Clinical Outcomes of Endoscopic Carpal Tunnel Release in Patients 65 and Over

Beck, John D.; Wingert, Nathaniel C.; Rutter, Michael R.; Irgıt, Kaan; Tang, Xiaoqin; Klena, Joel C.

doi:10.1016/j.jhsa.2013.05.016

Cited by 19 publications

(18 citation statements)

References 28 publications

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“…It was suggested that this could be related to cervical radiculopathy and/or myelopathy due to cervical spondylosis among the elderly group, 89.4% of which were shown to have cervical spondylosis in an X-ray [ 23 ]. Of patients aged 65 or older, 79% were satisfied or very satisfied with endoscopic carpal tunnel release [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

Does Aging Matter? The Efficacy of Carpal Tunnel Release in the Elderly

2015

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Open release remains the gold standard in the treatment of carpal tunnel syndrome in cases where conservative treatment fails. However, the efficacy of carpal tunnel release in the elderly has been debated in the literature throughout the years. This review aims to review the current evidence pertaining to the efficacy of carpal tunnel release in the elderly. Based on the current evidence, the outcome of carpal tunnel release is unpredictable in the elderly. Elderly patients are also less satisfied with the operation compared to younger patients. The authors recommend that these messages be conveyed to elderly patients before surgery. Moreover, open carpal tunnel release should be offered in the early stages of treatment whenever operative management is indicated.

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Section: Resultsmentioning

confidence: 99%

Does Aging Matter? The Efficacy of Carpal Tunnel Release in the Elderly

2015

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“…In their study, the mean preoperative symptom severity score of 3.4 and functional capacity score of 3 receded to 1.9 and 2, respectively, in the postoperative period. In another study, the postoperative BCTQ scale scores were found significantly lower (19). In a comparison of the clinical results of carpal tunnel release performed with standard open surgery versus mini open surgery, postoperative 6th and 12th months results of the mini open surgery was significantly better (7).…”

Section: Resultsmentioning

confidence: 88%

“…The efficacy of the surgical treatment of CTS was evaluated with clinical symptoms and findings in some studies (18,19). In some other studies, radiological examinations such as MRI (20) or ultrasonography (21,22) were utilized to support the clinical findings.…”

Section: Resultsmentioning

confidence: 99%

“…The prevalence of scar tissue sensitivity was reported as 10%, pillar pain as 5% and recurrence as 3.6% in the postoperative period (7). Recently, mini open palmar incisions (5,8,24) and endoscopic release procedures (5,19) have been employed to avoid the unfavorable results of the standard open carpal tunnel surgery and a decrease was observed in the postoperative morbidity rates and in the time to return to work (1,7). The time to return to work reported to vary from three to six weeks after standard open carpal tunnel surgery is merely 10 to 21 days following mini open and endoscopic surgery (5,7,14).…”

Section: Resultsmentioning

confidence: 99%

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Carpal Tunnel Release with a Minimally Invasive Surgical Approach at the Proximal of the Distal Wrist Crease: The Evaluation of the Efficacy of the Technique with Clinical and Magnetic Resonance Imaging

Yılmaz¹

2019

btd

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Amaç: Karpal tünel sendromunun cerrahi tedavisi çoğunlukla palmar bölgede standart açık teknik, sınırlı insizyon ve endoskopik işlemler ile yapılmaktadır. Bu prospektif çalışmada, karpal tünel gevşetmesi için distal el bileği kırışıklığı proksimalinde minimal invasiv cerrahi tekniğin etkinliğini klinik ve pre ve postoperatif manyetik resonans görüntüleme (MRG) bulguları ile değerlendirmeyi amaçladık.Yöntemler: Klinik ve elektrofizyolojik çalışmalar ile karpal tünel sendromu tanısı konan 65 hastanın 102 eline, distal el bileği kırışıklığı proksimalinde yapılan mini insizyon ile karpal tünel gevşetmesi uygulandı. Olguların klinik değerlendirilmesi ameliyat öncesi ve ameliyat sonrası 3., 6. ve 12. ayda Boston Karpal Tünel Anketi ile yapıldı. Pre-ve postoperatif MRG değerlendirmesinde median sinir sinyal yoğunluğunda artış, fleksör retinakulumda palmar bowing ve sinirde yassılaşmanın varlığı araştırıldı.Bulgular: Klinik değerlendirmede ameliyat öncesi ve ameliyat sonrası 3. ay değerleri arasında anlamlı fark vardı (p<0.001). Preoperatif MRG'de tesbit edilen bulgular postoperatif MRG'de anlamlı oranda azaldı (p<0.001). Hastalar fizyolojik ihtiyaçlarını postoperatif 2 gün içinde karşıladılar. Hiçbir hastada pillar ağrısı ve skar dokusu hassasiyeti görülmedi. Yeniden ameliyat gerekmedi. Sonuç: Distal el bileği kırışıklığı proksimalinde, mini invasiv yaklaşımla uygulanan karpal tünel gevşetmesi etkin bir yöntemdir. Hastaların fizyolojik aktivitelerini erken başarmaları yaşam konforlarını artırmıştır. Anahtar Kelimeler: Karpal tünel sendomu, dekompresyon, minimal invasiv cerrahi işlemler, el bileği, manyetik rezonans görüntüleme Objective: The surgical treatment of carpal tunnel syndrome is usually performed via standard open technique, limited incision and endoscopic procedures in the palmar region.In this prospective study, we aimed to evaluate the efficacy of minimally invasive surgical technique at the proximal of the distal wrist crease for carpal tunnel release with clinical and pre-and postoperative magnetic resonance imaging (MRI) findings. Methods:Following the diagnosis of carpal tunnel syndrome via clinical and electrophysiological examinations, carpal tunnel release was performed on 102 wrists of 65 patients with a mini-incision at the proximal of the distal wrist crease. Clinical assessment of the patients was made with the Boston Carpal Tunnel Questionnaire before surgery and at the third, sixth and twelfth months after surgery. Preoperative and postoperative third month MRIs were examined for presence of an increase in the signal intensity of the median nerve, palmar bowing of the flexor retinaculum or nerve flattening. Results:There was a clinically significant difference between the preoperative and postoperative third month results (p<0.001). The findings from the preoperative MRIs have significantly declined in the postoperative MRIs (p<0.001). Patients were able to meet their physiological needs by the postoperative second day. None of the patients experienced pillar pain or scar tissue sensitivity. No...

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“…3,4 Research evaluating outcome after carpal tunnel release (CTR) has typically focused on patient age and on chronicity and severity of disease as prognostic indicators for successful CTR. 5 Recent studies after CTR in patients older than 65 years have shown mixed results in self-reported symptom severity and functional status outcomes. [6][7][8] As a result, controversy exists regarding surgical treatment in older persons, especially those with severe, chronic disease.…”

mentioning

confidence: 99%

Improvement in Patient-Specific Outcomes After Carpal Tunnel Release in Patients Older Than 80 Years

Richardson

Lawless

Ranjan

et al. 2016

Annals of Plastic Surgery

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Outcomes after carpal tunnel release (CTR) may be influenced by age, disease chronicity, and disease severity. Multiple studies report mixed results between age and improvement through a validated instrument, the Brigham and Women's Carpal Tunnel Questionnaire (BWQ). However, these investigations did not control for confounders and had small cohorts of younger patients. We hypothesized that patients older than 80 years have statistically significant improvement in symptom severity and functional status after CTR. Patients completed the BWQ preoperatively and postoperatively. The main outcome measurement was difference in average BWQ scores, verified with Wilcoxon signed rank test. A standardized response mean was used to calculate effect size. Covariates were based on potential confounders, such as body mass index, hypothyroidism, American Society of Anesthesiologists (ASA) status, and thenar electromyography findings. The t test or χ test was used for univariate analysis. Logistical regression predicted odds of large versus small improvement in BWQ scores in a multivariate model, which was assessed with receiver operating characteristic and Hosmer-Lemeshow tests. Statistically significant improvement was seen among the 44 patients who completed the BWQ, with symptom severity scores of 2.97 points; functional status scores, 1.52 points; and combined scores, 2.51 points. Age did not predict effect size; however, ASA status had a statistically significant inverse relation, with a decrease in the odds of large improvement by 77%. Age did not predict improvement in BWQ scores in a regression model analysis in 1 of the largest cohorts of patients older than 80 years who underwent CTR. Patients of this age do benefit from CTR. Although age is not associated with the size of this benefit, ASA status is associated, suggestive that other medical comorbidities adversely affect outcomes after CTR in this elderly population.

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Clinical Outcomes of Endoscopic Carpal Tunnel Release in Patients 65 and Over

Cited by 19 publications

References 28 publications

Does Aging Matter? The Efficacy of Carpal Tunnel Release in the Elderly

Does Aging Matter? The Efficacy of Carpal Tunnel Release in the Elderly

Carpal Tunnel Release with a Minimally Invasive Surgical Approach at the Proximal of the Distal Wrist Crease: The Evaluation of the Efficacy of the Technique with Clinical and Magnetic Resonance Imaging

Improvement in Patient-Specific Outcomes After Carpal Tunnel Release in Patients Older Than 80 Years

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