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1.
Orthop Clin North Am ; 51(3): 361-368, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498954

RESUMO

Carpal tunnel is the most common peripheral compressive neuropathy. Nonoperative management may provide temporary alleviation of symptoms, but in most cases surgical decompression is warranted. There are a multitude of approaches ranging from open release under general anesthesia to wide awake in-office endoscopic carpal tunnel release. The present article describes the technical considerations for the single incision, antegrade approach to endoscopic carpal tunnel release using the SEGWay system and technique.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Endoscopia/métodos , Nervo Mediano/cirurgia , Doenças do Sistema Nervoso Periférico/cirurgia , Descompressão Cirúrgica/efeitos adversos , Endoscopia/efeitos adversos , Humanos , Resultado do Tratamento
2.
Ideggyogy Sz ; 73(05-06): 185-188, 2020 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-32579308

RESUMO

Background and purpose: After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose - The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Methods: Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. Results: A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Conclusion: Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.


Assuntos
Sistema Nervoso Autônomo/fisiologia , Síndrome do Túnel Carpal/cirurgia , Resposta Galvânica da Pele/fisiologia , Sistema Nervoso Simpático/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Nervo Mediano , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Complicações Pós-Operatórias , Resultado do Tratamento , Nervo Ulnar/fisiologia , Nervo Ulnar/fisiopatologia
3.
Plast Reconstr Surg ; 145(5): 1197-1203, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332539

RESUMO

BACKGROUND: The authors conducted a prospective study to compare patients' intraoperative experience of open carpal tunnel release under "wide awake, local anesthesia, no tourniquet" (WALANT) on the one hand and intravenous regional anesthesia on the other. The authors hypothesized that WALANT would offer a better intraoperative experience than intravenous regional anesthesia. METHODS: Twenty-four patients with bilateral carpal tunnel syndrome had one hand operated on using WALANT and the contralateral hand with the intravenous regional anesthesia method. At the postoperative second hour, patients completed a questionnaire to quantify their pain levels on a numerical rating scale and compare the operation with dental procedures. They were also asked about their expectations and feelings about reoperation with the anesthesia methods. The results were compared for the two anesthesia methods. RESULTS: There were no significant differences between numerical rating scale pain values during anesthetic administration or for surgical site pain on the WALANT and intravenous regional anesthesia sides. Patients reported moderate tourniquet pain for intravenous regional anesthesia sides. For WALANT sides, a significantly higher number of patients reported carpal tunnel release to be an easier procedure than dental procedures (91.6 percent WALANT and 37.5 percent intravenous regional anesthesia). For WALANT sides, a significantly higher number of patients reported carpal tunnel release to be an easier procedure than they expected (91.6 percent WALANT and 50 percent intravenous regional anesthesia). For the reoperation, 83.3 percent of patients preferred WALANT, 8.3 percent preferred intravenous regional anesthesia, and 8.3 percent reported no preference. CONCLUSIONS: WALANT offered a better intraoperative experience. Tourniquet pain, preoperative preparation basics, and the extended anesthesia duration are likely the major drawbacks of the intravenous regional anesthesia method.


Assuntos
Anestesia Intravenosa/métodos , Anestesia Local/métodos , Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/efeitos adversos , Dor Pós-Operatória/diagnóstico , Adulto , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Preferência do Paciente , Estudos Prospectivos , Torniquetes/efeitos adversos , Vigília
4.
Plast Reconstr Surg ; 145(5): 1204-1214, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332540

RESUMO

BACKGROUND: The first aim of this study was to determine the rate of revision carpal tunnel release in five urban hospitals over a period of 14 years. The secondary aim was to assess what demographic, condition-related, and treatment-related factors are associated with revision carpal tunnel release. METHODS: Between 2002 and 2015, 7464 patients underwent carpal tunnel release. After manually reviewing the medical records, the authors identified 113 patients who underwent revision surgery. Multivariable logistic regression analysis was performed to study association with demographics (age, sex, and race), unilateral or bilateral treated wrist(s) (including carpal tunnel release performed simultaneously and separately), and type of surgery (open or endoscopic). To gain further insight into these factors, a matched case-control analysis in a 1:3 ratio was performed. RESULTS: One hundred thirteen of 7464 patients (1.5 percent) underwent revision carpal tunnel surgery. The median (interquartile range) time to revision surgery was 1.23 years (0.47 to 3.89 years). In multivariable logistic regression analysis, older age, male sex, bilateral carpal tunnel release, and endoscopic carpal tunnel release were independently associated with higher odds for revision surgery. Multivariable conditional logistic regression of the matched case-control cohort showed that smoking and rheumatoid arthritis were independently associated with revision carpal tunnel release. Splint treatment before the initial surgery was independently associated with single carpal tunnel release. CONCLUSION: Endoscopic release, male sex, smoking, rheumatoid arthritis, and undergoing staged or simultaneous bilateral carpal tunnel release are risk factors for revision surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/estatística & dados numéricos , Endoscopia/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Síndrome do Túnel Carpal/epidemiologia , Estudos de Casos e Controles , Feminino , Hospitais Urbanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Fumar/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
Muscle Nerve ; 62(1): 60-69, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32304244

RESUMO

INTRODUCTION: The quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health-care expenditures. METHODS: We evaluated test quality among 338 adults with workers' compensation claims for carpal tunnel syndrome. Using simulations, we examined how it influences the appropriateness of surgery. Using regression, we evaluated associations with symptoms and functional limitations (Boston Carpal Tunnel Questionnaire), overall health (12-item Short Form Health Survey version 2), actual receipt of surgery, and expenditures. RESULTS: In simulations, suboptimal quality tests rendered surgery inappropriate for 99 of 309 patients (+32 percentage points). In regression analyses, patients with the highest quality tests had larger declines in symptoms (-0.50 point; 95% confidence interval [CI], -0.89 to -0.12) and functional impairment (-0.42 point; 95% CI, -0.78 to -0.06) than patients with the lowest quality tests. Test quality was not associated with overall health, actual receipt of surgery, or expenditures. DISCUSSION: Test quality is pivotal to determining surgical appropriateness and associated with meaningful differences in symptoms and function.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Eletrodiagnóstico/normas , Gastos em Saúde/normas , Serviços de Saúde do Trabalhador/normas , Medidas de Resultados Relatados pelo Paciente , Indicadores de Qualidade em Assistência à Saúde/normas , Adulto , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/economia , Eletrodiagnóstico/economia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Serviços de Saúde do Trabalhador/economia , Indicadores de Qualidade em Assistência à Saúde/economia , Resultado do Tratamento
6.
World Neurosurg ; 139: 548, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32348893

RESUMO

Carpal tunnel syndrome represents compression of the median nerve in the carpal tunnel, which is defined by the carpal bones on the lateral, medial, and dorsal aspects and the transverse carpal ligament on the anterior aspect.1 Symptoms of carpal tunnel syndrome include paresthesia, anesthesia, paresis, and pain located in the median nerve distribution. In severe cases, there may be atrophy of median nerve-innervated thenar muscles. In the United States, carpal tunnel syndrome affects approximately 3.72% of the population.2 Conservative measures, such as bracing, steroid injections, and physical and occupational therapy, are commonly employed.1 However, many patients still require more definitive surgical management, which may be in the form of open or endoscopic procedures. Regardless of surgical approach, the clinical success rates of carpal tunnel release have been reported to be 75%-90%.3 Recurrence rates are 8.4%-15% over 4-5 years,4,5 with the lower end of this range representing the Agee single-portal technique. Endoscopic carpal tunnel release leads to reduced postoperative pain and an increase in transient neurologic deficits; however, no improvements have been reported in overall complication rate, subjective satisfaction, return to work, postoperative grip and pinch strength, and operative time.6 In this technical video, we present a case of single-incision endoscopic carpal tunnel release in a patient with severe symptoms after conservative measures failed. The patient experienced a noncomplicated postoperative course and demonstrated an excellent recovery at follow-up visits. Surgical decompression is an important treatment for refractory carpal tunnel syndrome, and videos such as this provide guidance for safe and effective treatment (Video 1).


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Endoscopia/métodos , Cirurgia Vídeoassistida/métodos , Eletromiografia/métodos , Feminino , Humanos , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/cirurgia , Pessoa de Meia-Idade
7.
Plast Reconstr Surg ; 145(6): 1455-1463, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32195858

RESUMO

BACKGROUND: Surgical videos are increasingly common, although their role in residency curricula remains unclear. The aim of this study was to evaluate the impact of an educational surgical video on resident performance of an open carpal tunnel release through an Objective Structured Assessment of Technical Skills and serial questionnaires. METHODS: Twenty-two residents representing six postgraduate years were randomized to receive text-based materials with or without a surgical video before performing a carpal tunnel release on human cadavers. Procedures were video recorded, anonymized, and independently evaluated by three hand surgeons using the Objective Structured Assessment of Technical Skills global rating scale, a procedure-specific technical rating scale, a record of operative errors, and pass/fail designation. Residents completed questionnaires before and after the procedure to track confidence in their technical skills. RESULTS: Residents in their first and second postgraduate years (n = 10) who watched the surgical video committed fewer operative errors (median, 4 versus 1.3; p = 0.043) and were more confident in their abilities following the procedure (median, 75 versus 32; p = 0.043) than those receiving text resources alone. There were no significant differences in Objective Structured Assessment of Technical Skills performance or questionnaire responses among more senior residents (n = 12). The technical rating scale was internally consistent (Cronbach α = 0.95; 95 percent CI, 0.91 to 0.98), reliable (intraclass correlation coefficient, 0.73; 95 percent CI, 0.40 to 0.88), and correlated with surgical experience (Spearman ρ = 0.57; p = 0.006). CONCLUSION: Watching an educational surgical video to prepare for a cadaveric procedure significantly reduced operative errors and improved confidence among junior trainees performing a carpal tunnel release.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Competência Clínica/estatística & dados numéricos , Internato e Residência/métodos , Cirurgiões/educação , Gravação em Vídeo , Adulto , Recursos Audiovisuais , Cadáver , Currículo , Avaliação Educacional/estatística & dados numéricos , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Projetos Piloto , Estudos Prospectivos , Reprodutibilidade dos Testes , Treinamento por Simulação/métodos , Cirurgiões/estatística & dados numéricos
8.
Pain Physician ; 23(2): E175-E183, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214296

RESUMO

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, which results from median nerve compression. A lot of nonsurgical modalities are available for the management of mild to moderate situations. Local Hyalase hydrodissection (HD) of the entrapped median nerve could offer a desirable sustained symptom alleviation. OBJECTIVES: To evaluate the clinical efficacy of Hyalase/saline solution carpal tunnel HD on pain, functional status, and nerve conduction in patients with CTS. STUDY DESIGN: A randomized, double-blinded trial. SETTING: Anesthesia, pain, and rheumatology clinics in a university hospital. METHODS: Patients: 60 patients with CTS (> 6 months' duration). INTERVENTION: patients were allocated equally into either group 1 (HD with Hyalase + 10 mL saline solution injection), or group 2 (HD with 10 mL saline solution only). MEASUREMENTS: assessment of pain using Visual Analog Scale (VAS), functional disability (FD) score, and nerve conduction studies before injection, and over 6 months after injection. Nerve conduction parameters before injection and postinjection by the end of 3 and 6 months were evaluated as well. RESULTS: Statistically significant lower postinjection values of VAS (1 ± 1.8, 2 ± 1.1, 2 ± 1.2, 2 ± 1.1) in group 1 versus (2 ± 1.2, 3 ± 1.7, 4 ± 1.5, 5 ± 2.6) in group 2 by the end of the first week, and the first, third, and sixth months, and significantly lower FD scores (15.3 ± 1.2, 13 ± 1.3, 10.2 ± 1.3, 10.2 ± 1.3) in group 1 versus (17.5 ± 1.8, 16.6 ± 2.8, 19.4 ± 3.2, 21.2 ± 2.5) in group 2 during the same time intervals. Nerve conduction study parameters have shown significantly higher velocity and lower latency in the Hyalase group than in the saline solution group by the 3 and 6 month follow-up. LIMITATION: We suggest a longer period could be reasonable. CONCLUSIONS: Carpal tunnel HD with Hyalase with saline solution is considered as an efficient technique offering a rapid onset of pain relief and functional improvements, and better median nerve conduction in patients with CTS over 6 months follow-up duration. KEY WORDS: Carpal tunnel syndrome, Hyalase, median nerve hydrodissection.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Dissecação/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Manejo da Dor/métodos , Resultado do Tratamento , Punho/diagnóstico por imagem , Punho/inervação , Punho/cirurgia
9.
Jt Dis Relat Surg ; 31(1): 50-5, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160494

RESUMO

OBJECTIVES: This study aims to describe a retrospective study using prospectively gathered data to compare mini-open and extended open release techniques for moderate to severe carpal tunnel syndrome (CTS). PATIENTS AND METHODS: The data of 198 consecutive patients (139 males, 59 females; mean age 57.0±4.5 years; range, 44 to 75 years) treated for CPS were used. For matching, age, gender and severity of the compression, the Greathouse Ernst Halle Schaffer neurophysiological classification system was used. After matching, 63 observations in each group (group 1: mini-open and group 2: extended open) were used for analysis. A Jamar hydraulic hand dynamometer was used to measure pre- and postoperative third month grip strengths. The key pinch test was performed also at third month. Patients completed the Boston Carpal Tunnel Questionnaire at the last follow-up. RESULTS: Symptom severity and functional status were improved up to half fold in both groups at final follow-up; however, there was no statistically significant clinical difference between the groups (p>0.05). There were totally six patients with paresthesia symptoms (three in each group; 4.7%), which improved in three months. Eight patients (6.3%, one in group 1 and seven in group 2, p=0.032) had dysesthesia and pillar pain. CONCLUSION: Mini-open and extended open carpal tunnel release have similar clinical outcomes without any major complications.


Assuntos
Síndrome do Túnel Carpal , Descompressão Cirúrgica/métodos , Dor , Parestesia , Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Dor/diagnóstico , Dor/etiologia , Medição da Dor/métodos , Parestesia/diagnóstico , Parestesia/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Punho/fisiopatologia , Punho/cirurgia
10.
Jt Dis Relat Surg ; 31(1): 56-61, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160495

RESUMO

OBJECTIVES: This study aims to analyze the nationwide trends in carpal tunnel surgery by surgeons practicing in Turkey according to experience in years, training received (plastic surgery or orthopedics), and working location (Turkey or abroad) by slightly modifying Munns' survey. MATERIALS AND METHODS: A printed and online survey consisting of 11 questions was sent to Turkish and international surgeons. The surgeon's province of practice, years in practice, type of education received as a resident, preferred operation room, preferred surgical approach, type of anesthesia used, use of postoperative orthosis and therapy were assessed in the survey. RESULTS: The survey was completed by 198 surgeons (a 25% response rate). The majority of surgeons practicing in Turkey (87%) and 67% of surgeons practicing abroad demanded electromyography (EMG) and nerve conduction studies. Sixty- one percent of respondents from Turkey and 76% of respondents practicing abroad did not administer antibiotics preoperatively. While the most common anesthetic technique used by international surgeons was subcutaneous local anesthesia (42%), Turkish surgeons preferred wrist block (18%). Surgeons practicing in Turkey with fewer than five years of experience were more likely to administer antibiotics preoperatively, use EMG/nerve conduction studies, utilize a mini-open approach and apply an orthosis postoperatively (p<0.05). CONCLUSION: There are comparable differences between Turkish and international surgeons regarding pre- and postoperative management of carpal tunnel surgery. Province of practice, years in practice, and type of education received as a resident have influence over the management of carpal tunnel syndrome.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Humanos , Internacionalidade , Procedimentos Ortopédicos/métodos , Assistência Perioperatória/métodos , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões , Inquéritos e Questionários , Turquia
11.
Plast Reconstr Surg ; 145(3): 737-744, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097317

RESUMO

BACKGROUND: Open carpal tunnel release is commonly performed with the use of a tourniquet. The combination of local anesthetic and epinephrine with a pneumatic tourniquet helps provide clear visualization during decompression of the median nerve. There has been a rapid expansion of literature challenging the use of tourniquets in open carpal tunnel release. Consequently, the local anesthesia/no tourniquet approach has become increasingly popular. The authors evaluated the outcomes of awake open carpal tunnel release with and without a tourniquet. METHODS: The authors attempted to identify all relevant studies, regardless of language or publication status. A systematic database search for relevant studies was conducted in MEDLINE, EMBASE, EBSCO, and CENTRAL. Included studies compared patients undergoing awake open carpal tunnel release with and without an arm or forearm tourniquet. RESULTS: Eight studies evaluating 765 patients and 866 hands were included. Open carpal tunnel release with the wide awake, local anesthesia, no tourniquet approach resulted in a 2.14 point reduction on the visual analog scale (95% CI, 1.30 to 2.98; p < 0.001). The procedure was 1.82 minutes faster with the use of a tourniquet (95% CI, -3.26 to -0.39; p = 0.01). There were no significant differences between groups in intraoperative blood loss, surgeon perceived difficulty, and complications. CONCLUSION: This systematic review found that tourniquet use causes significantly more pain with no significant clinical benefit as compared with using a wide awake, no tourniquet approach in carpal tunnel decompression.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Nervo Mediano/cirurgia , Dor Pós-Operatória/diagnóstico , Torniquetes/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/normas , Epinefrina , Humanos , Medição da Dor/estatística & dados numéricos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Guias de Prática Clínica como Assunto , Torniquetes/normas , Resultado do Tratamento , Vasoconstritores/administração & dosagem , Vigília
12.
Plast Reconstr Surg ; 145(2): 360e-367e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985640

RESUMO

BACKGROUND: Carpal tunnel release is one of the most common procedures in hand surgery. There is only scarce evidence regarding whether platelet inhibitors increase the risk of developing postoperative hemorrhage in carpal tunnel release. METHODS: This is a multicenter, propensity score-matched study including 635 carpal tunnel releases in 497 patients. Multivariate regression models were adjusted with the propensity score, which was developed to mitigate differences in patients with and without platelet inhibition with acetylsalicylic acid. Propensity score matching provides results close to the statistical quality of randomized controlled trials. The primary study endpoint was postoperative bleeding complication, defined as acute bleeding leading to reoperation or hematoma leading to physician visit. Patient satisfaction, functional outcome measured with the Boston Carpal Tunnel Questionnaire, and onset of surgical-site infection were also analyzed. RESULTS: Bleeding complications were observed in 56 procedures (8.8 percent). After propensity score matching, there was no significant difference between the patients with and without acetylsalicylic acid treatment (p = 0.997). History of thyroid disease (p = 0.035) and of rheumatoid arthritis (p = 0.026) were independent risk factors, whereas higher body mass index might have a beneficial effect (p = 0.006). Patients with postoperative bleeding had significantly impaired functional outcome as measured with the Boston Carpal Tunnel Questionnaire (p = 0.026). Median satisfaction in the investigated study population was 10 of 10 points and did not differ significantly between the antiplatelet and the non-antiplatelet cohorts (p = 0.072) CONCLUSION:: Carpal tunnel release under platelet inhibition with acetylsalicylic acid is safe and can be performed without interruption of such medication. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Aspirina/efeitos adversos , Síndrome do Túnel Carpal/cirurgia , Inibidores da Agregação de Plaquetas/efeitos adversos , Hemorragia Pós-Operatória/induzido quimicamente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Hemorragia Pós-Operatória/prevenção & controle , Pontuação de Propensão , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco
13.
Plast Reconstr Surg ; 145(2): 459-467, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31985641

RESUMO

BACKGROUND: Injuries to the upper extremity lymphatic system from cancer may require measures to prevent secondary lymphedema. Guidelines were established relating to the use of tourniquet and elective hand and upper extremity surgery. However, reports in the setting of hand surgery have indicated that prior guidelines may not be protective to the patient. METHODS: The study systematically reviewed the current literature evaluating elective hand surgery in breast cancer patients. The authors evaluated the risk of complications, including new or worsening lymphedema and infection. RESULTS: One hundred ninety-eight abstracts were identified, and a bibliographic review was performed. Nine studies pertained to our subject, and four were included for final review. All studies included patients with prior breast cancer treatment involving breast surgery and axillary lymph node dissection. Pneumatic tourniquets were used during nearly all operations. Patients without presurgery ipsilateral lymphedema had a 2.7 percent incidence of developing new lymphedema and a 0.7 percent rate of postoperative infection. Patients with presurgery lymphedema had a 11.1 percent incidence of worsening lymphedema and a 16.7 percent rate of infection. However, all cases of new or exacerbated lymphedema resolved within 3 months. Tourniquet use was not found to increase rates of lymphedema. CONCLUSIONS: Based on the available evidence, there is no increased risk of complications for elective hand surgery in patients with prior breast cancer treatment. Breast cancer patients with preexisting ipsilateral lymphedema carry slightly increased risk of postoperative infection and worsening lymphedema. It is the authors' opinion and recommendation that elective hand surgery with a tourniquet is not a contradiction in patients who have received previous breast cancer treatments.


Assuntos
Neoplasias da Mama/cirurgia , Mãos/cirurgia , Linfedema/cirurgia , Neoplasias da Mama/complicações , Neoplasias da Mama/radioterapia , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/cirurgia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfedema/complicações , Mastectomia/efeitos adversos , Mastectomia/métodos , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia de Second-Look/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/efeitos adversos , Biópsia de Linfonodo Sentinela/métodos , Infecção da Ferida Cirúrgica/etiologia , Torniquetes , Resultado do Tratamento
14.
15.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 63(6): 400-407, nov.-dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-188935

RESUMO

Objetivo: Evaluar los beneficios para el paciente y el impacto económico de la implantación de un circuito de cirugía con anestesia local sin manguito ni sedación (wide awake local anesthesia no tourniquet technique [WALANT], por sus siglas en inglés) comparado con pacientes intervenidos en quirófano con cirugía mayor ambulatoria. Método: Se diseñó un estudio de cohortes prospectivo comparando 150 casos intervenidos (túneles carpianos y dedo en resorte) de forma ambulatoria mediante técnica WALANT con otros 150 pacientes operados en circuito de cirugía mayor ambulatoria, con evaluación preoperatoria, anestesia regional y torniquete, en quirófano convencional. El dolor pre-, intra- y postoperatorio fue monitorizado, así como los días que precisaron de analgesia postoperatoria. Se evaluaron los costos y recursos utilizados. El grado de satisfacción del paciente fue evaluado mediante un formulario específico. Resultados: El dolor intraoperatorio fue similar en ambos grupos, hallando diferencias significativas en cuanto a la necesidad de analgesia postoperatoria a favor del grupo WALANT. El grado de satisfacción fue mayor para el grupo de anestesia local. La utilización de recursos materiales y de personal fue menor en WALANT, calculando un ahorro por paciente de 1,019 euros. Conclusiones: Cirugías como el túnel carpiano y el dedo en resorte pueden llevarse a cabo de forma segura mediante la técnica WALANT. La satisfacción del paciente es mayor que la de los pacientes intervenidos en el quirófano. El control del dolor es excelente, especialmente durante el postoperatorio. La técnica WALANT reporta un beneficio para el paciente en términos de bienestar y rapidez, además de permitir prescindir de pruebas y visita preoperatorias. Su implantación supone un ahorro significativo de recursos hospitalarios


Objectives: To evaluate benefits for the patient and the economic impact for the implementation of a wide awake local anesthesia no tourniquet (WALANT) hand surgery compared to traditional major outpatient circuit. Methods: A prospective cohort study was planned comparing 150 cases of ambulatory hand surgery (carpal tunnel and trigger finger) using WALANT technique intervention out from the operating room; with another 150 which underwent intervention, outpatient setting, with preoperative evaluation, sedation and tourniquet, in the operation room. Preoperative, intraoperative and postoperative pain was monitored, as well as the days that required postoperative analgesia.The resources used and costs were evaluated. Satisfaction was evaluated using a specific survey. Results: The pain during the surgery was equivalent for both groups and was significantly lower postoperatively for the WALANT group, with less need for the use of analgesics. Satisfaction was greater for the local anesthesia group. The use of personnel resources and hospital material was less for the WALANT group, with total saving calculated by 1,019 euros per patient. Conclusions: Procedures such as carpal tunnel surgery and trigger finger surgery can be safely performed using wide awake surgery. Patient satisfaction is higher to conventional procedure in the operation room. Pain control is excellent, especially during the postoperative period. WALANT technique for hand surgery represents a benefit for the patient in comfort, timeliness and no need for preoperative tests or evaluation. In addition, it represents a significant savings in hospital resources


Assuntos
Humanos , Masculino , Feminino , Anestesia Local , Síndrome do Túnel Carpal/cirurgia , Dedo em Gatilho/cirurgia , Procedimentos Ortopédicos/métodos , Estudos Prospectivos
16.
Neurosciences (Riyadh) ; 24(4): 296-301, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31872809

RESUMO

OBJECTIVE: To translate and validate the Arabic version of the Boston carpal tunnel questionnaire (BCTQ-A). METHODS: We recruited consecutive patients with carpal tunnel syndrome (CTS). Reliability was assessed with Cronbach alpha, reproducibility with intraclass correlation coefficients, construct validity with factor analysis, and responsiveness post carpal tunnel release (CTR) with the Wilcoxon signed-rank test. RESULTS: In 134 patients, the mean total scores for the symptom severity scale (SSS) and functional status scale (FSS) were 32.0+/-8.4 (alpha=0.88, ICC=0.88) and 18.5+/-7.6 (alpha=0.87, ICC=0.89), respectively. As in the original Boston carpal tunnel questionnaire (BCTQ), a 3-factor model of the BCTQ-A best fitted the data. The BCTQ-A, SSS, and FSS scores were significantly lower post-CTR. CONCLUSION: The BCTQ-A is reliable, valid, reproducible, and responsive to interventions. The Arabic version can be now used with Arabic-speaking patients with CTS.


Assuntos
Síndrome do Túnel Carpal/patologia , Características Culturais , Medidas de Resultados Relatados pelo Paciente , Inquéritos e Questionários/normas , Adulto , Árabes/psicologia , Síndrome do Túnel Carpal/cirurgia , Síndrome do Túnel Carpal/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Traduções
17.
J Hand Surg Asian Pac Vol ; 24(4): 389-391, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690194

RESUMO

Background: Wide Awake Local Anesthesia No Tourniquet (WALANT) uses a mixture of lidocaine and epinephrine for anesthesia and has found great success in hand surgery. At the Philippine Orthopedic Center (POC), we still use local anesthesia along with a tourniquet which gives the patient pain and discomfort at the tourniquet site. This study aims to determine perioperative and post-operative pain, intraoperative bleeding and immediate clinical outcomes of patients using WALANT for surgical anesthesia for carpal tunnel release. Methods: A case series of all patients who underwent carpal tunnel release under WALANT from April 2016 to September 2016 is presented. Those with concomitant trigger finger and de quervain disease which required release on the affected hand were also included. A tourniquet was on standby in case of uncontrollable bleeding. Intraoperative bleeding, pain NRS scores, and return to daily activity were noted. Results: Thirteen patients were included in the study; 3 were male, 10 were female. Mean age was 58 years, Mean surgical time was 15 minutes. Twelve were reported to have "some bleeding" and one was reported to have "bleeding but was still manageable". None of the surgeries were totally bloodless or had too much bleeding that necessitated a tourniquet. Pain NRS scores during injection of local anesthesia had a mean of 2. None of the patients felt pain during and immediately after the surgery. Average time return to daily activity was 6 days. No complications were noted. Conclusions: Patients included in the study who underwent carpal tunnel release under WALANT did not experience pain associated with a tourniquet. Visualization of the field was adequate enough for the surgeons to do the surgery without the need for a tourniquet and with no associated complications.


Assuntos
Anestesia Local/métodos , Síndrome do Túnel Carpal/cirurgia , Procedimentos Ortopédicos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Filipinas , Projetos Piloto , Torniquetes
18.
J Hand Surg Asian Pac Vol ; 24(4): 494-497, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690196

RESUMO

A 49-year-old female patient with carpal tunnel syndrome at both hands was performed open carpal tunnel release. 4 months later, on the left hand, severance of the thenar branch was found by electromyography. On the 138th day, re-exploration was performed for direct nerve repair. During exploration, we identified the transligamentous variation of recurrent motor branch. Direct nerve repair was successful. At 6 months after direct repair, the nerve function began to return. At 2 years after direct repair, the nerve function has almost returned. There are some variations on the recurrent motor branch. And we overlooked transligamentous variation when we perform more decompression around the median nerve. It is important that recognize variations of thenar branch when we perform carpal tunnel release for not occurrence of severance of thenar branch.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Nervo Mediano/lesões , Traumatismos dos Nervos Periféricos/cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/métodos , Eletromiografia , Feminino , Seguimentos , Humanos , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/etiologia , Fatores de Tempo
19.
Eklem Hastalik Cerrahisi ; 30(3): 212-6, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650916

RESUMO

OBJECTIVES: This study aims to compare endoscopic carpal tunnel release versus mini-open carpal tunnel release regarding volume changes in the carpal tunnel and median nerve by magnetic resonance imaging (MRI). PATIENTS AND METHODS: The study included 17 wrists of 13 patients (1 male, 12 females; mean age 55 years; range, 51 to 64 years) who were diagnosed with carpal syndrome. Ten wrists underwent mini-open carpal tunnel release, while seven wrists underwent uni-portal endoscopic carpal tunnel release. Carpal tunnel and median nerve volumetric changes were evaluated by MRI pre- and postoperatively. RESULTS: Surgical section of transverse carpal ligament significantly increased the postoperative volume of the carpal tunnel and median nerve compared to preoperative (p<0.05). However, the endoscopic and mini-open carpal tunnel techniques had no superiority over one another regarding volume expansion (p>0.05). CONCLUSION: Both methods can be preferred to release the transverse carpal ligament in patients with idiopathic carpal tunnel syndrome. The surgeon should decide on which method to use considering the advantages and disadvantages reported in the literature.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Endoscopia , Nervo Mediano/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Feminino , Humanos , Ligamentos Articulares/cirurgia , Imagem por Ressonância Magnética , Masculino , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Articulação do Punho/cirurgia
20.
Turk Neurosurg ; 29(6): 927-932, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573064

RESUMO

AIM: To evaluate the feasibility of the mini-open incision method in patients who underwent median nerve decompression in the carpal tunnel with a mini incision made proximal to the distal wrist crease. MATERIAL AND METHODS: A total of 80 patients (84 hands) operated by a single surgeon with a mini incision were included. The patients were evaluated postoperatively for the presence of pillar pain, pain on the incision scar, and scar sensitivity in addition to preoperative findings. The Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) questionnaire was used for clinical scoring. To evaluate the effectiveness of the method, the findings were recorded at and compared between at 12 and 24 months follow-ups. RESULTS: No complications were observed at the wound site in the early postoperative period. Ten patients reported numbness, 5 experienced weakness, and 4 revealed positive Tinel's sign. Keloid formation without pain and scar sensitivity was detected in 2 patients at 6 months. No patient reported night pain, pain on pillar or incision scar, scar sensitivity, recent sensory loss, and disease recurrence. Numbness was present in 7 patients at 12 months and in 3 at 24 months; 3 and 2 patients reported weakness at 12 and 24 months, respectively. The mean Quick DASH score was 72.7 preoperatively, 10.2 at 12 months, and 9.1 at 24 months. CONCLUSION: The median nerve decompression in the carpal tunnel may be performed with a mini incision made proximal to the distal wrist crease is effective and safe method, and provides less complications and higher patient comfort.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Nervo Mediano/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ferida Cirúrgica , Articulação do Punho/cirurgia , Adulto , Idoso , Síndrome do Túnel Carpal/diagnóstico , Feminino , Humanos , Masculino , Nervo Mediano/patologia , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/cirurgia , Medição da Dor/métodos , Ferida Cirúrgica/patologia , Inquéritos e Questionários , Resultado do Tratamento , Articulação do Punho/patologia
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