DOI QR코드

DOI QR Code

Effectiveness of mini-open carpal tunnel release: An outcome study

  • van den Broeke, Lieselotte R. (Department of Plastic, Reconstructive and Hand Surgery, Gelre Hospital) ;
  • Theuvenet, Willem.J. (Department of Plastic, Reconstructive and Hand Surgery, Gelre Hospital) ;
  • van Wingerden, Jan.J. (Department of Plastic, Reconstructive and Hand Surgery, Gelre Hospital)
  • Received : 2018.05.26
  • Accepted : 2019.02.01
  • Published : 2019.07.15

Abstract

Background Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy with a high morbidity and healthcare-related costs. Currently there is no consensus about the best treatment option. The purpose of this prospective cohort study conducted at a single institution was to evaluate the clinical outcomes and patient satisfaction following a mini-open carpal tunnel release for idiopathic CTS. Methods A total of 72 patients (53 female and 19 male patients; mean age, $57.8{\pm}15.3$ years; range, 24-94 years) had a mini-open carpal tunnel release performed by a single senior surgeon between June 2015 and June 2016. The patients were evaluated preoperatively, and at 3 and 12 months post-intervention. At every follow-up, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and visual analogue scale (VAS) scores for pain and satisfaction were completed. Digital sensibility (using Semmes-Weinstein monofilaments) was assessed and pinch and grip strengths were measured. Results Statistically significant and clinically relevant improvement was found in terms of digital sensibility, grip and pinch strength (except for 2-point pinch), BCTSQ scores and pain scores. The complication rate was minimal, and no major complications occurred. Two patients experienced recurrence. The availability of follow-up records (including patient-reported outcomes, BCTSQ and VAS scores, and the complication rate) at 1-year post-intervention varied between 69% and 74% (50-53 patients) depending on which parameter was assessed. Patient satisfaction was high (mean, $80.9{\pm}26.0$; range, 0-100). Conclusions This study demonstrates that mini-incision carpal tunnel release is clinically effective in the short and long term.

Keywords

References

  1. Padua L, Coraci D, Erra C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol 2016;15:1273-84. https://doi.org/10.1016/S1474-4422(16)30231-9
  2. Nederlandse Vereniging voor Neurologie. Richtlijn 'Diagnostiek en behandeling van het carpale-tunnelsyndroom [Internet]. 2005, 1-149. Available from https://www.neurologie.nl/publiek/beroepsinformatie/richtlijnen/nvn-richtlijnen.
  3. Iida J, Hirabayashi H, Nakase H, et al. Carpal tunnel syndrome: electrophysiological grading and surgical results by minimum incision open carpal tunnel release. Neurol Med Chir (Tokyo) 2008;48:554-9. https://doi.org/10.2176/nmc.48.554
  4. Graham B, Peljovich AE, Afra R, et al. The American academy of orthopaedic surgeons evidence-based clinical practice guideline on: management of carpal tunnel syndrome. J Bone Joint Surg Am 2016;98:1750-4. https://doi.org/10.2106/JBJS.16.00719
  5. Vasiliadis HS, Georgoulas P, Shrier I, et al. Endoscopic release for carpal tunnel syndrome. Cochrane Database Syst Rev 2014;(1):CD008265.
  6. Sayegh ET, Strauch RJ. Open versus endoscopic carpal tunnel release: a meta-analysis of randomized controlled trials. Clin Orthop Relat Res 2015;473:1120-32. https://doi.org/10.1007/s11999-014-3835-z
  7. Smits FV, Ottenhof M, Feitz R, et al. Nederlandse vertaling van de 'Boston carpal Tunnel Questionnaire'voor evaluatie van het carpaletunnel-syndroom (BcTQ-dlV). Nederlands Tijdschrift voor Plastische Chirurgie 2014;5:70-3.
  8. Anbarasan A, Thevarajah N, Sadagatullah AN. The functional outcome of mini carpal tunnel release. J Hand Microsurg 2017;9:6-10. https://doi.org/10.1055/s-0037-1598089
  9. Murthy PG, Goljan P, Mendez G, et al. Mini-open versus extended open release for severe carpal tunnel syndrome. Hand (N Y) 2015;10:34-9. https://doi.org/10.1007/s11552-014-9650-x
  10. Soltani AM, Allan BJ, Best MJ, et al. Revision decompression and collagen nerve wrap for recurrent and persistent compression neuropathies of the upper extremity. Ann Plast Surg 2014;72:572-8. https://doi.org/10.1097/SAP.0b013e3182956475
  11. Kim JK, Koh YD, Kim JO, et al. Changes in clinical symptoms, functions, and the median nerve cross-sectional area at the carpal tunnel inlet after open carpal tunnel release. Clin Orthop Surg 2016;8:298-302. https://doi.org/10.4055/cios.2016.8.3.298
  12. Yoshii Y, Tung WL, Ishii T. Measurement of median nerve strain and applied pressure for the diagnosis of carpal tunnel syndrome. Ultrasound Med Biol 2017;43:1205-9. https://doi.org/10.1016/j.ultrasmedbio.2017.02.018
  13. Choi SJ, Ahn DS. Correlation of clinical history and electrodiagnostic abnormalities with outcome after surgery for carpal tunnel syndrome. Plast Reconstr Surg 1998;102:2374-80. https://doi.org/10.1097/00006534-199812000-00016
  14. Rotman MB, Enkvetchakul BV, Megerian JT, et al. Time course and predictors of median nerve conduction after carpal tunnel release. J Hand Surg Am 2004;29:367-72. https://doi.org/10.1016/j.jhsa.2004.01.011
  15. Kim JK, Yi JW, Kook SH. The minimal clinical important difference of the carpal tunnel syndrome questionnaire in surgically treated patients. J Hand Surg Am 2011;36:7. https://doi.org/10.1016/S0363-5023(10)01508-X
  16. Rodrigues JN, Mabvuure NT, Nikkhah D, et al. Minimal important changes and differences in elective hand surgery. J Hand Surg Eur Vol 2015;40:900-12.
  17. Heller GZ, Manuguerra M, Chow R. How to analyze the visual analogue scale: myths, truths and clinical relevance. Scand J Pain 2016;13:67-75. https://doi.org/10.1016/j.sjpain.2016.06.012
  18. Mahomed NN, Liang MH, Cook EF, et al. The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol 2002;29:1273-9.
  19. Zhang S, Vora M, Harris AH, et al. Cost-minimization analysis of open and endoscopic carpal tunnel release. J Bone Joint Surg Am 2016;98:1970-7. https://doi.org/10.2106/JBJS.16.00121

Cited by

  1. Anatomical variations of the innervated radial artery superficial palmar branch flap: A series of 28 clinical cases vol.47, pp.5, 2019, https://doi.org/10.5999/aps.2020.00423
  2. Optimizing Costs and Outcomes for Carpal Tunnel Release Surgery : A Cost-Effectiveness Analysis from Societal and Health-Care System Perspectives vol.103, pp.23, 2021, https://doi.org/10.2106/jbjs.20.02126
  3. Does Recurrence of Carpal Tunnel Syndrome (CTS) after Complete Division of the Transverse Ligament Really Exist? vol.10, pp.18, 2021, https://doi.org/10.3390/jcm10184208