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Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome

Year 2023, Volume: 6 Issue: 3, 411 - 415, 01.07.2023
https://doi.org/10.19127/bshealthscience.1233643

Abstract

Carpal tunnel syndrome (CTS) is a condition in which the median nerve is compressed between the transverse ligament and the carpal bones. There are various techniques used in the surgical treatment of CTS. The present study aimed to investigate the reasons for reoperation by examining the reoperated cases diagnosed with CTS. Patients who underwent surgery for CTS at Kahramanmaraş Sütçü İmam University Department of Neurosurgery between January 1, 2015 and September 1, 2022 were evaluated retrospectively. All patients were operated by the same surgical team. Patients who underwent two or more operations with the same diagnosis were included in the study, while those operated for the first time due to CTS and with missing data were excluded. The included patients were analyzed in terms of gender, age, occupation, side of the surgery, presence of systemic diseases causing CTS such as diabetes mellitus (DM), number of the operations they underwent, time until the next operation, surgical technique, and medical branch that performed the surgery (orthopedics, neurosurgery, or plastic surgery). Forty-eight patients who met the study criteria were evaluated. Out of the 48 reoperated patients, 14 were male and 34 were female. Eighteen patients had been operated using the mini-incision open method, while 22 had undergone laparoscopic surgery, including 14 patients with biportal endoscopic surgery, and eight with uniportal endoscopic surgery. Out of the 48 patients, 31 (64.6%), 11 (22.9%), and six patients were first operated by orthopedic and traumatology physicians, plastic and reconstructive surgeons, and neurosurgeons, respectively. The use of open surgical technique is the gold standard in CTS and complete incision of the transverse ligament provides complete decompression of the median nerve. We believe that decompression with closed or small incisions due to aesthetic concerns may not be sufficient and may increase the risk of complications.

References

  • Abdullah AF, Wolber PH, Ditto EW. 1995. Sequelae of carpal tunnel surgery. Neurosurgery, 37(5): 931-936.
  • Açıkgöz B. 2010. Karpal tünel sendromu. In: Demircan N, Zileli M, editors. Periferik sinir cerrahisi. Türk Nöroşirürji Derneği, Ankara, Türkiye, pp: 281–304.
  • Andrew Lee WP, Strickland JW. 1998. Safe carpal tunnel release via a limited palmar incision. Plast Reconstr Surg, 101(2): 418-424.
  • Cage ES, Beyer JJ, Ebraheim NA. 2023. Injections for treatment of carpal tunnel syndrome: A narrative review of the literature. J Orthop, 37: 81-85.
  • Cellocco P, Rossi C, El Boustany S, Di Tanna GL, Costanzo G. 2009. Minimally invasive Carpal Tunnel release. Orthop Clin North Am, 40(4): 441-448.
  • Chow JCY. 1993. The chow technique of endoscopic release of the carpal ligament for carpal tunnel syndrome: Four years of clinical results. Arthrosc J Arthrosc Relat Surg, 9(3): 301-314.
  • Dorwart BB. 1984. Carpal tunnel syndrome: A review. Semin Arthritis Rheum, 14(2): 134-140.
  • Graham JG, Plusch KJ, Hozack BA, Ilyas AM, Matzon JL. 2023. Early revision rate following primary carpal tunnel release. J Hand Surg Glob Online, 5(3): 277-283. DOI: 10.1016/j.jhsg.2023.01.010.
  • Haglin JM, Hinckley NB, Moore ML, Deckey DG, Lai CH, Renfree KJ. 2023. Long-term trends in open vs endoscopic carpal tunnel release among the medicare population in the United States. HAND, 0(0). DOI: 10.1177/15589447231168977.
  • Jimenez DF, Gibbs SR, Clapper AT. 1998. Endoscopic treatment of carpal tunnel syndrome: A critical review. J Neurosurg, 88(5): 817-826.
  • Karjalanen T, Raatikainen S, Jaatinen K, Lusa V. 2022. Update on efficacy of conservative treatments for carpal tunnel syndrome. J Clin Med, 11(4): 950.
  • Khalid SI, Deysher D, Thomson K, Khilwani H, Mirpuri P, Maynard M. 2023. Outcomes following endoscopic versus open carpal tunnel release-a matched study. World Neurosurg, 171: 162-171.
  • Kıbıcı K, Köksal V. 2010. Mini açik teknikle yapilan karpal tünel cerrahisi ve fonksiyonel sonuçlari. Türk Nöroşirürji Derg, 20(1): 7-14.
  • Lam KHS, Wu Y-T, Reeves KD, Galluccio F, Allam AE-S, Peng PWH. 2023, Ultrasound-guided interventions for carpal tunnel syndrome: A systematic review and meta-analyses. Diagnostics, 13(6): 1138.
  • Lanz U. 1977. 2 Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg Am, (1): 44-53.
  • Lee D, van Holsbeeck MT, Janevski PK, Ganos DL, Ditmars DM, Darian VB. 1999. Diagnosis of carpal tunnel syndrome. Radiol Clin North Am, 37(4): 859-872.
  • Lee YS, Youn H, Shin SH, Chung YG. 2023. Minimally invasive Carpal Tunnel release using a hook knife through a small transverse carpal incision: Technique and outcome. Clin Orthop Surg, 15(2): 318.
  • Mao B, Li Y, Yin Y, Zhang Z, Li J, Fu W. 2023. Local corticosteroid injection versus physical therapy for the treatment of carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Asian J Surg, DOI: 10.1016/j.asjsur.2023.04.104.
  • Mende K, Kamphuis SJM, Schmid V, Schaefer DJ, Kaempfen A, Gohritz A. 2023. Early postoperative recovery after modified ultra-minimally invasive sonography-guided thread Carpal Tunnel release. J Pers Med, 13(4): 610.
  • Murthy PG. Goljan P, Mendez G, Jacoby SM, Shin EK, Osterman AL. 2015. Mini-open versus extended open release for severe carpal tunnel syndrome. HAND, 10(1): 34-39.
  • Oertel J, Schroeder HWS, Gaab MR. 2006. Dual-portal endoscopic release of the transverse ligament in Carpal Tunnel Syndrome: Results of 411 procedures with special reference to technique, efficacy and complications. Neurosurgery, 59(2): 333-340.
  • Önder H. 2018. Nonparametric statistical methods used in biological experiments. BSJ Eng Sci, 1(1): 1-6.
  • Osiak K, Elnazir P, Walocha JA, Pasternak A. 2022. Carpal tunnel syndrome: state-of-the-art review. Folia Morphol (Warsz), 81(4): 851-862.
  • Palmer AK, Toivonen DA. 1999. Complications of endoscopic and open carpal tunnel release. J Hand Surg Am, 24(3): 561-565.
  • Papanicolaou GD, McCabe SJ, Firrell J. 2001. The prevalence and characteristics of nerve compression symptoms in the general population. J Hand Surg Am, 26(3): 460-466.
  • Pfeffer GB, Gelberman RH, Boyes JH, Rydevik B. 1988. The history of carpal tunnel syndrome. J Hand Surg Am, 13(1): 28-34.
  • Rengahary S. 1985. Entrapment neuropathies. In: Wilkins R, editor. Neurosurgery. Graw Hill Back Company, New York, US, pp: 1771-1777.
  • Skuladottir AT, Bjornsdottir G, Ferkingstad E, Einarsson G, Stefansdottir L, Nawaz MS. 2022. A genome-wide meta-analysis identifies 50 genetic loci associated with carpal tunnel syndrome. Nat Commun, 13(1): 1598.
  • Szabo R, Steinberg D. 1994. Nerve entrapment syndromes in the wrist. J Am Acad Orthop Surg, 2(2): 115-123.
  • Tindall S. 1990. Chronic injuries of peripheral nerves by entrapment. In: Youmans J, editor. Neurological surgery. Saunders W.B., New York, US, pp: 2511-2524.
  • Topuz AK, Eroğlu A, Atabey C, Dinç C, Göçmen NS, Çolak A. 2012. Nüks 18 Karpal Tünel Sendromu olgusu ve nedenlerinin değerlendirilmesi. Türk Nöroşirürji Derg, 22(11): 10-15.
  • Urbaniak JR, Desai SS. 1996. Complications of nonoperative and operative treatment of carpal tunnel syndrome. Hand Clin, 12(2): 325-335.
  • Vögelin E, Mészàros T, Schöni F, Constantinescu MA. 2014. Sonographic wrist measurements and detection of anatomical features in carpal tunnel syndrome. Sci World J, 2014: 1-6.
  • Walker FO. 2023. A 15-year review of clinical practice patterns in Carpal Tunnel syndrome based on continuous certification by the American board of plastic surgery. Plast Reconstr Surg, 151(3): 524e-525e.
  • Yamamoto M, Curley J, Hirata H. 2022. Trends in open vs. endoscopic carpal tunnel release: A comprehensive survey in Japan. J Clin Med, 11(17): 4966.
  • Zhang D, Dyer GSM, Blazar P, Earp BE. 2023. The environmental impact of open versus endoscopic Carpal Tunnel release. J Hand Surg Am, 48(1): 46-52.
  • Zimmerman M, Gottsäter A, Dahlin LB. 2022. Carpal tunnel syndrome and diabetes-A comprehensive review. J Clin Med, 11(6): 1674.
  • Ziyal İM, Döşpğlu M, Duman H, Öztürk A, Gezen F. 1999. Carpal tunnel syndrome: Comparison of the surgical outcomes of 36 cases (50 hands) with the literature data. Düzce Tıp Fak Derg, 1(1): 55-62.

Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome

Year 2023, Volume: 6 Issue: 3, 411 - 415, 01.07.2023
https://doi.org/10.19127/bshealthscience.1233643

Abstract

Carpal tunnel syndrome (CTS) is a condition in which the median nerve is compressed between the transverse ligament and the carpal bones. There are various techniques used in the surgical treatment of CTS. The present study aimed to investigate the reasons for reoperation by examining the reoperated cases diagnosed with CTS. Patients who underwent surgery for CTS at Kahramanmaraş Sütçü İmam University Department of Neurosurgery between January 1, 2015 and September 1, 2022 were evaluated retrospectively. All patients were operated by the same surgical team. Patients who underwent two or more operations with the same diagnosis were included in the study, while those operated for the first time due to CTS and with missing data were excluded. The included patients were analyzed in terms of gender, age, occupation, side of the surgery, presence of systemic diseases causing CTS such as diabetes mellitus (DM), number of the operations they underwent, time until the next operation, surgical technique, and medical branch that performed the surgery (orthopedics, neurosurgery, or plastic surgery). Forty-eight patients who met the study criteria were evaluated. Out of the 48 reoperated patients, 14 were male and 34 were female. Eighteen patients had been operated using the mini-incision open method, while 22 had undergone laparoscopic surgery, including 14 patients with biportal endoscopic surgery, and eight with uniportal endoscopic surgery. Out of the 48 patients, 31 (64.6%), 11 (22.9%), and six patients were first operated by orthopedic and traumatology physicians, plastic and reconstructive surgeons, and neurosurgeons, respectively. The use of open surgical technique is the gold standard in CTS and complete incision of the transverse ligament provides complete decompression of the median nerve. We believe that decompression with closed or small incisions due to aesthetic concerns may not be sufficient and may increase the risk of complications.

References

  • Abdullah AF, Wolber PH, Ditto EW. 1995. Sequelae of carpal tunnel surgery. Neurosurgery, 37(5): 931-936.
  • Açıkgöz B. 2010. Karpal tünel sendromu. In: Demircan N, Zileli M, editors. Periferik sinir cerrahisi. Türk Nöroşirürji Derneği, Ankara, Türkiye, pp: 281–304.
  • Andrew Lee WP, Strickland JW. 1998. Safe carpal tunnel release via a limited palmar incision. Plast Reconstr Surg, 101(2): 418-424.
  • Cage ES, Beyer JJ, Ebraheim NA. 2023. Injections for treatment of carpal tunnel syndrome: A narrative review of the literature. J Orthop, 37: 81-85.
  • Cellocco P, Rossi C, El Boustany S, Di Tanna GL, Costanzo G. 2009. Minimally invasive Carpal Tunnel release. Orthop Clin North Am, 40(4): 441-448.
  • Chow JCY. 1993. The chow technique of endoscopic release of the carpal ligament for carpal tunnel syndrome: Four years of clinical results. Arthrosc J Arthrosc Relat Surg, 9(3): 301-314.
  • Dorwart BB. 1984. Carpal tunnel syndrome: A review. Semin Arthritis Rheum, 14(2): 134-140.
  • Graham JG, Plusch KJ, Hozack BA, Ilyas AM, Matzon JL. 2023. Early revision rate following primary carpal tunnel release. J Hand Surg Glob Online, 5(3): 277-283. DOI: 10.1016/j.jhsg.2023.01.010.
  • Haglin JM, Hinckley NB, Moore ML, Deckey DG, Lai CH, Renfree KJ. 2023. Long-term trends in open vs endoscopic carpal tunnel release among the medicare population in the United States. HAND, 0(0). DOI: 10.1177/15589447231168977.
  • Jimenez DF, Gibbs SR, Clapper AT. 1998. Endoscopic treatment of carpal tunnel syndrome: A critical review. J Neurosurg, 88(5): 817-826.
  • Karjalanen T, Raatikainen S, Jaatinen K, Lusa V. 2022. Update on efficacy of conservative treatments for carpal tunnel syndrome. J Clin Med, 11(4): 950.
  • Khalid SI, Deysher D, Thomson K, Khilwani H, Mirpuri P, Maynard M. 2023. Outcomes following endoscopic versus open carpal tunnel release-a matched study. World Neurosurg, 171: 162-171.
  • Kıbıcı K, Köksal V. 2010. Mini açik teknikle yapilan karpal tünel cerrahisi ve fonksiyonel sonuçlari. Türk Nöroşirürji Derg, 20(1): 7-14.
  • Lam KHS, Wu Y-T, Reeves KD, Galluccio F, Allam AE-S, Peng PWH. 2023, Ultrasound-guided interventions for carpal tunnel syndrome: A systematic review and meta-analyses. Diagnostics, 13(6): 1138.
  • Lanz U. 1977. 2 Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg Am, (1): 44-53.
  • Lee D, van Holsbeeck MT, Janevski PK, Ganos DL, Ditmars DM, Darian VB. 1999. Diagnosis of carpal tunnel syndrome. Radiol Clin North Am, 37(4): 859-872.
  • Lee YS, Youn H, Shin SH, Chung YG. 2023. Minimally invasive Carpal Tunnel release using a hook knife through a small transverse carpal incision: Technique and outcome. Clin Orthop Surg, 15(2): 318.
  • Mao B, Li Y, Yin Y, Zhang Z, Li J, Fu W. 2023. Local corticosteroid injection versus physical therapy for the treatment of carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Asian J Surg, DOI: 10.1016/j.asjsur.2023.04.104.
  • Mende K, Kamphuis SJM, Schmid V, Schaefer DJ, Kaempfen A, Gohritz A. 2023. Early postoperative recovery after modified ultra-minimally invasive sonography-guided thread Carpal Tunnel release. J Pers Med, 13(4): 610.
  • Murthy PG. Goljan P, Mendez G, Jacoby SM, Shin EK, Osterman AL. 2015. Mini-open versus extended open release for severe carpal tunnel syndrome. HAND, 10(1): 34-39.
  • Oertel J, Schroeder HWS, Gaab MR. 2006. Dual-portal endoscopic release of the transverse ligament in Carpal Tunnel Syndrome: Results of 411 procedures with special reference to technique, efficacy and complications. Neurosurgery, 59(2): 333-340.
  • Önder H. 2018. Nonparametric statistical methods used in biological experiments. BSJ Eng Sci, 1(1): 1-6.
  • Osiak K, Elnazir P, Walocha JA, Pasternak A. 2022. Carpal tunnel syndrome: state-of-the-art review. Folia Morphol (Warsz), 81(4): 851-862.
  • Palmer AK, Toivonen DA. 1999. Complications of endoscopic and open carpal tunnel release. J Hand Surg Am, 24(3): 561-565.
  • Papanicolaou GD, McCabe SJ, Firrell J. 2001. The prevalence and characteristics of nerve compression symptoms in the general population. J Hand Surg Am, 26(3): 460-466.
  • Pfeffer GB, Gelberman RH, Boyes JH, Rydevik B. 1988. The history of carpal tunnel syndrome. J Hand Surg Am, 13(1): 28-34.
  • Rengahary S. 1985. Entrapment neuropathies. In: Wilkins R, editor. Neurosurgery. Graw Hill Back Company, New York, US, pp: 1771-1777.
  • Skuladottir AT, Bjornsdottir G, Ferkingstad E, Einarsson G, Stefansdottir L, Nawaz MS. 2022. A genome-wide meta-analysis identifies 50 genetic loci associated with carpal tunnel syndrome. Nat Commun, 13(1): 1598.
  • Szabo R, Steinberg D. 1994. Nerve entrapment syndromes in the wrist. J Am Acad Orthop Surg, 2(2): 115-123.
  • Tindall S. 1990. Chronic injuries of peripheral nerves by entrapment. In: Youmans J, editor. Neurological surgery. Saunders W.B., New York, US, pp: 2511-2524.
  • Topuz AK, Eroğlu A, Atabey C, Dinç C, Göçmen NS, Çolak A. 2012. Nüks 18 Karpal Tünel Sendromu olgusu ve nedenlerinin değerlendirilmesi. Türk Nöroşirürji Derg, 22(11): 10-15.
  • Urbaniak JR, Desai SS. 1996. Complications of nonoperative and operative treatment of carpal tunnel syndrome. Hand Clin, 12(2): 325-335.
  • Vögelin E, Mészàros T, Schöni F, Constantinescu MA. 2014. Sonographic wrist measurements and detection of anatomical features in carpal tunnel syndrome. Sci World J, 2014: 1-6.
  • Walker FO. 2023. A 15-year review of clinical practice patterns in Carpal Tunnel syndrome based on continuous certification by the American board of plastic surgery. Plast Reconstr Surg, 151(3): 524e-525e.
  • Yamamoto M, Curley J, Hirata H. 2022. Trends in open vs. endoscopic carpal tunnel release: A comprehensive survey in Japan. J Clin Med, 11(17): 4966.
  • Zhang D, Dyer GSM, Blazar P, Earp BE. 2023. The environmental impact of open versus endoscopic Carpal Tunnel release. J Hand Surg Am, 48(1): 46-52.
  • Zimmerman M, Gottsäter A, Dahlin LB. 2022. Carpal tunnel syndrome and diabetes-A comprehensive review. J Clin Med, 11(6): 1674.
  • Ziyal İM, Döşpğlu M, Duman H, Öztürk A, Gezen F. 1999. Carpal tunnel syndrome: Comparison of the surgical outcomes of 36 cases (50 hands) with the literature data. Düzce Tıp Fak Derg, 1(1): 55-62.
There are 38 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research Article
Authors

Emrullah Cem Kesilmez 0000-0003-3905-2206

Zafer Yüksel 0000-0002-9234-5908

Early Pub Date June 13, 2023
Publication Date July 1, 2023
Submission Date January 15, 2023
Acceptance Date May 29, 2023
Published in Issue Year 2023 Volume: 6 Issue: 3

Cite

APA Kesilmez, E. C., & Yüksel, Z. (2023). Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome. Black Sea Journal of Health Science, 6(3), 411-415. https://doi.org/10.19127/bshealthscience.1233643
AMA Kesilmez EC, Yüksel Z. Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome. BSJ Health Sci. July 2023;6(3):411-415. doi:10.19127/bshealthscience.1233643
Chicago Kesilmez, Emrullah Cem, and Zafer Yüksel. “Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome”. Black Sea Journal of Health Science 6, no. 3 (July 2023): 411-15. https://doi.org/10.19127/bshealthscience.1233643.
EndNote Kesilmez EC, Yüksel Z (July 1, 2023) Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome. Black Sea Journal of Health Science 6 3 411–415.
IEEE E. C. Kesilmez and Z. Yüksel, “Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome”, BSJ Health Sci., vol. 6, no. 3, pp. 411–415, 2023, doi: 10.19127/bshealthscience.1233643.
ISNAD Kesilmez, Emrullah Cem - Yüksel, Zafer. “Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome”. Black Sea Journal of Health Science 6/3 (July 2023), 411-415. https://doi.org/10.19127/bshealthscience.1233643.
JAMA Kesilmez EC, Yüksel Z. Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome. BSJ Health Sci. 2023;6:411–415.
MLA Kesilmez, Emrullah Cem and Zafer Yüksel. “Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome”. Black Sea Journal of Health Science, vol. 6, no. 3, 2023, pp. 411-5, doi:10.19127/bshealthscience.1233643.
Vancouver Kesilmez EC, Yüksel Z. Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome. BSJ Health Sci. 2023;6(3):411-5.