Changing Concepts for the Diagnosis of Carpal Tunnel Syndrome in Powerlifting Athletes with Disabilities.

Objective To examine the prevalence of carpal tunnel syndrome in powerlifting athletes with disabilities. Methods The present study evaluated the presence and intensity of pain (numerical scale), nocturnal paresthesia (self-report), and nerve compression (Tinel and Phalen signs) in wheelchair- and non-wheelchair-bound powerlifting athletes with disabilities. The clinical diagnosis of carpal tunnel syndrome was confirmed by the presence of two or more signs/symptoms. Results In total, 29 powerlifting athletes with disabilities were evaluated. None of the athletes reported the presence of pain or nocturnal paresthesia. The Tinel sign was present in 1 (3.45%) wheelchair-bound athlete. A positive Phalen test was present in 3 (10.35%) athletes (1 wheelchair-bound and 2 non-wheelchair-bound). Concurrent positive Tinel sign and Phalen sign tests were found in 2 (6.89%) athletes (1 wheelchair-bound and 1 non-wheelchair-bound). Conclusion Carpal tunnel syndrome was clinically diagnosed in 2 (6.89%) out of 29 powerlifting athletes with disabilities.

Changing Concepts for the Diagnosis of Carpal Tunnel Syndrome in Powerlifting Athletes with Disabilities / Mudando os conceitos para o diagnóstico da Síndrome do Túnel do Carpo em atletas do halterofilismo do esporte adaptado

Abstract Objective To examine the prevalence of carpal tunnel syndrome in powerlifting athletes with disabilities. Methods The present study evaluated the presence and intensity of pain (numerical scale), nocturnal paresthesia (self-report), and nerve compression (Tinel and Phalen signs) in wheelchair- and non-wheelchair-bound powerlifting athletes with disabilities. The clinical diagnosis of carpal tunnel syndrome was confirmed by the presence of two or more signs/symptoms. Results In total, 29 powerlifting athletes with disabilities were evaluated. None of the athletes reported the presence of pain or nocturnal paresthesia. The Tinel sign was present in 1 (3.45%) wheelchair-bound athlete. A positive Phalen test was present in 3 (10.35%) athletes (1 wheelchair-bound and 2 non-wheelchair-bound). Concurrent positive Tinel sign and Phalen sign tests were found in 2 (6.89%) athletes (1 wheelchair-bound and 1 non-wheelchair-bound). Conclusion Carpal tunnel syndrome was clinically diagnosed in 2 (6.89%) out of 29 powerlifting athletes with disabilities.

Resumo Objetivo Examinar a prevalência da síndrome do túnel do carpo em atletas do halterofilismo do esporte adaptado. Métodos Este estudo avaliou a presença e a intensidade da dor (escala numérica), a parestesia noturna (autorrelato), e a compressão nervosa (sinais de Tinel e de Phalen) em atletas do halterofilismo do esporte adaptado em cadeira de rodas e sem cadeira de rodas. O diagnóstico clínico da síndrome do túnel do carpo foi confirmado pela presença de dois ou mais sinais/sintomas. Resultados Vinte e nove atletas de halterofilismo de esporte adaptado foram avaliados. Nenhum dos atletas relatou a presença de dor ou parestesia noturna. O sinal de Tinel estava presente em 1 (3,45%) atleta de cadeira de rodas. O teste de Phalen positivo estava presente em 3 (10,35%) atletas (1 em cadeira de rodas e 2 sem cadeira de rodas). Testes positivos de sinais de Tinel e de Phalen foram encontrados concomitantemente em 2 (6,89%) atletas (1 em cadeira de rodas e 1 sem cadeira de rodas). Conclusão A síndrome do túnel do carpo foi diagnosticada clinicamente em 2 (6,89%) dos 29 atletas com deficiência física.

Prevalence of Absence of Function of the Flexor Digitorum Superficialis Muscle Tendons in the Fourth and Fifth Fingers of the Hand in the Brazilian Population.

Objectives To evaluate the prevalence of absence of flexor digitorum superficialis muscle tendons function of the fourth and fifth fingers of the hand in the Brazilian population Methods Prospective study performed at the orthopedics and traumatology department of a university hospital. The study was conducted from October 2017 to April 2018. The sample consisted of volunteers with no history of upper limb trauma, surgery or any other condition. This study included both male and female individuals over 18 years old. The flexor digitorum superficialis muscle tendons of the fourth and fifth fingers were evaluated through clinical tests by three independent examiners. The data were analyzed using GraphPad Prism 5.0 (GraphPad Software, San Diego, CA, USA). Results A total of 2,016 hands from 1,008 volunteers were analyzed. The prevalence of absence of flexor digitorum superficialis muscle tendon function of the fourth finger was 0.56% at the right hand and 0.99% at the left hand. At the right hand, this prevalence was higher in females compared to males ( p = 0.0328). No difference between genders was noted in the left hand ( p = 0.7562). The prevalence of absence of flexor digitorum superficialis muscle tendon function of the fifth finger was 34.53% in the right hand and 30.06% in the left hand. This prevalence was higher in females compared to males, both at the right hand ( p = 0.0001) and the left hand ( p = 0.0003). Conclusion Even though there are studies performed separately in different ethnic groups, there were no data in the literature regarding the prevalence of absence of flexor digitorum superficialis muscle tendons function of the fourth and fifth fingers of the hand in a multiethnic population such as the Brazilian one.

Prevalence of Absence of Function of the Flexor Digitorum Superficialis Muscle Tendons in the Fourth and Fifth Fingers of the Hand in the Brazilian Population / Prevalência de ausência de função dos tendões do músculo flexor superficial do quarto e quinto dedos da mão na população brasileira

Abstract Objectives To evaluate the prevalence of absence of flexor digitorum superficialis muscle tendons function of the fourth and fifth fingers of the hand in the Brazilian population Methods Prospective study performed at the orthopedics and traumatology department of a university hospital. The study was conducted from October 2017 to April 2018. The sample consisted of volunteers with no history of upper limb trauma, surgery or any other condition. This study included both male and female individuals over 18 years old. The flexor digitorum superficialis muscle tendons of the fourth and fifth fingers were evaluated through clinical tests by three independent examiners. The data were analyzed using GraphPad Prism 5.0 (GraphPad Software, San Diego, CA, USA). Results A total of 2,016 hands from 1,008 volunteers were analyzed. The prevalence of absence of flexor digitorum superficialis muscle tendon function of the fourth finger was 0.56% at the right hand and 0.99% at the left hand. At the right hand, this prevalence was higher in females compared to males (p= 0.0328). No difference between genders was noted in the left hand (p= 0.7562). The prevalence of absence of flexor digitorum superficialis muscle tendon function of the fifth finger was 34.53% in the right hand and 30.06% in the left hand. This prevalence was higher in females compared to males, both at the right hand (p= 0.0001) and the left hand (p= 0.0003). Conclusion Even though there are studies performed separately in different ethnic groups, there were no data in the literature regarding the prevalence of absence of flexor digitorum superficialis muscle tendons function of the fourth and fifth fingers of the hand in a multiethnic population such as the Brazilian one.

Resumo Objetivos Avaliar a prevalência da ausência de função dos tendões do músculo flexor superficial do quarto e quinto dedos em uma população brasileira. Métodos Estudo prospectivo foi realizado no departamento de ortopedia e traumatologia de um hospital universitário. O estudo foi desenvolvido no período de outubro de 2017 a abril 2018. A amostra foi formada por voluntários sem histórico de trauma, cirurgia ou qualquer afecção dos membros superiores. Foram incluídos neste estudo indivíduos de ambos os gêneros com idade igual ou superior a 18 anos. A avaliação da função do tendão do múculo flexor superficial do quarto e quinto dedos foi realizada por meio de testes clínicos por três examinadores independentes. Para análise dos dados foi utilizado o programa GraphPad Prism 5.0 (GraphPad Software, San Diego, CA, EUA). Resultados Foram analisados 1.008 voluntários totalizando 2.016 mãos. A prevalência da ausência de função do tendão do músculo flexor superficial do quarto dedo foi de 0,56% na mão direita e 0,99% na mão esquerda. Em relação ao gênero, foi verificado na mão direita uma maior prevalência da ausência de função do flexor superficial do quarto dedo no gênero feminino quando comparado ao masculino (p= 0,0328). Na mão esquerda não foi observada diferença entre os gêneros (p= 0,7562). A ausência de função do músculo flexor superficial no quinto dedo foi de 34,53% na mão direita e de 30,06% na mão esquerda. Quando analisamos o quinto dedo em relação aos gêneros, foi verificado que a prevalência da ausência de função do músculo flexor superficial foi mais frequente no gênero feminino que no masculino, tanto na mão direita (p= 0.0001) como na mão esquerda (p= 0.0003). Conclusão Apesar de haver estudos realizados separadamente em diversas etnias, não havia na literatura dados referentes à prevalência da ausência de função do músculo flexor superficial do quarto e quinto dedos da mão em uma população miscigenada como a brasileira.

Minimal important difference after hand surgery: a prospective assessment for DASH, MHQ, and SF-12.

INTRODUCTION: Minimal important difference (MID) score is an important measure for surgical clinical research and impacts on treatment decisions. Our approach considered patient satisfaction as the relevant anchor criteria. The aims of this study were: determine after surgery MID for three relevant questionnaires: Disabilities of the Arm, Shoulder and Hand (DASH), Michigan Hand Questionnaire (MHQ), and Short Form 12 (SF-12); and assess the correlation between these scores and patient reported satisfaction. METHODS: Adult patients where surgery was indicated for any hand/wrist conditions. Study was conducted in a teaching hospital, São Paulo, Brazil. Participants responded to DASH, SF-12, MHQ, and a Likert satisfaction scale before and three months after a procedure. Satisfaction was considered as the anchor for determining MID after a procedure. The correlation between satisfaction and the instruments were measured. Two statistical approaches were utilized for determining MIDs and were used for consistency and generalizability purposes. For MID determination, receiver operating curves were utilized and MID cut-offs were followed by sensitivity and specificity measures. RESULTS: Fifty patients were included with no follow-up losses. MID for DASH was 18.8 and 15.4. MID for MHQ was 14.7 for both approaches. Data from SF-12 was not reliable after statistical analyses and demonstrated poor correlation with patient satisfaction. MID for DASH and MHQ were found and demonstrated larger standards than literature-reported patients when surgery was not the main intervention. DASH and MHQ had moderate correlation with patient reported satisfaction. SF-12 MID was not reliable and had poor correlation to patient satisfaction. These data suggests that ambulatory hand surgery patients may have greater expectations regarding improvement than other patients.

Translation and Cross-Cultural Adaptation of the 6-Item Carpal Tunnel Syndrome Symptoms Scale and Palmar Pain Scale Questionnaire Into Brazilian Portuguese.

BACKGROUND: There are several medical questionnaires to evaluate the quality of life of carpal tunnel syndrome patients. However, most measures are only available in English. We chose to translate and culturally adapt to Portuguese the Six-Item Carpal Tunnel Syndrome Symptoms Scale and Palmar Pain Scale (CTS-6) questionnaire because it provides objective assessment using a small number of questions. METHODS: The translation and cultural adaptation were carried out according to the medical literature and consisted of five steps: (1) initial translation by two translators fluent in both languages, (2) association of initial translations, (3) back translation to Portuguese by two native speakers of English, (4) association of back translation and (5) comparison with the original version. RESULTS: The Portuguese version was administered to patients with carpal tunnel syndrome and difficulties were noted concerning the comprehension and completion of the translated questionnaire. Patients had difficulty in understanding the horizontal layout of the response choices. Without altering the content, we changed the response choices to a vertical layout and re-administered the questionnaire to a new sample of patients followed up in the same ambulatory care service. We noted a substantial improvement in comprehension and completion of the questionnaire after the modifications. CONCLUSIONS: Availability of a Portuguese version of the Six-Item Carpal Tunnel Syndrome Symptoms Scale and Palmar Pain Scale (CTS-6) questionnaire will allow an objective evaluation of the treatment of a syndrome that is very prominent in medical practice.

GLYCOSAMINOGLYCANS AND PROTEOGLYCANS IN PALMAR FASCIA OF PATIENTS WITH DUPUYTREN.

OBJECTIVE: : To evaluate and compare the behavior of glycosaminoglycans (GAGs) in Dupuytren disease (DD). METHODS: : This is an experimental study with 23 patients diagnosed with DD. Tissue collected through fasciectomy with incision type Brunner or McCash were evaluated by electrophoresis for identification of GAGs. The quantification was carried out by immunofluorescence and dosage of proteins for different types of glycosaminoglycans. The results were expressed in percentage and statistically evaluated. RESULTS: : A significant increase was observed through eletrophoresis in GAGs, as compared to the control (p<0.05). Immunofluorescence of hyaluronic acid was reduced (23 times) when compared to the control (p<0.0001). CONCLUSION: : An increase of sulfated GAGs in Dupuytren's disease, mainly dermatan sulfate, was evident from our results, as well as a pronounced decrease of hyaluronic acid in the palmar aponeurosis from the same patients. Level of Evidence III, Case-Control Study.

Corticoid injection as a predictive factor of results of carpal tunnel release.

OBJECTIVE: To evaluate whether the symptoms relief after local corticoid injection correlate with better results of surgical treatment in carpal tunnel syndrome. METHODS: Between February 2011 and June 2013, 100 wrists of 88 patients were included in the study. All patients were subjected to corticoid injections in the carpal tunnel and evaluated before and after infiltration and surgery. The following parameters were evaluated: visual analog scale (VAS) for pain, Boston questionnaire, sensitivity and strength. RESULTS: Only 28 out of 100 wrists subjected to injection were symptom-free after six months follow up. Sixty out of the 72 patients who did not present relief or relapse symptoms were treated surgically. Surgical results were better regarding VAS, Boston questionnaire and sensitivity in a specific group of patients, which had a longer relief of symptoms after the corticoid injection, with statistical significance. CONCLUSION: Longer relief of symptoms after corticoid injection correlated with better results of surgical treatment.

Peripheral nerve regeneration with conduits: use of vein tubes.

Treatment of peripheral nerve injuries remains a challenge to modern medicine due to the complexity of the neurobiological nerve regenerating process. There is a greater challenge when the transected nerve ends are not amenable to primary end-to-end tensionless neurorraphy. When facing a segmental nerve defect, great effort has been made to develop an alternative to the autologous nerve graft in order to circumvent morbidity at donor site, such as neuroma formation, scarring and permanent loss of function. Tubolization techniques have been developed to bridge nerve gaps and have been extensively studied in numerous experimental and clinical trials. The use of a conduit intends to act as a vehicle for moderation and modulation of the cellular and molecular ambience for nerve regeneration. Among several conduits, vein tubes were validated for clinical application with improving outcomes over the years. This article aims to address the investigation and treatment of segmental nerve injury and draw the current panorama on the use of vein tubes as an autogenous nerve conduit.

Does dorsal capsule interposition improve the results of proximal row carpectomy in Kienböck's disease? One year randomized trial.

INTRODUCTION: Proximal row carpectomy (PRC) is an option as a salvage procedure in late stage Kienböck's disease. In this study, we hypothesize that interposition of a dorsal capsular flap following PRC improves functional outcomes. No comparative study is available to assess whether interposition is effective from the functional perspective. This study aims to determine whether the addition of this procedure may improve functional outcomes at a one year assessment. METHODS: Thirty adult patients with IIIA and IIIB Lichtman stages, aged 18-54 years, were randomized into two study groups. Fourteen patients were allocated to the "no interposition group" and 16 to the "interposition" group. DASH questionnaire was used to evaluate quality of life. Cooney's system was used to assess pain, functional state, range of motion, and grip strength. Complications were also assessed. Final followup and clinical assessment occurred after 12 months. RESULTS: After 12 months and no patient losses, outcomes were similar in both groups. DASH scores (41.9 (7.5) vs. 42.9 (12.8), p = 0.79)), Cooney's system (poor results, 0.6 vs. 0.14, p = 0.54), and complications were similar between groups. In conclusion, the inclusion of a dorsal capsular flap does not improve functional outcomes in PRC. Low rates of complications were found in both groups.

Quantification of platelets obtained by different centrifugation protocols in SHR rats.

OBJECTIVE: To quantify the platelet concentration in the blood of SHR rats, by means of different centrifugation protocols, and to evaluate what the most effective method for obtaining platelets is. METHODS: We used 40 male rats of the isogenic SHR lineage. The animals were divided into three groups: control, using whole blood without centrifugation; single centrifugation, using whole blood subjected to a single centrifugation at 200 × g and 400 × g; and double centrifugation, using whole blood subjected one centrifugation at different rotations, followed by collection of whole plasma subjected to another centrifugation at different rotations: 200 × g + 200 × g; 200 × g + 400 × g; 200 × g + 800 × g; 400 × g + 400 × g; 400 × g + 800 × g. Samples of 3 ml of blood were drawn from each animal by means of cardiac puncture. The blood was stored in Vacutainer collection tubes containing 3.2% sodium citrate. The blood from the control group animals was analyzed without being subjected to centrifugation. After the blood from the other groups of animals had been subjected to centrifugation, the whole plasma was collected and subjected to platelet counting in the lower third of the sample. RESULTS: We obtained greatest platelet enrichment in the subgroup with two centrifugations comprising 400 × g for 10 min + 400 × g for 10 min, in which the mean platelet concentration was 11.30 times higher than that of the control group. CONCLUSION: It was possible to obtain a high platelet concentration using viable simple techniques, by means of centrifugation of whole blood and use of commonly used materials. The most effective method for obtaining platelet concentrate was found in samples subjected to two centrifugations.

OBJETIVO: Quantificar a concentração de plaquetas do sangue de ratos SHR, por meio de diferentes protocolos de centrifugação, e avaliar qual o método mais eficaz de obtenção de plaquetas. MÉTODOS: Usamos 40 ratos machos da linhagem isogênica SHR. Os animais foram divididos em três grupos: Controle (GCT) - sangue total sem centrifugação; Única Centrifugação (GUC) - sangue total submetido a uma única centrifugação: 200 g e 400 g; Dupla Centrifugação (GDC) - sangue total submetido a uma centrifugação, seguido de coleta do plasma total, e realizado uma centrifugação, em diferentes rotações: 200 g + 200 g; 200 g + 400 g; 200 g + 800 g; 400 g + 400 g; 400 g + 800 g. Foram retirados 3 ml de sangue de cada animal por meio de punção cardíaca. O sangue foi acondicionado em tubo de coleta vacutainer com citrato de sódio 3,2%. O sangue dos animais do grupo controle não foi submetido à centrifugação e foi analisado. Após a centrifugação do sangue dos animais, submetido à centrifugação, o plasma total foi coletado e submetido à contagem de plaquetas no terço inferior da amostra. RESULTADOS: Obtivemos maior enriquecimento de plaquetas no subgrupo de duas centrifugações (400 g por 10 minutos + 400 g por 10 minutos), no qual ocorreu uma concentração média de plaquetas 11,30 vezes superior em relação ao grupo controle. CONCLUSÃO: Foi possível obter uma alta concentração plaquetária, com técnica simples e viável, por meio de centrifugação do sangue total e uso de materiais de uso corriqueiro; e método mais eficaz de obtenção de concentrado de plaquetas ocorreu nas amostras submetidas a duas centrifugações.

A systematic review of complications and recurrence rate of arthroscopic resection of volar wrist ganglion.

UNLABELLED: The purpose of this systematic review is to determine the incidence of complications and the recurrence rate of a volar wrist ganglion following arthroscopic resection. We performed a systematic review of English and non-English articles using Google Scholar, Medline, and Web of Knowledge. Articles were screened for study inclusion by three independent reviewers using the terms "arthroscopic treatment of volar wrist ganglion" and "arthroscopic resection of volar wrist ganglion". INCLUSION CRITERIA: (1) level I-V evidence, (2) documentation of the number of wrists subjected to surgery, (3) documentation of surgical techniques used on wrists, and (4) documentation of surgical or post-surgical complications and recurrence rate of a volar wrist ganglion after arthroscopic resection. A complication was defined as an adverse outcome that was directly related to the operative procedure. Between 2001 and 2012, 13 articles met the inclusion criteria. Two articles were excluded and 11 were reviewed. A total of 232 wrists underwent arthroscopic surgery with 14 recurrences. The recurrence rate ranged from 0 to 20%, with mean of 6.03%. There were 16 (6.89%) complications. There was no connection with the ganglion in six wrists, three haematomas, three cases of neuropraxia of the dorsal radial nerve, two partial lesions of the median nerve, and two lesions of a branch of the radial artery. Patients did not have a decrease in the arc range of motion. Treatment of volar ganglia of the midcarpal joint was technically difficult and associated with a higher number of complications. In general, arthroscopic resection results in fewer complications and lower recurrence rates than an open surgical approach, but there is no clear evidence of such an advantage for arthroscopic resection of a volar wrist ganglion. Additional prospective, controlled clinical trials will be essential to address this important issue.

Translation and cultural adaptation of the Brief Michigan Hand Questionnaire to Brazilian Portuguese language.

PURPOSE: The use of patient-reported outcome questionnaires is recommended in orthopedic studies. However, validated tools are necessary to ensure the comparability of results across different studies, centers, and countries. The Brief Michigan Hand Questionnaire (BMHQ) can be used for outcome measures in self-evaluation after carpal tunnel release. This study aimed to translate the BMHQ to Portuguese to permit cross-cultural adaptation to Brazilians patients. METHODS: We translated the Brief Michigan Hand Questionnaire from the original version (English) to Brazilian Portuguese. The translation and cultural adaptation of the content of this tool consisted of six stages, according to the methodology proposed by medical literature: (1) initial translation of the questionnaire by two independent translators; (2) synthesis of translations and reconciliation; (3) back-translation to English of the reconciled version; (4) verification of the cultural equivalence process by an expert committee; (5) pre-testing in a sample of patients to verify understanding of the items; and (6) development of a final version of the BMHQ. RESULTS: The pre-final version of the tool was applied to 43 patients to verify its understanding. Pre-testing showed that the questions and options were satisfactorily understood. The number of items from the original English version was maintained in the Brazilian Portuguese version of BMHQ. DISCUSSION: The Brazilian Portuguese version of the BMHQ is easily understood by patients and will be useful to clinicians and researchers.

Evaluation of patients with carpal tunnel syndrome treated by endoscopic technique.

OBJECTIVE: To evaluate the postoperative results of patients with carpal tunnel syndrome by the endoscopic release technique with single portal. METHODS: 78 patients (80 wrists) were evaluated preoperatively and postoperatively at 1, 3 and 6 months by the Boston questionnaire, the visual analogue scale (VAS) for pain, monofilament test sensitivity, grip strength, lateral pinch, pulp to pulp pinch and tripod pinch. RESULTS: Statistical analysis was significant (p <0.05) in the progressive decline of pain and improved function (Boston) during follow-up. The sensitivity significantly improved comparing the data pre and postoperatively. The grip strength, lateral pinch, pulp to pulp pinch and tripod pinch decreased in the first month after surgery, returning to preoperative values around the third month postoperatively. CONCLUSION: The technique proved to be safe and effective in improving pain, function, and return sensitivity and strength. Level of Evidence II, Prospective study.

Percutaneous release of trigger fingers.

Open surgery has been indicated as the surgical treatment for trigger finger for many years; however, minimally invasive techniques are replacing conventional methods. Minimally invasive techniques enable early recovery of the patient with minimal damage to soft tissues. The authors' study showed that levels of effectiveness of open surgical and percutaneous methods were superior to those of the conservative method using corticosteroid based on the cure and reappearance rates of the trigger. Percutaneous pulley release for treating trigger finger is a safe, effective, and minimally invasive surgical alternative.

The IDEAL classification system: a new method for classifying fractures of the distal extremity of the radius - description and reproducibility.

CONTEXT AND OBJECTIVE There is no consensus concerning which classification for distal radius fractures is best and the existing methods present poor reproducibility. This study aimed to describe and assess the reproducibility of the new IDEAL classification, and to compare it with widely used systems. DESIGN AND SETTING Reproducibility study, Hand Surgery Section, Universidade Federal de São Paulo. METHODS The IDEAL classification and its evidence-based rationale are presented. Sixty radiographs (posteroanterior and lateral) from patients with distal radius fractures were classified by six examiners: a hand surgery specialist, a hand surgery resident, an orthopedic generalist, an orthopedic resident and two medical students. Each of them independently assessed the radiographs at three different times. We compared the intra and interobserver concordance of the IDEAL, AO, Frykman and Fernandez classifications using Cohen's kappa (κ) (for two observers) and Fleiss's κ (for more than two observers). RESULTS The concordance was high for the IDEAL classification (κ = 0.771) and moderate for Frykman (κ = 0.556), Fernandez (κ = 0.671) and AO (κ = 0.650). The interobserver agreement was moderate for the IDEAL classification (κ = 0.595), but unsatisfactory for Frykman (κ = 0.344), Fernandez (κ = 0.496) and AO (κ = 0.343). CONCLUSION The reproducibility of the IDEAL classification was better than that of the other systems analyzed, thus making the IDEAL system suitable for application. Complementary studies will confirm whether this classification system makes adequate predictions for therapy and prognosis.

Influence of compensation status on time off work after carpal tunnel release and rotator cuff surgery: a meta-analysis.

BACKGROUND: The assessment of post-surgical outcomes among patients with Workers' Compensation is challenging as their results are typically worse compared to those who do not receive this compensation. These patients' time to return to work is a relevant outcome measure as it illustrates the economic and social implications of this phenomenon. In this meta-analysis we aimed to assess the influence of this factor, comparing compensated and non-compensated patients. FINDINGS: Two authors independently searched MEDLINE (Ovid), Embase (Ovid), CINAHL, Google Scholar, LILACS and the Cochrane Library and also searched for references from the retrieved studies. We aimed to find prospective studies that compared carpal tunnel release and elective rotator cuff surgery outcomes for Workers' Compensation patients versus their non-compensated counterparts. We assessed the studies' quality using the Guyatt & Busse Risk of Bias Tool. Data collection was performed to depict included studies characteristics and meta-analysis. Three studies were included in the review. Two of these studies assessed the outcomes following carpal tunnel release while the other focused on rotator cuff repair. The results demonstrated that time to return to work was longer for patients that were compensated and that there was a strong association between this outcome and compensation status - Standard Mean Difference, 1.35 (IC 95%; 0.91-1.80, p < 0.001). CONCLUSIONS: This study demonstrated that compensated patients have a longer return to work time following carpal tunnel release and elective rotator cuff surgery, compared to patients who did not receive compensation. Surgeons and health providers should be mindful of this phenomenon when evaluating the prognosis of a surgery for a patient receiving compensation for their condition. TYPE OF STUDY/LEVEL OF EVIDENCE: Meta-analysis of prospective Studies/ Level III.