We developed a self-administered questionnaire for the assessment of severity of symptoms and functional status in patients who have carpal tunnel syndrome. The reproducibility, internal consistency, validity, and responsiveness to clinical change of scales for the measurement of severity of symptoms and functional status were evaluated in a clinical study. The scales were highly reproducible (Pearson correlation coefficient, r = 0.91 and 0.93 for severity of symptoms and functional status, respectively) and internally consistent (Cronbach alpha, 0.89 and 0.91 for severity of symptoms and functional status, respectively). Both scales had positive, but modest or weak, correlations with two-point discrimination and Semmes-Weinstein monofilament testing (Spearman coefficient, r = 0.12 to 0.42). In thirty-eight patients who were operated on in 1990 and were evaluated a median of fourteen months postoperatively, the mean symptom-severity score improved from 3.4 points preoperatively to 1.9 points at the latest follow-up examination, while the mean functional-status score improved from 3 to 2 points (5 points is the worst score and 1 point is the best score for each scale). Similar improvement was noted in twenty-six patients who were evaluated before and three months after the operation. We concluded that the scales for the measurement of severity of symptoms and functional status are reproducible, internally consistent, and responsive to clinical change, and that they measure dimensions of outcomes not captured by traditional measurements of impairment of the median nerve. These scales should enhance standardization of measurement of outcomes in studies of treatment for carpal tunnel syndrome.

A Self-Administered Questionnaire for the Assessment of Severity of Symptoms and Functional Status in Carpal Tunnel Syndrome.

To define the role of two-portal endoscopic carpal-tunnel release as a method for the treatment of compression of the median nerve at the wrist, a prospective, randomized, multicenter study was performed on 169 hands in 145 patients. Either open or endoscopic carpal-tunnel release was performed in all of the patients who had clinical signs and symptoms consistent with carpal tunnel syndrome, had not responded to or had refused non-operative management, and had had electrodiagnostic studies consistent with carpal tunnel syndrome. Follow-up evaluations were performed at twenty-one, forty-two, and eighty-four days. At the end of the follow-up period, both the open and endoscopic methods had resulted in high levels of achievement of the primary outcomes (relief of pain and paresthesias). The numbness and paresthesias were relieved in eighty (98 per cent) of eighty-two hands in the open-release group compared with seventy-seven (99 per cent) of seventy-eight hands in the endoscopic-release group. This parameter was not recorded for three hands in the open-release group or six hands in the endoscopic-release group. The satisfaction of the patients with the procedure, graded on a scale of 0 to 100 per cent, averaged 84 per cent in the open-release group compared with 89 per cent in the group that had had endoscopic release. We found no significant differences between the two groups with regard to the secondary quantitative-outcome measurements, including two-point discrimination, postoperative interstitial-pressure data for the carpal canal, Semmes-Weinstein monofilament testing, and motor strength. The open technique resulted in more tenderness of the scar than did the endoscopic method. Thirty-two (39 per cent) of eighty-two hands in the open-release group and fifty (64 per cent) of seventy-eight hands in the endoscopic-release group were not tender at eighty-four days. This parameter was not recorded for three hands in the open-release group and six hands in the endoscopic-release group. The open method also resulted in a longer interval until the patient could return to work (median, twenty-eight days, compared with fourteen days for the open-release and endoscopic-release groups). Four complications occurred in the endoscopic carpal-tunnel release group: one partial transection of the superficial palmar arch, one digital-nerve contusion, one ulnar-nerve neuropraxia, and one wound hematoma.(ABSTRACT TRUNCATED AT 400 WORDS)

Carpal tunnel release : a prospective, randomized assessment of open and endoscopic methods

Purpose: To compile the major complications of carpal tunnel surgery and compare reported complications for open and endoscopic techniques Methods: A literature assessment was performed for published complications of open and endoscopic carpal tunnel release procedures; 80 publications, representing a period from 1966 through 2001, were reviewed Complications were identified as neurapraxia; nerve, tendon, or artery injury; and wound infection or dehiscence that required antibiotics or additional operative care Differences in the proportions of complications between carpal tunnel release procedures were explored with the use of Fisher exact tests Results: The literature review yielded 22,327 cases of endoscopic carpal tunnel release and 5,669 cases of open carpal tunnel release For structural damage to nerves, arteries, or tendons, the incidence for open carpal tunnel release is 049% and for endoscopic methods (transbursal and extra-bursal), 019% This difference is statistically significant ( P Conclusions: The proportion of complications for carpal tunnel release, performed through an endoscopic or open approach, is very low Selection of an open versus an endoscopic approach on the basis of structural complications for nerve, arteries, or tendons is not supported by statistical analysis of published complications Level of Evidence: Level III, retrospective comparative therapeutic study

Complications of Endoscopic and Open Carpal Tunnel Release

Patients (n = 3336) who had been tested for suspected carpal tunnel syndrome (CTS) were contacted by postal questionnaire and their opinions sought of the overall subjective outcome of any treatments using a five-point rating scale. Operative results were compared with preoperative nerve conduction, clinical and demographic variables, and a multiple logistic regression analysis used to identify significant prognostic factors. Among 1268 surgical procedures that were identified, the overall surgical success rate was 69%. Preoperative nerve conduction study findings, greater age, lower symptom scores, longer disease duration, and male gender were significant predictors of poor outcome. Nerve conduction studies had the strongest effect, with patients with middle-grade abnormalities having better results than those with either very severe or no abnormality. Surgical carpal tunnel decompression has a significant failure rate. The preoperative nerve conduction studies account for a proportion of the total variation in outcome.

Do nerve conduction studies predict the outcome of carpal tunnel decompression

This article represents a review of 149 carpal tunnel decompressions on 109 carpal tunnel syndrome patients, and a 22-month clinical result on endoscopic carpal ligament release The symptoms were relieved and no permanent nerve damage, vascular complications, hematomas, infections, or recurrences were reported Postoperatively, one patient had a temporary loss of the interosseous muscle but recovered spontaneously in 4 weeks In this 22-month survey, 289% of the patients were able to return to normal activities and work within 1 week, 585% returned within 2 weeks, 754% returned within 3 weeks, and 859% returned within 4 weeks A pinch-and-grip study was performed; 32% regained normal pinch-and-grip strength within 1 week, 74% regained it in 2 weeks, 93% regained it in 3 weeks, and 100% regained it in 4 weeks Based on our results, there has been rapid recovery, less scarring, decreased postoperative pain, and no loss of pinch-and-grip strength

J.C. Semple

Papers

Carpal-tunnel syndrome. Results of surgical decompression.

Carpal-tunnel syndrome