Thumb Opposition Recovery Following Surgery for Severe Carpal Tunnel Syndrome: A Clinical, Radiological, and Electrophysiological Pilot Study

Garg, Bhavuk; Manhas, Vikrant; Vardhan, Anand; Srivastava, Deep Narayan; Das, Chandan Jyoti; Vibha, Deepti; Gupta, Vivek; Malhotra, Rajesh; Kotwal, Prakash

doi:10.1016/j.jhsa.2018.05.004

Cited by 14 publications

(8 citation statements)

References 25 publications

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“…Garg et al [ 17 ] examined the predictors of thumb opposition recovery after CTS surgery. In this study, patients suffering from severe CTS with thenar atrophy and detectable CMAP of the wrist showed promising improvements following CTS surgery.…”

Section: Discussionmentioning

confidence: 99%

Clinical predictors of surgical outcomes of severe carpal tunnel syndrome patients: utility of palmar stimulation in a nerve conduction study

Sasaki

Terao

Saito

et al. 2020

BMC Musculoskelet Disord

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Background Carpal tunnel syndrome is a common peripheral nerve compression disorder. However, there is no established opinion regarding the predictors of symptom improvement after surgery. This study aimed to identify the predictors of surgical outcomes of severe carpal tunnel syndrome patients. Methods In the patients who underwent a carpal tunnel syndrome surgery, we selected the patients who had a preoperative Bland’s classification of grade 5 or 6, and assessed for the changes in Bland’s classification grade before and after surgery. Those who showed improvement from preoperative grades 5–6 to postoperative grades 1–4 comprised the improvement group. In contrast, those who did not show improvement and had postoperative grades 5 or 6 comprised the non-improvement group. In a nerve conduction study, amplitudes of the compound muscle action potential and sensory nerve action potential of the palms were assessed between the improvement and non-improvement groups. Results Among the 60 hands of 46 patients who had a preoperative Bland’s classification of grade 5 or 6, 49 hands of 37 patients comprised the improvement group, and 11 hands of 9 patients comprised the non-improvement group. The amplitudes of the compound muscle action potential and sensory nerve action potential of the palms before surgery were significantly higher in the improvement group. The degree of improvement in Bland’s classification grade was correlated with the degree of clinical symptom improvement. Conclusions Amplitudes of compound muscle action potential and sensory nerve action potential before surgery induced by palmar stimulation can predict improvements in nerve conduction study scores and clinical findings after surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Clinical predictors of surgical outcomes of severe carpal tunnel syndrome patients: utility of palmar stimulation in a nerve conduction study

Sasaki

Terao

Saito

et al. 2020

BMC Musculoskelet Disord

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“…Early-stage CTS, prior to thenar atrophy, can be treated conservatively by using a night splint, anti-inflammatory injection, or surgical intervention [1]; however, for advanced-stage CTS with thenar atrophy, carpal tunnel release surgery is the first choice [3,6,7]. Despite carpal tunnel release surgery for CTS with thenar atrophy, recovery of the atrophy takes longer than a year after surgery in most cases [8]. Therefore, performing surgery before thenar atrophy develops is key to avoid inconvenience in daily life activities.…”

Section: Introductionmentioning

confidence: 99%

A Tablet-Based App for Carpal Tunnel Syndrome Screening: Diagnostic Case-Control Study

Fujita

Watanabe

Kuroiwa

et al. 2019

JMIR Mhealth Uhealth

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BackgroundCarpal tunnel syndrome (CTS), the most common neuropathy, is caused by a compression of the median nerve in the carpal tunnel and is related to aging. The initial symptom is numbness and pain of the median nerve distributed in the hand area, while thenar muscle atrophy occurs in advanced stages. This atrophy causes failure of thumb motion and results in clumsiness; even after surgery, thenar atrophy does not recover for an extended period. Medical examination and electrophysiological testing are useful to diagnose CTS; however, visits to the doctor tend to be delayed because patients neglect the symptom of numbness in the hand. To avoid thenar atrophy-related clumsiness, early detection of CTS is important.ObjectiveTo establish a CTS screening system without medical examination, we have developed a tablet-based CTS detection system, focusing on movement of the thumb in CTS patients; we examined the accuracy of this screening system.MethodsA total of 22 female CTS patients, involving 29 hands, and 11 female non-CTS participants were recruited. The diagnosis of CTS was made by hand surgeons based on electrophysiological testing. We developed an iPad-based app that recorded the speed and timing of thumb movements while playing a short game. A support vector machine (SVM) learning algorithm was then used by comparing the thumb movements in each direction among CTS and non-CTS groups with leave-one-out cross-validation; with this, we conducted screening for CTS in real time.ResultsThe maximum speed of thumb movements between CTS and non-CTS groups in each direction did not show any statistically significant difference. The CTS group showed significantly slower average thumb movement speed in the 3 and 6 o’clock directions (P=.03 and P=.005, respectively). The CTS group also took a significantly longer time to reach the points in the 2, 3, 4, 5, 6, 8, 9, and 11 o’clock directions (P<.05). Cross-validation revealed that 27 of 29 CTS hands (93%) were classified as having CTS, while 2 of 29 CTS hands (7%) did not have CTS. CTS and non-CTS were classified with 93% sensitivity and 73% specificity.ConclusionsOur newly developed app could classify disturbance of thumb opposition movement and could be useful as a screening test for CTS patients. Outside of the clinic, this app might be able to detect middle-to-severe-stage CTS and prompt these patients to visit a hand surgery specialist; this may also lead to medical cost-savings.

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“…Thumb opposition consists of pronation and palmar abduction and is important for hand functions such as pulp pinch and grasp (Edmunds, 2011; Lee et al., 2003). Measurements of the extent of opposition is often used in reports of disorder that cause impairment of thumb opposition, such as severe carpal tunnel syndrome (CTS) and trapeziometacarpal (TMC) osteoarthritis (OA) (Badia and Sambandam, 2006; Garg et al., 2019).…”

Section: Introductionmentioning

confidence: 99%

Measurement of thumb pronation and palmar abduction angles with a small motion sensor: a comparison with Kapandji scores

Kuroiwa

Nimura

Suzuki

et al. 2019

J Hand Surg Eur Vol

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The Kapandji score is used widely to record thumb opposition and is the only alternative to angular measurements. We aimed to verify the extent to which the Kapandji score reflects the angle of pronation. We recruited volunteers with unaffected upper limbs (33 hands) and patients with carpal tunnel syndrome (20 hands). We attached a small gyroscope to the thumb metacarpal and measured the pronation and palmar abduction angles at each position of the Kapandji score in both groups. The Kapandji score showed a strong ceiling effect, and the increase in angle size at each Kapandji score levelled off around a score of 6 in both groups. A Kapandji score greater than 6 does not necessarily reflect thumb opposition. Level of Evidence: III

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Thumb Opposition Recovery Following Surgery for Severe Carpal Tunnel Syndrome: A Clinical, Radiological, and Electrophysiological Pilot Study

Cited by 14 publications

References 25 publications

Clinical predictors of surgical outcomes of severe carpal tunnel syndrome patients: utility of palmar stimulation in a nerve conduction study

Clinical predictors of surgical outcomes of severe carpal tunnel syndrome patients: utility of palmar stimulation in a nerve conduction study

A Tablet-Based App for Carpal Tunnel Syndrome Screening: Diagnostic Case-Control Study

Measurement of thumb pronation and palmar abduction angles with a small motion sensor: a comparison with Kapandji scores

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