Decompression for recurrent carpal tunnel syndrome provides significant functional improvement and patient satisfaction

Abstract

This prospective single-centre study describes the functional outcomes, satisfaction and health-related quality of life after open revision carpal tunnel decompression for recurrent carpal tunnel syndrome. The QuickDASH, patient satisfaction and EuroQol-5 dimensions questionnaires were collected preoperatively and postoperatively over a 5-year period (2013–2018). The median time to revision was 13.3 years (range 3.9–35.4 years; interquartile range 7.2–15.9 years). Outcomes were available for 14 hands in 13 patients at a mean of 20 months after revision surgery. The mean preoperative and postoperative QuickDASH scores were 55 and 29, respectively, and the mean improvement in QuickDASH was 26. The mean improvement in EuroQol-5 dimensions score was 0.1, and 13 of the 14 patients were satisfied. The net promoter score was 85. This study confirms that patients undergoing revision open carpal tunnel decompression for recurrent carpal tunnel syndrome experience a significant improvement in function and health-related quality of life. Level of evidence: IV

Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

“…Detailed characteristics are presented in Online Tables S2 and S3. Studies were grouped by type of intervention: open revision (CTRopen, n ¼ 6: Cobb et al, 1996;Impelmans et al, 2001;Kluemper et al, 2019;Stirling et al, 2020;Unglaub et al, 2008;Wadstroem and Nigst, 1986), open revision with flap coverage (CTR flap, n ¼ 11: Craft et al, 2007;Dahlin et al, 2002;Fusetti et al, 2009;Karthik et al, 2012;Mathoulin et al, 2000;Rose et al, 1991;Strickland et al, 1996;Stutz et al, 2008;Sun et al, 2020;Vogelin et al, 2008;Wichelhaus et al, 2015) or implant (CTR-implant, n ¼ 3: Bilasy et al, 2012;Carmona et al, 2019;Nassar and Atiyya, 2014). Most studies in the CTR-flap group used the hypothenar fat pad flap (n ¼ 7).…”

Standard incision and median nerve external neurolysis for recalcitrant carpal tunnel syndrome

“…In a homogenous case series involving 13 patients with recurrent symptoms who underwent surgery using a similar technique, Duclos and Sokolow [23] reported a symptom(s) disappearance rate of 92% over an average of 27.5-month follow-up. More recently, over an average of 20-month follow-up of 14 patients with recurrent CTS treated with a similar technique, other authors reported a statistically significant improvement in QuickDASH scores, improvement in mean EuroQol 5-Dimension 3-Level (EQ-5D-5L) general health questionnaire scores, satisfaction among 13 patients, a net promoter score of 85, and lack of complications [11]. Neither of these studies, however, assessed the speed of symptom-(s) recovery, which was the focus of the present investigation.…”

“…ported in the literature, ranging from simple release to those using complicated flaps and interposing tissue [6,8,10,11]. These perioperative challenges affecting patient consultation are also encountered when opting for the simplest techniquenamely, repeated decompression without added proceduresdue to the limited number of studies exclusively addressing its outcomes [6,12].…”

“…Despite the positive outcomes in the long-term improvement of patients, there have been few studies reporting the speed of postoperative recovery of symptoms and functional recovery following a revision surgery, which both constitute an important aspect of patient satisfaction and preoperative consultation owing to loss of function reflected in the presenting symptoms [1,6,[8][9][10][11]. Therefore, the present study aimed to determine the speed of symptom(s) improvement and early functional recovery pattern(s) following a simple revision technique that included repeated decompression through a standard incision and median nerve external neurolysis without any additional procedures.…”

High-resolution sonographic study of the communicating branch of Berrettini: an anatomical feasibility study

“…However, revision surgery is required in in 5-10% of patients (Westenberg et al, 2020). Repeated decompression with or without external or internal neurolysis has been reported as the standard technique (Stirling et al, 2020;Unglaub et al, 2008). In this situation, we now carry out preoperative bilateral ultrasound examination.…”