A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.

We developed a self-administered questionnaire for the assessment of severity of symptoms and functional status in patients who have carpal tunnel syndrome. The reproducibility, internal consistency, validity, and responsiveness to clinical change of scales for the measurement of severity of symptoms and functional status were evaluated in a clinical study. The scales were highly reproducible (Pearson correlation coefficient, r = 0.91 and 0.93 for severity of symptoms and functional status, respectively) and internally consistent (Cronbach alpha, 0.89 and 0.91 for severity of symptoms and functional status, respectively). Both scales had positive, but modest or weak, correlations with two-point discrimination and Semmes-Weinstein monofilament testing (Spearman coefficient, r = 0.12 to 0.42). In thirty-eight patients who were operated on in 1990 and were evaluated a median of fourteen months postoperatively, the mean symptom-severity score improved from 3.4 points preoperatively to 1.9 points at the latest follow-up examination, while the mean functional-status score improved from 3 to 2 points (5 points is the worst score and 1 point is the best score for each scale). Similar improvement was noted in twenty-six patients who were evaluated before and three months after the operation. We concluded that the scales for the measurement of severity of symptoms and functional status are reproducible, internally consistent, and responsive to clinical change, and that they measure dimensions of outcomes not captured by traditional measurements of impairment of the median nerve. These scales should enhance standardization of measurement of outcomes in studies of treatment for carpal tunnel syndrome.

Dislocation of the elbow complicated by arterial injury. Reconstructive strategy and functional outcome.

Four cases of arterial injury complicating posterior dislocation of the elbow are described. All of these patients were treated by emergent revascularization; reconstruction of the soft-tissue constraints of the elbow joint was performed by using osseous suture anchors. Despite prompt treatment of the vascular injury and successful restoration of elbow articulation and stability, all of the patients had residual functional disability. The previous literature has not discussed the functional results of these reconstructions. This report underscores the severity of these injuries, details our reconstructive strategy, and analyzes the functional outcome of these badly traumatized extremities.

Etiologies of shoulder pain in cervical spinal cord injury.

A protocol including physical examination, plain radiography, and shoulder arthrography was designed to study prospectively the causes of shoulder pain in patients with cervical spinal cord injury. Twenty-four patients (30 shoulders) were studied and subdivided into acute and chronic groups. The causes of shoulder pain in the acute group of 11 patients (15 shoulders) included capsular contracture or capsulitis or both in 6 shoulders; rotator cuff tears in 4; anterior instability in 2; and rotator cuff impingement, osteoarthritis with osteonecrosis, and osteoarthritis in 1 each. Of 13 patients (15 shoulders) assigned to the chronic group, the diagnoses included anterior instability in 5 shoulders; multidirectional instability in 3; capsular contracture or capsulitis or both in 3; and Charcot arthropathy, rotator cuff tear, rotator cuff impingement, and scapular pain in 1 each. To prevent and treat shoulder pain, therapeutic protocols for these patients must be individualized after a correct diagnosis is made.

Compression of the ulnar nerve at the elbow in association with synovial cysts.

Compression neuropathies around joints in association with synovial cyst formation are rare events. A case of a posttraumatic ulnar nerve palsy in a patient with osteoarthritis of the elbow is presented. At operative exploration of the cubital tunnel, the ulnar nerve was found to be compressed by a synovial cyst. Cyst formation should be considered in determining the etiology of compression neuropathies in patients with posttraumatic and degenerative processes occurring around the joints.

Preoperative arthroscopic assessment of fractures about the shoulder.

Soft tissue lesions in fractures about the shoulder are not completely defined by conventional imaging procedures. The purpose of the present study was to arthroscopically determine the soft-tissue pathology of the labrum, capsuloligamentous, and rotator cuff structures associated with fractures of the proximal humerus and/or scapula and to correlate them to the fracture type. In a series of 80 fractures (52 proximal humeral fractures, 20 fracture-dislocations, 8 glenoid or scapular fractures) arthroscopy was performed through a posterior approach under general anesthesia. Arthroscopy revealed significant numbers of labral, capsuloligamentous, and rotator cuff lesions, as well as cartilage damage not identified by clinical examination or preoperative imaging. Fracture dislocations (Neer type VI) and more benign fractures of the two-part variety are frequently associated with labral lesions (in 56% and 31%, respectively). This data suggest that it is important not to underestimate soft-tissue pathology in fractures that seem radiologically relatively harmless. Arthroscopic assessment in shoulder fractures is shown to be a useful tool in completely understanding the extent of the injury.

Symptoms, functional status, and neuromuscular impairment following carpal tunnel release.

This study examined the resolution of symptoms, functional limitations and neuromuscular impairments following carpal tunnel release. Thirty-five patients were evaluated preoperatively and 6 weeks, 3 months, 6 months, and a mean of 27 months postoperatively. Evaluation consisted of physical examination (performed in a subset of patients) and previously validated questionnaire scales measuring symptoms, functional limitations, and satisfaction. Nocturnal pain, tingling, and numbness improved within 6 weeks after surgery. Weakness and functional status improved more gradually. Grip and pinch strength worsened initially, returned to pre-operative levels after about 3 months, and improved significantly by 24 months. The Tinel and Phalen signs remained positive in two and seven patients, respectively, after 2 years, and two-point discrimination remained abnormal in over half of patients after 2 years. These temporal patterns should be discussed with patients to foster realistic expectations of the response to surgery.