Background: Carpal tunnel syndrome (CTS) is one of the most common compressive neuropathies and affects a large amount of individuals. We investigated the direct and indirect cost to society of operative versus nonoperative management of CTS. Methods: A Monte Carlo simulation model was used to estimate the lifetime direct and indirect costs associated with nonoperative and operative treatment of CTS, and its utility to patients. Results: Operative treatment of CTS had a lower total cost and a higher utility when compared with nonoperative treatment. Conclusions: CTS surgery is clearly a cost-effective treatment strategy that should be included in the societal perspective regarding evolving costs and savings associated with health care.

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Background: Ankle injuries and joint degeneration may be related to ankle bone morphology. Little data exist to characterize healthy hindfoot bone morphology. The purpose of this study was to characterize side-to-side symmetry and sex differences in ankle and hindfoot bone morphology, and to identify the primary shape factors that differentiate ankle and hindfoot bone morphology among individuals. Methods: Computed tomography was used to create 3D surface models of the distal tibia, talus, and calcaneus for 40 ankle and hindfoot bones from 20 healthy individuals. Morphologic differences between left and right bones of the same individual and between males and females were determined. Statistical shape modeling was performed to identify primary shape variations among individuals. Results: Side-to-side differences in bone morphology averaged 0.79 mm or less. The average distal tibia in males was larger overall than in females. No significant sex difference was noted in the tali. The average female calcaneus was longer and thinner than the average male calcaneus. Variability in ankle and hindfoot bone morphology is primarily associated with articulating surface shape, overall length and width, and tendon/ligament attachment points. Conclusion: In general, the contralateral ankle can serve as an accurate guide for operative restoration of native ankle morphology; however, specific regions demonstrate higher asymmetry. Clinical Relevance: Knowledge of regions of high and low bilateral symmetry can improve hindfoot and ankle reconstruction. Design of ankle prostheses can be improved by accounting for differences in bone morphology associated with sex and shape differences among individuals.

Category: Ankle, Hindfoot Introduction/Purpose: Restoration of bilateral symmetry is used clinically to evaluate surgical and conservative treatment outcomes. However, the degree of symmetry and differences between sexes in ankle kinematics in healthy individuals remain unknown. Because relative motion between the tibia, talus and calcaneus cannot be accurately measured using conventional skin- mounted motion capture systems, biplane radiography is emerging as the preferred technique to measure in vivo ankle kinematics during functional activities. Therefore, the aims of the present study were to use biplane radiography to determine the degree of bilateral symmetry in ankle kinematics in healthy individuals and to identify sex-dependent differences in kinematics during the support phase of gait. It was hypothesized that rotational ankle range of motion (ROM) during gait is not different between males and females. Methods: Twenty healthy individuals (10 male, 10 female, age 30.7 ± 6.3years) with no history of ankle injury provided consent to participate in this IRB-approved study. Each participant walked through a biplane radiography system 6 times at a self-selected pace (1.3±0.2 m/s). Synchronized radiographs of the ankle were collected at 100 images/second for 3 trials of each ankle (90 kV, 125 mA, 1 ms exposure/image). Motion of the tibia, talus and calcaneus was tracked using a validated model-based tracking process that matches 3D bone models to the radiographs. Anatomic coordinate systems were created and used to calculate ankle kinematics. All kinematics were converted to percent stance phase and averaged over all trials for each ankle. Bilateral symmetry was determined by calculating the average absolute difference between right and left ankle joint kinematics over the full support phase of gait. Differences between male and female rotational ROM were identified using unpaired t-tests. Results: The average absolute side-to-side difference in tibio-talar joint rotations was 3.3° or less, while the average absolute side-to-side difference in subtalar joint rotations was 3.0° or less (Table 1A). For males and females, at the tibio-talar joint, the largest ROM was plantar-dorsiflexion, followed by internal/external rotation and then inversion/eversion (Table 1B). At the subalar joint, the largest ROM was inversion/eversion, with similar amounts of dorsiflexion/plantarflexion and internal/external rotation, on the order of 2° to 3°. Males demonstrated significantly less ROM in subtalar dorsiflexion/plantarflexion and tibio-talar internal/external rotation (Table 1B). Conclusion: The average side-to-side differences in healthy ankle ROM during gait are small, suggesting that the contralateral ankle may serve as a reference standard to assess kinematic outcomes after conservative or surgical treatments. The difference between male and female subtalar ROM (0.6°) may be too small to be functionally significant, however, sex differences in tibio- talar ROM appear large enough to merit consideration when assessing functional outcomes and designing ankle joint replacements. The results are limited to over-ground gait performed by relatively young and healthy adults and may not be applicable to other activities or older adults.