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Delayed Improvement after Endoscopic Carpal Tunnel Release

  • Kim, Dong-Ho (Department of Neurosurgry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Cho, Byung-Moon (Department of Neurosurgry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Oh, Sae-Moon (Department of Neurosurgry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Park, Dong-Sik (Department of Rehabilitation Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Park, Se-Hyuck (Department of Neurosurgry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine)
  • 투고 : 2014.02.03
  • 심사 : 2014.06.29
  • 발행 : 2014.11.28

초록

Objective : In most patients with carpal tunnel syndrome (CTS), pain and/or paresthesia disappeared or decreased in a month after endoscopic carpal tunnel release (ECTR). However, subpopulation of patients showed delayed improvement following ECTR. We analyzed the delayed improvement hands to investigate the characteristics of those patients and to determine the predictable factors of delayed improvement. Methods : Single-portal ECTRs were performed in 1194 hands of 793 CTS patients from 2002 to 2011. Five-hundred seventy hands with minimal 1-year postoperative follow-up were included. We divided the 545 satisfied hands into early (group A) and delayed (group B) groups according to improvement period of 1 month. Demographic data, clinical severity and electrodiagnostic abnormality were compared between groups. Results : Group A included 510 hands and group B included 35 hands. In group B, 11 hands improved in 2 months, 15 hands in 3 months and 9 hands in 6 months, respectively. In group A/B, according to clinical severity, 60/1 hands were graded to I, 345/24 hands to II, 105/10 hands to III. In group A/B, based on electrodiagnostic abnormality, 57/3 hands were classified to mild, 221/11 hands to moderate and 222/21 hands to severe group. Statistical analysis between groups did not reach significance but electrodiagnostic or clinical severity had a tendency to affect the delayed response. Conclusion : It is difficult to predict the factors contributing to postoperatively-delayed response in subpopulation of CTS patients. However, we recommend that postoperative observation for at least 6 months is necessary in patients without symptomatic improvement.

키워드

참고문헌

  1. Agee JM, McCarroll HR Jr, Tortosa RD, Berry DA, Szabo RM, Peimer CA : Endoscopic release of the carpal tunnel : a randomized prospective multicenter study. J Hand Surg Am 17 : 987-995, 1992 https://doi.org/10.1016/S0363-5023(09)91044-9
  2. al-Qattan MM, Bowen V, Manktelow RT : Factors associated with poor outcome following primary carpal tunnel release in non-diabetic patients. J Hand Surg Br 19 : 622-625, 1994 https://doi.org/10.1016/0266-7681(94)90130-9
  3. American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation : Practice parameter for electrodiagnostic studies in carpal tunnel syndrome : summary statement. Muscle Nerve 25 : 918-922, 2002 https://doi.org/10.1002/mus.10185
  4. Aroori S, Spence RA : Carpal tunnel syndrome. Ulster Med J 77 : 6-17, 2008
  5. Ashworth NL : Carpal tunnel syndrome. Clin Evid (Online) 2011 : pii : 1114, 2011
  6. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I : Prevalence of carpal tunnel syndrome in a general population. JAMA 282 : 153-158, 1999 https://doi.org/10.1001/jama.282.2.153
  7. Brown MG, Keyser B, Rothenberg ES : Endoscopic carpal tunnel release. J Hand Surg Am 17 : 1009-1011, 1992 https://doi.org/10.1016/S0363-5023(09)91047-4
  8. Choi SJ, Ahn DS : Correlation of clinical history and electrodiagnostic abnormalities with outcome after surgery for carpal tunnel syndrome. Plast Reconstr Surg 102 : 2374-2380, 1998 https://doi.org/10.1097/00006534-199812000-00016
  9. Chow JC : Endoscopic release of the carpal ligament : a new technique for carpal tunnel syndrome. Arthroscopy 5 : 19-24, 1989 https://doi.org/10.1016/0749-8063(89)90085-6
  10. Chow JC : Endoscopic release of the carpal ligament for carpal tunnel syndrome : long-term results using the Chow technique. Arthroscopy 15 : 417-421, 1999 https://doi.org/10.1016/S0749-8063(99)70060-5
  11. de Krom MC, Kester AD, Knipschild PG, Spaans F : Risk factors for carpal tunnel syndrome. Am J Epidemiol 132 : 1102-1110, 1990 https://doi.org/10.1093/oxfordjournals.aje.a115753
  12. Deniz FE, Oksüz E, Sarikaya B, Kurt S, Erkorkmaz U, Ulusoy H, et al. : Comparison of the diagnostic utility of electromyography, ultrasonography, computed tomography, and magnetic resonance imaging in idiopathic carpal tunnel syndrome determined by clinical findings. Neurosurgery 70 : 610-616, 2012 https://doi.org/10.1227/NEU.0b013e318233868f
  13. DeStefano F, Nordstrom DL, Vierkant RA : Long-term symptom outcomes of carpal tunnel syndrome and its treatment. J Hand Surg Am 22 : 200-210, 1997 https://doi.org/10.1016/S0363-5023(97)80152-9
  14. Eversmann WW Jr, Ritsick JA : Intraoperative changes in motor nerve conduction latency in carpal tunnel syndrome. J Hand Surg Am 3 : 77-81, 1978 https://doi.org/10.1016/S0363-5023(78)80119-1
  15. Gelberman RH : Carpal tunnel release : open release of transverse carpal ligament in Gelberman RH (ed) : Operative nerve repair and reconstruction. Philadelphia : JB Lippincott, 1991, pp899-912
  16. Gelberman RH, Pfeffer GB, Galbraith RT, Szabo RM, Rydevik B, Dimick M : Results of treatment of severe carpal-tunnel syndrome without internal neurolysis of the median nerve. J Bone Joint Surg Am 69 : 896-903, 1987 https://doi.org/10.2106/00004623-198769060-00016
  17. Grant AG, Kliot M : General principles in evaluating and treating peripheral nerve injuries in Winn HR (ed) : Youmans Neurological Surgery, ed 5. New York : Saunders, 2004, Vol 4, pp3795-3797
  18. Green DP : Diagnostic and therapeutic value of carpal tunnel injection. J Hand Surg Am 9 : 850-854, 1984 https://doi.org/10.1016/S0363-5023(84)80065-9
  19. Guyette TM, Wilgis EF : Timing of improvement after carpal tunnel release. J Surg Orthop Adv 13 : 206-209, 2004
  20. Haupt WF, Wintzer G, Schop A, Löttgen J, Pawlik G : Long-term results of carpal tunnel decompression. Assessment of 60 cases. J Hand Surg Br 18 : 471-474, 1993 https://doi.org/10.1016/0266-7681(93)90149-A
  21. Higgs PE, Edwards D, Martin DS, Weeks PM : Carpal tunnel surgery outcomes in workers : effect of workers' compensation status. J Hand Surg Am 20 : 354-360, 1995 https://doi.org/10.1016/S0363-5023(05)80086-3
  22. Jimenez DF, Gibbs SR, Clapper AT : Endoscopic treatment of carpal tunnel syndrome : a critical review. J Neurosurg 88 : 817-826, 1998 https://doi.org/10.3171/jns.1998.88.5.0817
  23. Katz JN, Losina E, Amick BC 3rd, Fossel AH, Bessette L, Keller RB : Predictors of outcomes of carpal tunnel release. Arthritis Rheum 44 : 1184-1193, 2001 https://doi.org/10.1002/1529-0131(200105)44:5<1184::AID-ANR202>3.0.CO;2-A
  24. Kulick MI, Gordillo G, Javidi T, Kilgore ES Jr, Newmayer WL 3rd : Long-term analysis of patients having surgical treatment for carpal tunnel syndrome. J Hand Surg Am 11 : 59-66, 1986 https://doi.org/10.1016/S0363-5023(86)80104-6
  25. Menon J : Endoscopic carpal tunnel release : a single-portal technique. Contemp Orthop 26 : 109-116, 1993
  26. Michelsen H, Posner MA : Medical history of carpal tunnel syndrome. Hand Clin 18 : 257-268, 2002 https://doi.org/10.1016/S0749-0712(01)00006-3
  27. Muhlau G, Both R, Kunath H : Carpal tunnel syndrome--course and prognosis. J Neurol 231 : 83-86, 1984 https://doi.org/10.1007/BF00313722
  28. Naidu SH, Fisher J, Heistand M, Kothari MJ : Median nerve function in patients undergoing carpal tunnel release : pre- and post-op nerve conductions. Electromyogr Clin Neurophysiol 43 : 393-397, 2003
  29. Nau HE, Lange B, Lange S : Prediction of outcome of decompression for carpal tunnel syndrome. J Hand Surg Br 13 : 391-394, 1988
  30. Nolan WB 3rd, Alkaitis D, Glickel SZ, Snow S : Results of treatment of severe carpal tunnel syndrome. J Hand Surg Am 17 : 1020-1023, 1992 https://doi.org/10.1016/S0363-5023(09)91050-4
  31. Oertel J, Schroeder HW, Gaab MR : Dual-portal endoscopic release of the transverse ligament in carpal tunnel syndrome : results of 411 procedures with special reference to technique, efficacy, and complications. Neurosurgery 59 : 333-340; discussion 333-340, 2006 https://doi.org/10.1227/01.NEU.0000223500.25131.99
  32. Okutsu I, Ninomiya S, Natsuyama M, Takatori Y, Inanami H, Kuroshima N, et al. : [Subcutaneous operation and examination under the universal endoscope]. Nihon Seikeigeka Gakkai Zasshi 61 : 491-498, 1987
  33. Omer GE Jr : Median nerve compression at the wrist. Hand Clin 8 : 317-324, 1992
  34. Padua L, Padua R, Aprile I, Pasqualetti P, Tonali P; Italian CTS Study Group : Carpal tunnel syndrome : Multiperspective follow-up of untreated carpal tunnel syndrome : a multicenter study. Neurology 56 : 1459-1466, 2001 https://doi.org/10.1212/WNL.56.11.1459
  35. Padua L, Pazzaglia C, Caliandro P, Granata G, Foschini M, Briani C, et al. : Carpal tunnel syndrome : ultrasound, neurophysiology, clinical and patient-oriented assessment. Clin Neurophysiol 119 : 2064-2069, 2008 https://doi.org/10.1016/j.clinph.2008.05.004
  36. Phalen GS : The carpal-tunnel syndrome. Clinical evaluation of 598 hands. Clin Orthop Relat Res 83 : 29-40, 1972 https://doi.org/10.1097/00003086-197203000-00007
  37. Phalen GS : The carpal-tunnel syndrome. Seventeen years' experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am 48 : 211-228, 1966 https://doi.org/10.2106/00004623-196648020-00001
  38. Schrijver HM, Gerritsen AA, Strijers RL, Uitdehaag BM, Scholten RJ, de Vet HC, et al. : Correlating nerve conduction studies and clinical outcome measures on carpal tunnel syndrome : lessons from a randomized controlled trial. J Clin Neurophysiol 22 : 216-221, 2005
  39. Stevens JC : AAEM minimonograph #26 : the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve 20 : 1477-1486, 1997 https://doi.org/10.1002/(SICI)1097-4598(199712)20:12<1477::AID-MUS1>3.0.CO;2-5
  40. Straub TA : Endoscopic carpal tunnel release : a prospective analysis of factors associated with unsatisfactory results. Arthroscopy 15 : 269-274, 1999 https://doi.org/10.1016/S0749-8063(99)70033-2
  41. Uchiyama S, Itsubo T, Nakamura K, Kato H, Yasutomi T, Momose T : Current concepts of carpal tunnel syndrome : pathophysiology, treatment, and evaluation. J Orthop Sci 15 : 1-13, 2010 https://doi.org/10.1007/s00776-009-1416-x
  42. von Schroeder HP, Botte MJ : Carpal tunnel syndrome. Hand Clin 12 : 643-655, 1996
  43. Wintman BI, Winters SC, Gelberman RH, Katz JN : Carpal tunnel release. Correlations with preoperative symptomatology. Clin Orthop Relat Res : 135-145, 1996
  44. Yu GZ, Firrell JC, Tsai TM : Pre-operative factors and treatment outcome following carpal tunnel release. J Hand Surg Br 17 : 646-650, 1992 https://doi.org/10.1016/0266-7681(92)90192-5

피인용 문헌

  1. Efficacy of Keyhole Approach to Carpal Tunnel Syndrome under Ambulatory Strategy vol.2017, pp.None, 2014, https://doi.org/10.1155/2017/3549291
  2. Prevalence of Obesity in Carpal Tunnel Syndrome Patients: A Cross-Sectional Survey vol.9, pp.7, 2017, https://doi.org/10.7759/cureus.1519