Rehabilitation of carpal tunnel surgery patients using a short surgical incision and an early program of physical therapy

Nathan, Peter A.; Meadows, Kenneth D.; Keniston, Richard C.

doi:10.1016/0363-5023(93)90401-n

Cited by 112 publications

(70 citation statements)

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“…On the other hand, some authors recommend precocious mobilization of wrist and fingers after the surg e ry in order to enable the free longitudinal nerve movement in the surgical bed, what should avoid possible adhere n c e s from neighboring structures 16 . lowing open carpal tunnel release had not been previously studied using a validated outcome questionnaire.…”

Section: Discussionmentioning

confidence: 99%

Wrist immobilization after carpal tunnel release: a prospective study

Martins

Siqueira

Simplício

2006

Arq. Neuro-Psiquiatr.

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-This prospective study evaluates the possible advantages of wrist imobilization after open carpal tunnel release comparing the results of two weeks immobilization and no immobilization. Fifty two patients with idiopathic carpal tunnel syndrome were randomly selected in two groups after open carpal tunnel release. In one group (A, n=26) the patients wore a neutral-position wrist splint continuosly for two weeks. In the other group (B, n=26) no wrist immobilization was used. Clinical assessment was done preoperatively and at 2 weeks follow-up and included the two-point discrimination test at the second finger and two questionnaires as an outcome measurement of symptoms severity and intensity. All the patients p resented improvement in the postoperative evaluations in the three analyzed parameters. There was no significant difference between the two groups for any of the outcome measurements at the final followup. We conclude that wrist immobilization in the immediate post-operative period have no advantages when compared with no immobilization in the end result of carpal tunnel release.KEY WORDS: carpal tunnel syndrome, surgical decompression, wrist imobilization.Avaliação prospectiva da imobilização do pulso após descompressão cirúrgica do nervo mediano no túnel do carpo RESUMO -Neste estudo prospectivo avaliamos se há vantagens na imobilização pós-operatória do pulso após a ciru rgia para o tratamento da síndrome do túnel do carpo comparando este tratamento com a ausência de imobilização. Cinqüenta e dois pacientes portadores de síndrome do túnel do carpo idiopáti-ca foram randomizados em dois grupos após a ciru rgia. Em um grupo (grupo A, n=26) os pacientes utilizaram uma tala em posição neutra para imobilização do pulso por duas semanas. No outro grupo (B, n=26), nenhum tipo de imobilização foi adotada. A avaliação foi realizada antes da ciru rgia e re p e t i d a após duas semanas e incluiu a mensuração da sensibilidade discriminatória no segundo dedo e dois questionários que avaliaram a gravidade e intensidade dos sintomas. Em todos os pacientes houve melhora nos p a r â m e t ros avaliados. Não houve diferença estatisticamente significativa entre os dois grupos considerando os parâmetros avaliados. Concluímos que a imobilização do pulso no período pós-operatório imediato não apresenta vantagens quando comparada com a ausência de imobilização após a descompressão cirúr-gica do nervo mediano no punho. PALAVRAS-CHAVE: síndrome do túnel do carpo, descompressão cirúrgica, imobilização, pulso.Carpal tunnel syndrome (CTS) is the most comm o n peripheral entrapment mononeuropathy and is manifested by characteristic signs and symptoms re s u l ting from median nerve compression at the wrist and/ or palm 1 . Diagnosis is essentially clinical and often p atient history alone is indicative of CTS. The electrop h ysiologic studies confirm the diagnosis. The tre a t m e n t can be conservative, with cort i c o s t e roid infiltration, use of symptomatic drugs and/or wrist splinting 2 .The surgical treatment is ...

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Section: Discussionmentioning

confidence: 99%

Wrist immobilization after carpal tunnel release: a prospective study

Martins

Siqueira

Simplício

2006

Arq. Neuro-Psiquiatr.

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“…When a comparison was made by type of insurance reimbursement, patients who received WC required longer to recuperate and were more likely to require therapy than those who did not (7,9,10,(12)(13)(14)(15)(16)(17). Ninety-seven per cent of our short incision OHIP patients (171 of 177 hands) resumed ADL within 28 days.…”

Section: Resultsmentioning

confidence: 93%

“…Other studies reported a range of 33% to 63% within 28 days (7,8,14), a mean of 29.2 to 57.6 days (7,9,10,14,15) or a median of 57 to 71 days (12,14). The above studies were conducted in the United States, where many authors suspect that secondary gain is a factor in the recovery of WC patients (12,13,16,17). In Ontario, the Workers' Compensation Act (18) obligates employers to reinstate injured workers in their previous job or a suitable alternative, whenever possible.…”

Section: Resultsmentioning

confidence: 97%

“…Hallock and Lutz (9) obtained a mean return to function time of 46.3 days for the total group -22.6 days for non-WC cases and 59.5 days for WC cases. Nathan et al (13) reported better results using a program of early aggressive physical therapy. They described a median of 12 days to return to function for the total group -10 for non-WC cases and 18 for WC cases.…”

Section: Resultsmentioning

confidence: 99%

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Open carpal tunnel release: Comparison of a long versus short incision

Kruger¹,

Rebot²

1998

CAN J PLAST SURG

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A review of our patients who had been treated with open carpal tunnel release (OCTR) undertaken in 1991 revealed that 78% had an uneventful course of recovery, resuming full function within two to four weeks, and that 25% required out-patient rehabilitation due to the persistence and magnitude of their symptoms three to four weeks postoperatively. Resumption of activities of daily living (ADL) was delayed by weakness, peri-incisional tenderness, restricted range of movement and swelling.In an effort to decrease postoperative morbidity and shorten recovery time, our surgical protocol was re-examined. Decreased postoperative discomfort and shorter recovery A total of 225 adults with carpal tunnel release of 313 wrists were studied to compare the outcome of a long (at least 3.5 cm) with that of a short (2.0 cm or less) incision technique. The two groups were compared for postoperative complaints, length of time until full function was regained, rate of referral to rehabilitation and the effect of Workers' Compensation status. The surgical technique and rehabilitation protocol are described. The number and severity of postoperative complaints were significantly reduced in the short incision group. In the non-Workers' Compensation group, 96% of short incision patients resumed full function within 28 days. This finding compares favourably with published results for endoscopic release, and is superior to results obtained with the long incision. Workers' Compensation patients required longer to recuperate, with 78% regaining full function within 28 days. Of those with Workers' Compensation, 47% of the long incision group and 27% of the short incision group required out-patient therapy. For the non-Workers' Compensation group, this percentage decreased to 21% of those with the long incision and 3% with the short incision. A history of vocational or avocational repetitive motion patterns was the most common indicator for therapy and accounted for 67% of rehabilitation referrals. Key Words: Adult, Carpal tunnel release, Median nerve, Occupational therapy, Physical therapy, Treatment outcomeDégagement ouvert du canal carpien : comparaison d'une incision longue versus courte RÉSUMÉ : En tout, 225 adultes ayant subi un dégagement du canal carpien, totalisant 313 poignets, ont été étudiés afin de comparer les résultats d'une technique d'incision longue (au moins 3,5 cm) versus courte (2,0 cm ou moins). Les deux groupes ont été comparés au chapitre des plaintes postopératoires, du temps de retour à un fonctionnement normal, du taux de demandes auprès des programmes de réadaptation et de l'effet sur la compensation par la CSST. La technique chirurgicale et le protocole de réadaptation sont décrits. Le nombre et la gravité des problèmes postopératoires ont été significativement moindres dans le groupe ayant subi l'incision courte. Pour le groupe non inscrit à la CSST, 96 % des patients ayant subi une incision courte ont retrouvé un fonctionnement normal en 28 jours. Ces résultats se comparent favorablement aux résultats publiés a...

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“…In general, there is one operation performed for the treatment of carpal tunnel syndrome, which is release of the transverse carpal ligament. Much of the controversy of the operative procedure for carpal tunnel syndrome is the method by which to release the ligament but most surgeons would agree that successful management of patients with carpal tunnel syndrome depends on complete release of the flexor retinaculum [1,3,6,17,22]. In contrast for cubital tunnel syndrome, there are numerous operative procedures that have been described for the treatment of cubital tunnel syndrome ranging from simple decompression, medial epicondylectomy to transposition of the ulnar nerve [2,4,7,9,12,13,14,15,16,19,21,23,24,25,26,27,29,30,31].…”

Section: Discussionmentioning

confidence: 99%

Selection of Operative Procedures for Cubital Tunnel Syndrome

Novak

Mackinnon²

2008

Hand (New York, N,Y.)

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The purpose of this study was to investigate the primary operative procedures that are performed by hand surgeons for cubital tunnel syndrome and their reported satisfaction with these procedures. The survey consisted of 22 questions regarding primary operative treatment of cubital tunnel syndrome and demographics and was sent by email to the 459 active members of the American Association for Hand Surgery. One hundred sixty-four surgeons completed the survey (36% response rate). The total sample included 154 hand surgeons (143 males, 11 females) who operated on cubital tunnel syndrome and the majority of surgeons were in private practice (n=100) followed by academic practice (n=50). The most prevalent factors that influence the decision to operate include evidence of muscle atrophy (84%), abnormal nerve conduction studies (51%), and failed non-operative treatment (49%). Most surgeons (n=133) reported using more than one operative procedure for their patients with cubital tunnel syndrome. Factors that influenced the operative procedure selected included the degree of nerve compression (60%), medical comorbidities (30%), patient's occupation (28%), and obesity (22%). Following carpal tunnel surgery, 88% of the surgeons were "very satisfied" with their patient outcome and following surgery for cubital tunnel syndrome, only 44% were "very satisfied" with their patient outcome. Most surgeons use more than one operative procedure in their treatment of patients with cubital tunnel syndrome and the selection of the operative procedure is influenced by patient factors and surgeon preference.

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Rehabilitation of carpal tunnel surgery patients using a short surgical incision and an early program of physical therapy

Cited by 112 publications

References 5 publications

Wrist immobilization after carpal tunnel release: a prospective study

Wrist immobilization after carpal tunnel release: a prospective study

Open carpal tunnel release: Comparison of a long versus short incision

Selection of Operative Procedures for Cubital Tunnel Syndrome

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