2016 ◽  
Vol 8 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Richard M. Hinds ◽  
Michael B. Gottschalk ◽  
John T. Capo
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Temporal Trends ◽  
Fracture Dislocation ◽  
Annual Data ◽  
Case Volume ◽  
Hand Fracture ◽  
The Mean ◽  
Orthopaedic Residency ◽  
Case Logs

ABSTRACT Background  Mastery in performing carpal tunnel release (CTR) and hand fracture procedures is an essential component of orthopaedic residency training. Objective  To assess orthopaedic resident case log data for temporal trends in CTR and hand fracture cases and to determine the degree of variability in case volume among residents. Methods  Accreditation Council for Graduate Medical Education orthopaedic surgery resident case logs were reviewed for graduation years 2007 through 2014. Annual data regarding the mean number of CTR and hand fracture/dislocation procedures were recorded, as well as the median number of procedures reported by the top and bottom 10% of residents (by case volume). Temporal trends were assessed using linear regression modeling. Results  There was no change in the mean number of CTRs performed per resident. Over the 8-year period, the top 10% of residents performed a significantly greater number of CTRs than the bottom 10% (62.1 versus 9.3, P < .001). Similarly, no change was noted in the mean number of total hand fracture/dislocation cases performed, with the top 10% of residents performing significantly more hand fracture cases than the bottom 10% (47.1 versus 9.3, P < .001). Conclusions  Our results indicate no change in CTR and hand fracture caseload for orthopaedic residents. However, as resident experience performing both procedures varies significantly, this variability likely has important educational implications.

SURGICAL PROCESS RE-ENGINEERING: CARPAL TUNNEL DECOMPRESSION — A MODEL

Hand Surgery ◽  
2004 ◽  
Vol 09 (01) ◽  
pp. 19-27 ◽  
Author(s):  
J. A. Casaletto ◽  
V. Rajaratnam
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Procedure Time ◽  
Original Process ◽  
Depth Analysis ◽  
New Process ◽  
Common Operation ◽  
The Mean ◽  
Operative Findings ◽  
Made In

Surgical process re-engineering is a methodology where the entire surgical process is systematically analysed and re-designed. The process starts with mapping of the current process followed by in-depth analysis of the existing process. A new process is drafted with the aim of making the whole procedure more efficient. The new process is then discussed with all the staff involved in the operating room. Following implementation of the process, surgical process re-engineering should ideally be routinely carried out to continuously improve the procedure. We present an example of surgical process re-engineering which we carried out on the procedure of carpal tunnel release. We used carpal tunnel release as a model as it is a very common operation, with predictable intra-operative findings, and the patient is likely to benefit directly from procedure time reduction. A preliminary mapping of three procedures was done followed by a detailed timed mapping of five routine carpal tunnel decompression procedures. The mapped process was analysed in detail and a number of changes were made in the process. After implementing the new process, a further five procedures were mapped and timed again. In comparison to the original process, we achieved a reduction of 20% in the mean procedure time and a reduction of 42% in the number of steps from 66 to 37.

Carpal Tunnel Release Using a Short Palmar Incision and a New Knife

2000 ◽  
Vol 25 (4) ◽  
pp. 357-360 ◽  
Author(s):  
S. AVCI ◽  
U. SAYLI
Keyword(s):  
Light Source ◽  
Carpal Tunnel ◽  
Local Anaesthesia ◽  
Carpal Tunnel Release ◽  
Self Care ◽  
Operation Time ◽  
Major Complications ◽  
Flexor Retinaculum ◽  
The Mean

A new knife with its own battery powered light source (Knifelight®, Stryker Instruments, Kalamazoo, Michigan, USA) was used for carpal tunnel release in 31 wrists of 25 patients. Under local anaesthesia, a short palmar incision was used and the carpal tunnel contents were visualized during division of the flexor retinaculum. The mean operation time was 11 minutes and no major complications were seen. The patients could use their hands for self-care after 3 days and returned to work at a mean of 23 days. At a minimum follow-up of 6 months, all but one of the patients were satisfied with the final result. Mild scar tenderness was seen in two patients and pillar pain in one patient.

scholarly journals Function of Microscopic Carpal Tunnel Release in Cases Resistant to Conservative Therapy

2021 ◽  
Vol 6 (4) ◽  
pp. 89-96
Author(s):  
Jehan Zeb ◽  
Muhammad Ullah ◽  
Muhammad Shoaib ◽  
Syed Shah ◽  
Walayat Shah ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Carpal Tunnel Release ◽  
P Value ◽  
Symptom Severity Score ◽  
Tunnel Syndrome ◽  
The Mean ◽  
And Function

Purpose: To determine the outcome of microscopic carpal tunnel release in patients with carpal tunnel syndrome who failed to respond to conservative treatment. Methodology: This descriptive case series was carried at Department of Neurosurgery, D.H.Q Hosptial Charsadda over 1 year from Jan 2019 to Dec 2020, indicate the sampling method used to select the study participants involving 94 patients; both men and women with ages in the range 30-70 years diagnosed of carpal tunnel syndrome who failed to respond to conservative treatment and were planned for surgical release. Microscopic CTS release was performed and outcomes were assessed in terms of improvement in VAS score for wrist pain, symptom severity score and function status scale 3 and 6 months after the surgery. Recurrence of symptoms was also noted. A written informed consent was obtained from every patient. Indicate the method of data collection and data analysis Findings: The mean age of the patients with carpal tunnel syndrome was 41.6±7.9 years. There was slight female predominance with male to female ratio of 1:2.1. History of diabetes was recorded in 29 (31.0%) patients while 34 (37.0%) patients were obese. Right hand was more frequently involved (53.0%) than the left hand (47.0%). The mean VAS score for wrist pain reduced from 7.9±1.2 at baseline to 1.8±0.7 3 months after the surgery (p- value<0.001). Similar improvements were also noted in symptom severity score (3.8±0.8 to 1.6±0.8; p- value<0.001) and function status scale (2.7±0.8 to 1.5±0.8; p-value<0.001) at the end of 3 months after the surgery. Recurrence was not observed in any patient at the end of 6 months follow-up. Recommendation: Microscopic carpal tunnel release was found to relieve patient’s symptoms and improve wrist function yet with minimal scarring and without recurrence which advocates its preferred use in future practice provided necessary surgical skills and hardware are available.

scholarly journals Variability in trauma case volume in orthopedic surgery residents

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Travis D. Blood ◽  
Joseph A. Gil ◽  
Christopher T. Born ◽  
Alan H. Daniels
Keyword(s):  
Orthopedic Surgery ◽  
Trauma Surgery ◽  
Orthopedic Trauma ◽  
Upward Trend ◽  
Case Volume ◽  
Trauma Case ◽  
The Mean ◽  
The Difference ◽  
Case Logs ◽  
Orthopedic Trauma Surgery

Orthopedic trauma surgery is a critical component of resident education. Surgical case logs obtained from the Accreditation Council of Graduate Medical Students from 2009 to 2013 for orthopedic surgery residents were examined for variability between the 90<sup>th</sup> and 10<sup>th</sup> percentiles in regards to the volume of cases performed. There was an upward trend in the mean number of cases performed by senior residents from 484.4 in 2009 to 534.5 in 2013, representing a 10.3% increase. There was a statistically significant increase in the number of cases performed for humerus/elbow, forearm/wrist, and pelvis/hip during this period (Pth and 90<sup>th</sup> percentile case volumes narrowed over the study period, the difference between these groups remained significant in 2013 (P=0.02). In 2013, all categories of trauma cases had a greater than 2.2-fold difference between the 10<sup>th</sup> and 90<sup>th</sup> percentile of residents for numbers of trauma cases performed. Although case volume is not the sole determinant of residency education and competency, evidence suggests that case volume plays a crucial role in surgeon confidence and efficiency in performing surgery. Further studies are needed to better understand the effect of this variability seen among residents performing orthopedic trauma surgery.

The relationship of trigger finger and flexor tendon volar migration after carpal tunnel release

2013 ◽  
Vol 39 (7) ◽  
pp. 694-698 ◽  
Author(s):  
S. K. Lee ◽  
K. W. Bae ◽  
W. S. Choy
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Trigger Finger ◽  
Neutral Position ◽  
Wrist Flexion ◽  
Flexor Tendons ◽  
Tendon Biomechanics ◽  
The Mean ◽  
Relationship Of ◽  
The Relationship

It has been suggested that the increased frequency of trigger finger (TF) after carpal tunnel release (CTR) may be caused by the volar migration of the flexor tendons at the wrist altering the tendon biomechanics at the A1 pulley. This hypothesis has not been validated. We performed pre- and post-operative ultrasonography (USG) on the affected wrists of 92 patients who underwent CTR. Pre-operative USG was performed in neutral with no tendon loading; post-operative USG was performed in neutral unloaded and in various positions of wrist flexion whilst loading the flexor tendons with gripping. The mean volar migration of the flexor tendons after CTR was 2.2 (SD 0.4) mm in the unloaded neutral position. It was 1.8 (SD 0.4) mm in patients who did not develop TF and 2.5 (SD 0.5) mm in those who did ( p = 0.0067). In loaded wrist flexion, the mean volar migration of flexor tendons after CTR in patients who did not develop TF and those who did was 2.1 and 3.0 mm in 0° flexion; 3.2 and 3.9 mm in 15° flexion; 4.3 and 5.1 mm in 30° flexion; and 4.9 and 5.8 mm in 45° flexion, respectively. There were significant differences between patients with and without TF at each flexion angle. Our data indicate that patients with greater volar migration of the flexor tendons after CTR are more likely to develop TF. This conclusion supports the hypothesis that the occurrence of TF after CTR may be caused by the bowstringing effects of the flexor tendons.

Variability in Foot and Ankle Case Volume in Orthopaedic Residency Training

2017 ◽  
Vol 10 (6) ◽  
pp. 531-537 ◽  
Author(s):  
Steven F. DeFroda ◽  
Joseph A. Gil ◽  
Brad D. Blankenhorn ◽  
Alan H. Daniels
Keyword(s):  
Orthopaedic Surgery ◽  
Rapid Development ◽  
Foot And Ankle ◽  
Case Volume ◽  
New Techniques ◽  
Surgical Residency ◽  
Surgical Case ◽  
Orthopaedic Residency ◽  
Case Logs ◽  
Ankle And Foot

Surgical case volume during orthopaedic surgical residency is a concern among trainees and program directors alike. With an ongoing trend toward further subspecialization and the rapid development of new techniques and devices, the breadth of procedures that residents are exposed to continues to increase. Accreditation Council for Graduate Medical Education surgical case logs from 2009 to 2013 for graduating orthopaedic surgery residents were examined to assess the national averages of orthopaedic procedures logged by graduating orthopaedic surgery residents in the leg/ankle and foot/toes categories. This investigation revealed that there was an 8% increase in the total number of leg/ankle cases and 12% increase in foot/toes cases performed by graduating orthopaedic surgery residents, which has not significantly increased from 2009 to 2013. Across years examined in this study, significant variability existed between the 10th and 90th percentiles for total foot and ankle resident case exposure (P < .05), particularly within ankle arthroscopy, where there was a 15-fold difference in the number of arthroscopy cases performed by residents in the 90th percentile compared with the 10th percentile. The overall volume of foot and ankle cases performed by graduating orthopaedic surgery residents has increased despite not being statistically significantly from 2009 to 2013. Levels of Evidence: Level III: Cohort study

scholarly journals Microsurgical carpal tunnel release

1997 ◽  
Vol 3 (1) ◽  
pp. E5 ◽  
Author(s):  
Scott Shapiro
Keyword(s):  
Return To Work ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Workers Compensation ◽  
Complete Disappearance ◽  
Antibiotic Administration ◽  
Outpatient Basis ◽  
Improvement Rate ◽  
Steroid Dependent ◽  
The Mean

The author reports on a series of 482 patients who underwent primary carpal tunnel release (CTR) surgery beginning in 1987. Two hundred twenty-five patients underwent CTR in the right hand, 169 patients underwent CTR in the left hand, and 88 patients underwent bilateral CTR surgery, for a total of 570 hands. These surgeries were performed on an outpatient basis. After application of a local anesthetic, a microsurgical technique using a 2-cm longitudinal incision that did not cross the wrist flexion crease was accomplished. In five patients the recurrent thenar branch exited through the middle or ulnar portion of the ligament and this branch was preserved in all five. Perioperative complications included stitch abscesses in nine hands (2%), which were managed on an outpatient basis; deep wound infections occurred in three hands (0.5%) and these patients were admitted for intravenous antibiotic administration and wound care. One steroid-dependent patient suffered wound dehiscence due to a fall and the wound was primarily repaired. One patient required a second minor procedure to remove a retained suture. Two patients developed “trigger finger” 6 months postoperatively. The mean time until return to work for those patients not receiving Workers' Compensation was 3 weeks and for those receiving Workers' Compensation it was 6.5 weeks. Complete disappearance of painful dysesthesias occurred in 431 (89%) of 482 patients. Marked improvement occurred in another 33 (7%) patients, yielding an overall improvement rate of 96%. Motor improvement was noted in 438 (96%) of 454 patients with preoperative motor weakness. Bilateral symptoms resolved on the contralateral side following unilateral surgery in seven patients. Fifteen patients (12 of whom were receiving Workers' Compensation) experienced persistent dysesthesias and/or incision pain and did not return to work. An additional eight procedures were performed in patients who had previously undergone surgery at another institution; four showed no evidence of their transverse carpal ligament being sectioned. Five of the eight patients undergoing reexploration noted postoperative improvement in their symptoms. Finally, 14 (3%) patients presented 1 to 5 years postsurgery with thenar/hypothenar pain. These patients have responded to local steroid injections and are being followed by a hand surgeon. The reimbursement of the surgeon's fee is $253.00 from Medicaid, $360.00 from Medicare, and $560.00 from preferred provider insurance. The mean total time in the outpatient operating room is 35 to 40 minutes. The outcome and time to return to work are equal, if not superior, to those reported for endoscopic CTR surgery. Microsurgical CTR is thought to be safer and probably more cost-effective.

Significance of Incomplete Release of The Distal Portion of The Flexor Retinaculum

1994 ◽  
Vol 19 (3) ◽  
pp. 283-285 ◽  
Author(s):  
T.K. COBB ◽  
W.P. COONEY
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Distal Portion ◽  
Arch Width ◽  
Endoscopic Carpal Tunnel Release ◽  
Flexor Retinaculum ◽  
The Mean ◽  
Distal Aspect ◽  
Partial Release

Endoscopic carpal tunnel release has been shown in recent studies to result in a significant number of incomplete releases of the distal aspect of the flexor retinaculum. The significance of this complication is unknown. To address this question, we measured the amount of carpal arch widening after incomplete and complete release. The mean amount of change in carpal arch width in five cadaveric hands after partial release (all but the distal 4 mm) was 0.74 mm, which was statistically significant. The mean additional change after release of the remaining 4 mm of the flexor retinaculum was 0.12 mm, which was not significant. Incomplete release of the distal 4 mm of the distal aspect of the flexor retinaculum allows carpal arch widening that is no different from that of complete sectioning of the flexor retinaculum in the cadaver limb.

Quantitative analysis of the variation in angles of the carpal arch after open and endoscopic carpal tunnel release

2009 ◽  
Vol 111 (2) ◽  
pp. 311-316 ◽  
Author(s):  
Leandro Pretto Flores ◽  
Thiago F. P. Cavalcante ◽  
Oswaldo R. M. Neto ◽  
Fabiano S. Alcântara
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Open Surgery ◽  
Carpal Tunnel Release ◽  
Statistical Significance ◽  
Mean Values ◽  
Endoscopic Carpal Tunnel Release ◽  
Tunnel Syndrome ◽  
The Mean ◽  
The Difference

Object Previous studies have demonstrated that the volume of the carpal canal increases after open and endoscopic surgery in patients with carpal tunnel syndrome. There is some controversy regarding the contribution of the postoperative widening of the carpal arch to the increment in carpal canal volume. The objectives of this study were to: 1) evaluate the degree of variation in the angles formed by the borders of the carpal arch following the surgical division of the transverse carpal ligament; and 2) determine if there are differences in the variation of these angles after the classical open surgery versus endoscopic carpal tunnel release. Methods The authors prospectively studied 20 patients undergoing carpal tunnel syndrome surgery: 10 patients were treated via the standard open technique, and 10 underwent endoscopic carpal tunnel release. The angles of the carpal arch were measured on CT scans of the affected hand obtained before and immediately after the surgical procedures. Measurements were performed at the level of the pisiform-scaphoid hiatus and at the level of the hook of the hamate-trapezium hiatus. Results There was widening of the postoperative angles of the carpal arch after open and endoscopic division of the flexor retinaculum; however, the difference between pre- and postoperative angulations reached statistical significance only in those patients treated by means of the open procedure. The mean (± SD) values for the postoperative increase in the angles at the level of the pisiform-scaphoid hiatus were 5.1 ± 0.4° after open surgery and 2.5 ± 0.3° after the endoscopically assisted procedure (p < 0.05). At the level of the hook of the hamate-trapezium hiatus, the mean values for the widening of the angles were 6.2 ± 0.6° for the open surgery group and 1.2 ± 0.4° for those patients treated by means of the endoscopic technique (p < 0.05). Conclusions The widening of the postoperative angles of the carpal arch is a phenomenon observed at the proximal and distal levels of the carpal canal, and it can be noted after both open and endoscopically assisted carpal tunnel release. The endoscopic procedure yielded less increase in these angles than the open surgery.

scholarly journals Microsurgery Case Volume During Orthopedic Surgery Residency: A 7-Year Assessment

Hand ◽  
2016 ◽  
Vol 12 (6) ◽  
pp. 610-613 ◽  
Author(s):  
Richard M. Hinds ◽  
Christopher S. Klifto ◽  
Michael S. Guss ◽  
John T. Capo
Keyword(s):  
Medical Education ◽  
Orthopedic Surgery ◽  
Median Number ◽  
Regression Analyses ◽  
Case Volume ◽  
Educational Implications ◽  
Wide Clinical Application ◽  
The Mean ◽  
Case Logs ◽  
Analyze Case

Background: Microsurgery is a specialized surgical technique with wide clinical application. The purpose of this study was to analyze case logs of graduating orthopedic surgery residents to assess trends in case volume for microsurgery procedures. Methods: Accreditation Council for Graduate Medical Education case log reports were analyzed for microsurgery experience from 2007 to 2013. The mean number of adult, pediatric, and total microsurgery cases was noted. In addition, the median number of microsurgery procedures performed by the 90th, 50th, and 10th percentiles of residents (by case volume) was recorded. Temporal changes in case volume were calculated utilizing linear regression analyses. Results: The proportion of microsurgery procedures increased significantly (1.3% to 2%; P = .024). The mean number of adult (24.5 to 41.9; P = .01), pediatric (1.9 to 3.4; P = .011), and total (26.3 to 45.3; P = .01) microsurgery procedures also increased significantly. Similarly, residents in both the 90th (63 to 109; P = .01) and 50th (10 to 21; P = .036) percentiles sustained significant increases in the median number of microsurgery procedures. No change was noted for residents in 10th percentile (0 to 0; P > .999). Graduating residents in the 90th percentile performed over 6 times more microsurgery procedures than residents in the 50th percentile. Conclusions: Microsurgical caseload is increasing among graduating orthopedic residents. However, there is substantial variability in resident microsurgery case volume. Future investigations are needed to explore the educational implications of these findings and should seek to correlate microsurgical caseload with competency.

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