Bilateral carpal tunnel syndrome – A review

Carpal tunnel syndrome (CTS) is the most common upper extremity compressive neuropathy, with a prevalence of 3%–5% in the general population, and 6% in the group of females over the age of 40. It occurs about five times more common in females, with 2 peaks observed, in the 6th and 8th decades of life. Bilateral manifestation is more common than unilateral (60%), but significantly more often begins or is more strongly expressed in the dominant hand. Possible anatomical abnormalities underlying the development of CTS account for about 5% of cases. More and more scientific data confirm the significant role of central nervous system processes (including central sensitization) in the development of carpal tunnel syndrome, and changes in central nervous system body somatotopic representation, resulting from prolonged median nerve pathology, are described in consistence with the brain plasticity concept. This central involvement of bilateral CTS may explain that a proportion of patients following surgery for one hand experience improvement also in the non-operated hand

Recurrence of Dupuytren’s contracture: A consensus-based definition

Purpose: One of the major determinants of Dupyutren disease (DD) treatment efficacy is recurrence of the contracture. Unfortunately, lack of agreement in the literature on what constitutes recurrence makes it nearly impossible to compare the multiple treatments alternatives available today. The aim of this study is to bring an unbiased pool of experts to agree upon what would be considered a recurrence of DD after treatment; and from that consensus establish a much-needed definition for DD recurrence. Methods: To reach an expert consensus on the definition of recurrence we used the Delphi method and invited 43 Dupuytren’s research and treatment experts from 10 countries to participate by answering a series of questionnaire rounds. After each round the answers were analyzed and the experts received a feedback report with another questionnaire round to further hone in of the definition. We defined consensus when at least 70% of the experts agreed on a topic. Results: Twenty-one experts agreed to participate in this study. After four consensus rounds, we agreed that DD recurrence should be defined as “more than 20 degrees of contracture recurrence in any treated joint at one year post-treatment compared to six weeks post-treatment”. In addition, “recurrence should be reported individually for every treated joint” and afterwards measurements should be repeated and reported yearly. Conclusion: This study provides the most comprehensive to date definition of what should be considered recurrence of DD. These standardized criteria should allow us to better evaluate the many treatment alternatives

An analysis of the course of carpal tunnel syndrome before operation

This work reports the results of an analysis into the course of carpal tunnel syndrome before operation in 479 patients, predominantly women, aged a mean of 58 years, who were scheduled for carpal tunnel operation. The patients were asked to characterise in detail the course of the disease and what determined the decision to undergo surgery. Results. We identified two specific patterns of CTS course: progressive and preservative/mild. Patients with short-lasting disease suffer first of all from symptoms, but the longer the duration, the more pronounced the functional impairment. In a proportion of patients with longer-lasting disease, spontaneous resolution may occur, for up to a year or more. Bilateral involvement is more common than unilateral and the interval between involvement of the other hand is a mean of 10 months. For most patients the primary motivation to undergo surgery is troublesome symptoms (pain and paraesthesia). Functional impairment is of secondary importance, however, its prominence increases in older patients and in those with longer-lasting diseas

Outcomes of carpal tunnel surgery in patients with and without medical comorbidities with special attention to quality of life

The objective of this study was to compare the outcomes of carpal tunnel surgery in patients with and without medical comorbidities typical in this age range, with particular attention to evaluation of their quality of life. The outcomes of carpal tunnel release at 6 months after operation in 128 patients, 70 (55%) with and 58 (45%) without comorbidities were compared. The measurements were performed preoperatively and at 6 months after the operation and included pain intensity, grip strength, sensation, hand dexterity with the Levine and quality of life with the RAND SF-36 questionnaires. Results. At baseline, the patients with comorbidities had significantly poorer hand function and reduced perception of light touch. Carpal tunnel release resulted in significant improvement for all patients, although outcomes at 6 months were less favorable for those with comorbidities in terms of quality of life and general health status. This however does not mean that the presence of the comorbidities is prejudicial to the outcome of CTS surgery

A comparison of outcomes of K-wire vs plate fixation for distal radial fractures with regard to patients’ quality of life

The objective of the study was a comparison of outcomes of K-wire vs plate fixation for distal radial fractures with regard to patients’ quality of life. One hundred and two patients, 79 women and 23 men with displaced distal radial fractures, were non-randomly allocated for either K-wire (n=72) or palmar plate (n=30) fixation. In general, simpler fractures were fixed by pins, while plates were used for those that were more severe. No statistically significant differences were seen at 3- and 6-month follow-up assessment in any of the analyzed variables: wrist range of motion, total grip and key-pinch strength, and the DASH and SF-36 scores. We conclude that being guided by the postulated algorithm in treatment-choice of distal radial fractures is a reasonable balance between clinical- and cost-effectiveness. We also failed to find any advantage in health-related quality of life as an outcome measure in distal radial fractures compared to standard measures