BACKGROUND Trigger digit is a common disorder of the hand associated with carpal tunnel syndrome.Carpal tunnel release(CTR)surgery may be a risk factor for trigger digit development;however,the association between sur...BACKGROUND Trigger digit is a common disorder of the hand associated with carpal tunnel syndrome.Carpal tunnel release(CTR)surgery may be a risk factor for trigger digit development;however,the association between surgical approach to CTR and postoperative trigger digit is equivocal.AIM To investigate patient risk factors for trigger digit development following either open carpal tunnel release(OCTR)or endoscopic carpal tunnel release(ECTR).METHODS This retrospective chart analysis evaluated 967 CTR procedures from 694 patients for the development of postoperative trigger digit.Patients were stratified according to the technique utilized for their CTR,either open or endoscopic.The development of postoperative trigger digit was evaluated at three time points:within 6 mo following CTR,between 6 mo and 12 mo following CTR,and after 12 mo following CTR.Firth’s penalized likelihood logistic regression was conducted to evaluate sociodemographic and patient comorbidities as potential independent risk factors for trigger digit.Secondary regression models were conducted within each surgical group to reveal any potential interaction effects between surgical approach and patient risk factors for the development of postoperative trigger digit.RESULTS A total of 47 hands developed postoperative trigger digit following 967 CTR procedures(4.9%).In total,64 digits experienced postoperative triggering.The long finger was most commonly affected.There was no significant difference between the open and endoscopic groups for trigger digit development at all three time points following CTR.Furthermore,there were no significant independent risk factors for postoperative trigger digit;however,within group analysis revealed a significant interaction effect between gender and surgical approach(P=0.008).Females were more likely to develop postoperative trigger digit than males after OCTR(OR=3.992),but were less likely to develop postoperative trigger digit than males after ECTR(OR=0.489).CONCLUSION Patient comorbidities do not influence the development of trigger digit following CTR.Markedly,gender differences for postoperative trigger digit may depend on surgical approach to CTR.展开更多
AIM To compared outcomes between the hypothenar fat pad flap(HTFPF) and conventional open carpal tunnel release(COR) in primary carpal tunnel syndrome(CTS). METHODS Forty-five patients(49 hands) were enrolled into the...AIM To compared outcomes between the hypothenar fat pad flap(HTFPF) and conventional open carpal tunnel release(COR) in primary carpal tunnel syndrome(CTS). METHODS Forty-five patients(49 hands) were enrolled into the study from January 2014 to March 2016, 8 patients were excluded. Randomization was conducted in 37 patients(41 hands) by computer generated(Block of four randomization) into COR and HTFPF group. Nerve conduction study(NCS) included distal sensory latency(DSL), distal motor latency(DML), sensory amplitude (S-amp), motor amplitude(M-amp) and sensory nerve conduction velocity(SCV) were examined at 6 and 12 wk after CTR. Levine score, grip and pinch strength, pain [visual analog scale(VAS)], 2-point discrimination(2-PD), Semmes-Weinstein monofilament test(SWM), Phalen test and Tinel's sign were evaluated in order to compare treatment outcomes.RESULTS The COR group, 19 patients(20 hands) mean age 50.4 years. The HTFPF group, 20 patients(21 hands) mean age 53.3 years. Finally 33 patients(36 hands) were analysed, 5 patients were loss follow-up, 17 hands in COR and 19 hands in HTFPF group. NCS revealed significant difference of DSL in HTFPF group at 6 wk(P < 0.05) compared with the COR group. S-amp was significant improved postoperatively in both groups(P < 0.05) but not significant difference between two groups. No significant difference of DML, M-amp and SCV postoperatively in both groups and between two groups. Levine score, pain(VAS), grip and pinch strength, 2-PD, SWM, Phalen test and Tinel's sign were improved postoperatively in both groups, but there was no significant difference between two groups.CONCLUSION There is no advantage outcome in primary CTS for having additional HTFPF procedure in CTR. COR is still the standard treatment. Nevertheless, improvement of DSL and S-amp could be observed at 6 wk postoperatively.展开更多
Carpal tunnel syndrome(CTS)is a multifactorial compression neuropathy.It is reported to be very common and rising globally.CTS’s treatment varies from conservative measures to surgical treatments.Surgery has shown to...Carpal tunnel syndrome(CTS)is a multifactorial compression neuropathy.It is reported to be very common and rising globally.CTS’s treatment varies from conservative measures to surgical treatments.Surgery has shown to be an effective method for more severe cases.However few unclear aspects and room for further research and improvements still remains.We performed a narrative literature review on the most up to date progress and innovation in terms of surgical treatments for CTS.The simple algorithm of leaving the choice of the surgical method to surgeons’preference and experience(together with consideration of patients’related factors)seem to be the best available option,which is supported by the most recent metanalysis and systematic reviews.We suggest that surgeons(unless in presence of precise indications towards endoscopic release)should tend to perform a minimally invasive open approach release,favoring the advantage of a better neurovascular structures visualization(and a consequent higher chance to perform a complete release with long term relief of symptoms)instead of favoring an early reduction(in the first postoperative days)of immobilization and pain.Research towards a universally accepted standardization should be aimed for by the researchers,who have failed to date to sufficiently limit bias and limitations.展开更多
AIM: To determine whether patients taking aspirin during carpal tunnel release had an increase of complications.METHODS: Between January 2008 and January 2010, 150 patients underwent standard open carpal tunnel releas...AIM: To determine whether patients taking aspirin during carpal tunnel release had an increase of complications.METHODS: Between January 2008 and January 2010, 150 patients underwent standard open carpal tunnel release(CTR) under intravenous regional anaesthesia. They were divided into three groups: groups 1 and 2 were made of 50 patients each, on aspirin 100 mg/d for at least a year. In group 1 the aspirin was never stopped. In group 2 it was stopped at least 5 d before surgery and resumed 3 d after. Group 3 acted as a control, with 50 patients who did not take aspirin. The incidence of clinically significant peror post-operative complications was recorded and divided into local and cardio-cerebro-vascular complications. Local complications were then divided into minor and major according to Page and Stern. Local haematomas were assessed at 2 d(before resuming aspirin in group 2) and 14 d(after resuming aspirin in group 2) postoperatively. Patients were reviewed at 2, 14 and 90 d after surgery.RESULTS: There was no significant difference in the incidence of complications in the three groups. A total of 3 complications(2 major and 1 minor) and 27 visible haematomas were recorded. Two major complications were observed respectively in group 1(non stop aspirin) and in group 3(never antiaggregated). The minor complication, observed in one patient of group 2(stop aspirin), consisted of a wound dehiscence, which only led to delayed healing. All haematomas were observed in the first 48 h, no haematoma lasted for more than 2 wk and all resolved spontaneously. A major haematoma(score > 20 cm2) was observed in 8 patients. A minor haematoma(score < 20 cm2) was recorded in 19 patients. All patients at 90 d after surgery were satisfied with the result in terms of relief of their preoperative symptoms. Major and minor haematomas did not impair hand function or require any specific therapy.CONCLUSION: Our study demonstrates that continuation of aspirin did not increase the risk of complications. It is unnecessary to stop aspirin before CTR with good surgical techniques.展开更多
Carpal tunnel syndrome is one of the commonest entrapment neuropathies. Hand pain and numbness are mostly the presenting symptoms. Endoscopic carpal tunnel release (ECTR) has been demonstrated to reduce recovery time ...Carpal tunnel syndrome is one of the commonest entrapment neuropathies. Hand pain and numbness are mostly the presenting symptoms. Endoscopic carpal tunnel release (ECTR) has been demonstrated to reduce recovery time and allow faster return to the work. The purpose of this prospective descriptive study was to evaluate the efficacy and advantages of (ECTR) through single proximal incision. In this study, the procedure was done for 36 hands in 36 patients. The results showed that females:male = 9:1, mean age was 42 years. Right hand dominance was 90% and affected in 67%. Preoperatively, the condition was moderate in 61% and severe in 39%. The average operating time was 10 minutes and the mean follow up period was 6 months with no major postoperative complications. In 8%, transient neurapraxia was found and resolved in 1 week and tenderness was found in 70% and resolved in 4 weeks. we concluded that endoscopic carpal tunnel release is an effective minimal incisional safe procedure with a high success rate, rapid return to work.展开更多
基金Supported by the Blue Cross Blue Shield of Michigan Foundation,No.22590764
文摘BACKGROUND Trigger digit is a common disorder of the hand associated with carpal tunnel syndrome.Carpal tunnel release(CTR)surgery may be a risk factor for trigger digit development;however,the association between surgical approach to CTR and postoperative trigger digit is equivocal.AIM To investigate patient risk factors for trigger digit development following either open carpal tunnel release(OCTR)or endoscopic carpal tunnel release(ECTR).METHODS This retrospective chart analysis evaluated 967 CTR procedures from 694 patients for the development of postoperative trigger digit.Patients were stratified according to the technique utilized for their CTR,either open or endoscopic.The development of postoperative trigger digit was evaluated at three time points:within 6 mo following CTR,between 6 mo and 12 mo following CTR,and after 12 mo following CTR.Firth’s penalized likelihood logistic regression was conducted to evaluate sociodemographic and patient comorbidities as potential independent risk factors for trigger digit.Secondary regression models were conducted within each surgical group to reveal any potential interaction effects between surgical approach and patient risk factors for the development of postoperative trigger digit.RESULTS A total of 47 hands developed postoperative trigger digit following 967 CTR procedures(4.9%).In total,64 digits experienced postoperative triggering.The long finger was most commonly affected.There was no significant difference between the open and endoscopic groups for trigger digit development at all three time points following CTR.Furthermore,there were no significant independent risk factors for postoperative trigger digit;however,within group analysis revealed a significant interaction effect between gender and surgical approach(P=0.008).Females were more likely to develop postoperative trigger digit than males after OCTR(OR=3.992),but were less likely to develop postoperative trigger digit than males after ECTR(OR=0.489).CONCLUSION Patient comorbidities do not influence the development of trigger digit following CTR.Markedly,gender differences for postoperative trigger digit may depend on surgical approach to CTR.
文摘AIM To compared outcomes between the hypothenar fat pad flap(HTFPF) and conventional open carpal tunnel release(COR) in primary carpal tunnel syndrome(CTS). METHODS Forty-five patients(49 hands) were enrolled into the study from January 2014 to March 2016, 8 patients were excluded. Randomization was conducted in 37 patients(41 hands) by computer generated(Block of four randomization) into COR and HTFPF group. Nerve conduction study(NCS) included distal sensory latency(DSL), distal motor latency(DML), sensory amplitude (S-amp), motor amplitude(M-amp) and sensory nerve conduction velocity(SCV) were examined at 6 and 12 wk after CTR. Levine score, grip and pinch strength, pain [visual analog scale(VAS)], 2-point discrimination(2-PD), Semmes-Weinstein monofilament test(SWM), Phalen test and Tinel's sign were evaluated in order to compare treatment outcomes.RESULTS The COR group, 19 patients(20 hands) mean age 50.4 years. The HTFPF group, 20 patients(21 hands) mean age 53.3 years. Finally 33 patients(36 hands) were analysed, 5 patients were loss follow-up, 17 hands in COR and 19 hands in HTFPF group. NCS revealed significant difference of DSL in HTFPF group at 6 wk(P < 0.05) compared with the COR group. S-amp was significant improved postoperatively in both groups(P < 0.05) but not significant difference between two groups. No significant difference of DML, M-amp and SCV postoperatively in both groups and between two groups. Levine score, pain(VAS), grip and pinch strength, 2-PD, SWM, Phalen test and Tinel's sign were improved postoperatively in both groups, but there was no significant difference between two groups.CONCLUSION There is no advantage outcome in primary CTS for having additional HTFPF procedure in CTR. COR is still the standard treatment. Nevertheless, improvement of DSL and S-amp could be observed at 6 wk postoperatively.
文摘Carpal tunnel syndrome(CTS)is a multifactorial compression neuropathy.It is reported to be very common and rising globally.CTS’s treatment varies from conservative measures to surgical treatments.Surgery has shown to be an effective method for more severe cases.However few unclear aspects and room for further research and improvements still remains.We performed a narrative literature review on the most up to date progress and innovation in terms of surgical treatments for CTS.The simple algorithm of leaving the choice of the surgical method to surgeons’preference and experience(together with consideration of patients’related factors)seem to be the best available option,which is supported by the most recent metanalysis and systematic reviews.We suggest that surgeons(unless in presence of precise indications towards endoscopic release)should tend to perform a minimally invasive open approach release,favoring the advantage of a better neurovascular structures visualization(and a consequent higher chance to perform a complete release with long term relief of symptoms)instead of favoring an early reduction(in the first postoperative days)of immobilization and pain.Research towards a universally accepted standardization should be aimed for by the researchers,who have failed to date to sufficiently limit bias and limitations.
文摘AIM: To determine whether patients taking aspirin during carpal tunnel release had an increase of complications.METHODS: Between January 2008 and January 2010, 150 patients underwent standard open carpal tunnel release(CTR) under intravenous regional anaesthesia. They were divided into three groups: groups 1 and 2 were made of 50 patients each, on aspirin 100 mg/d for at least a year. In group 1 the aspirin was never stopped. In group 2 it was stopped at least 5 d before surgery and resumed 3 d after. Group 3 acted as a control, with 50 patients who did not take aspirin. The incidence of clinically significant peror post-operative complications was recorded and divided into local and cardio-cerebro-vascular complications. Local complications were then divided into minor and major according to Page and Stern. Local haematomas were assessed at 2 d(before resuming aspirin in group 2) and 14 d(after resuming aspirin in group 2) postoperatively. Patients were reviewed at 2, 14 and 90 d after surgery.RESULTS: There was no significant difference in the incidence of complications in the three groups. A total of 3 complications(2 major and 1 minor) and 27 visible haematomas were recorded. Two major complications were observed respectively in group 1(non stop aspirin) and in group 3(never antiaggregated). The minor complication, observed in one patient of group 2(stop aspirin), consisted of a wound dehiscence, which only led to delayed healing. All haematomas were observed in the first 48 h, no haematoma lasted for more than 2 wk and all resolved spontaneously. A major haematoma(score > 20 cm2) was observed in 8 patients. A minor haematoma(score < 20 cm2) was recorded in 19 patients. All patients at 90 d after surgery were satisfied with the result in terms of relief of their preoperative symptoms. Major and minor haematomas did not impair hand function or require any specific therapy.CONCLUSION: Our study demonstrates that continuation of aspirin did not increase the risk of complications. It is unnecessary to stop aspirin before CTR with good surgical techniques.
文摘Carpal tunnel syndrome is one of the commonest entrapment neuropathies. Hand pain and numbness are mostly the presenting symptoms. Endoscopic carpal tunnel release (ECTR) has been demonstrated to reduce recovery time and allow faster return to the work. The purpose of this prospective descriptive study was to evaluate the efficacy and advantages of (ECTR) through single proximal incision. In this study, the procedure was done for 36 hands in 36 patients. The results showed that females:male = 9:1, mean age was 42 years. Right hand dominance was 90% and affected in 67%. Preoperatively, the condition was moderate in 61% and severe in 39%. The average operating time was 10 minutes and the mean follow up period was 6 months with no major postoperative complications. In 8%, transient neurapraxia was found and resolved in 1 week and tenderness was found in 70% and resolved in 4 weeks. we concluded that endoscopic carpal tunnel release is an effective minimal incisional safe procedure with a high success rate, rapid return to work.
