MOC-PS(SM) CME article: self-assessment and performance in practice: the carpal tunnel.

LEARNING OBJECTIVES: After studying the article, the participant should be able to: 1. Conduct an appropriate history and physical examination for a patient suspected of having carpal tunnel syndrome. 2. Understand the role of provocative and other diagnostic tests pertinent to the diagnosis of carpal tunnel syndrome. 3. Understand the goals of the surgical treatment of carpal tunnel syndrome and how to obtain these. 4. Appreciate the common complications of carpal tunnel surgery and their management. SUMMARY: The purpose of this article is to review important aspects of the history, physical examination, diagnosis, and management of carpal tunnel syndrome. Associated diseases, predisposing factors, and prognostic features are explored. The significance of diagnostic studies and the variety of anesthetic techniques with which to perform the surgery are reviewed. Evidence regarding the different surgical approaches, such as the open versus the endoscopic, is examined. Postoperative care issues such as therapy and splinting are examined. Finally, complications of carpal tunnel surgery and their management are outlined.

Practice profiles in breast reduction: a survey among Canadian plastic surgeons.

BACKGROUND: Breast reduction is an increasingly common procedure performed by Canadian plastic surgeons. Recent studies in the United States show that use of the inferior/central pedicle inverted T scar method is predominant. However, it is unknown what the practice preferences are among Canadian plastic surgeons. OBJECTIVE: The goal of the present study was to assess trends in breast reduction surgery among Canadian surgeons, including patient selection criteria, surgical techniques and outcomes. METHOD: Surveys were distributed to plastic surgeons at the Canadian Society for Plastic Surgery meetings in 2005 and 2006. Completed surveys were obtained from 140 respondents, and results were analyzed with Excel and SAS software. RESULTS: There was a 40% response rate. The majority of surgeons (66%) used more than one technique for breast reduction. Most commonly, surgeons use the inverted T scar technique (66%) followed by vertical scar techniques (26%). The most popular vertical scar techniques included the Hall-Findlay (14%) and Lejour (13%) methods. Most surgeons (55%) reported complication rates of less than 5% and the most common complication reported was wound dehiscence. There was no difference in overall complication rates between inverted T scar and vertical scar surgeries. The majority of surgeons (98%) carried out breast reduction either exclusively as day surgery or in combination with same-day admission. Breast reduction performed as day surgery resulted in cost savings of $873 per patient. CONCLUSIONS: Canadian plastic surgeons are performing more vertical scar breast reductions than American surgeons. However, both groups rely predominantly on inverted T scar techniques.