Factors Associated with Upper Extremity Functionality After Mini-Open Release Surgery for Treatment of Carpal Tunnel Syndrome

Year 2024, Volume: 6 Issue: 2, 260 - 265, 16.05.2024

Mehmet Yetiş , Mehmet Canlı , Şafak Kuzu , İrem Valamur , Hikmet Kocaman , Nazım Tolgahan Yıldız , Anıl Özüdoğru , Halil Alkan , Aysu Yetiş

https://doi.org/10.37990/medr.1462617

Abstract

Aim: The objective of this study was to investigate the correlation between upper extremity functionality, pain intensity, muscle strength, and symptom severity among patients diagnosed with carpal tunnel syndrome (CTS) who underwent mini-open release surgery.
Material and Method: This retrospective study entailed the review of medical records of 70 patients diagnosed with CTS who underwent mini-open release surgery between January 2021 and January 2023. Data were collected from preoperative assessments and routine follow-up evaluations conducted at 3 months post-surgery. Upper extremity functionality was assessed utilizing the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire, pain severity was determined using the Visual Analog Scale (VAS), muscle strength was evaluated through hand grip strength, and disease severity was measured using the Boston Carpal Tunnel Questionnaire (BCTQ).
Results: A statistically significant improvement was observed in DASH questionnaire scores, VAS scores, hand grip strength, and BCTQ scores at the 3-month follow-up compared to preoperative values (p<0.05). Furthermore, significant correlations were found between DASH questionnaire scores and VAS scores, hand grip strength, and BCTQ scores during postoperative assessments (p<0.05).
Conclusion: Mini-open-release surgery demonstrates effectiveness as a surgical approach for achieving favorable clinical outcomes in patients with CTS. Furthermore, our findings suggest that postoperative upper extremity functionality may be influenced by factors such as pain intensity, symptom severity, and hand grip strength. Therefore, we advocate for the integration of these factors into postoperative patient evaluation protocols and treatment programs to optimize patient outcomes.

Keywords

Carpal tunnel syndrome, functionality, treatment, mini-open-release surgery

Ethical Statement

Ethical approval of the study was approved by the local ethics committee (Number:5-2024/11, Date: 07.03.2024).

References

• Keith MW, Masear V, Chung KC, et al. American academy of orthopaedic surgeons clinical practice guideline on: diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2009;91:2478-9.
• Neal SL, Fields KB. Peripheral nerve entrapment and injury in the upper extremity. Am Fam Physician. 2010;81:147-55.
• Luckhaupt SE, Dahlhamer JM, Ward BW, et al. Prevalence and work‐relatedness of carpal tunnel syndrome in the working population, United States, 2010 national health interview survey. Am J Ind Med. 2013;56:615-24.
• Mitake T, Iwatsuki K, Hirata H. Differences in characteristics of carpal tunnel syndrome between male and female patients. J Orthop Sci. 2020;25:843-6.
• Katz JN, Losina E, Amick III BC, et al. Predictors of outcomes of carpal tunnel release. Arthritis Rheum. 2001;44:1184-93.
• Bobowik PŻ. Effectiveness of physiotherapy in carpal tunnel syndrome (CTS). Advances in Rehabilitation. 2019;33:47-58.
• Hybbinette C-H, Mannerfelt L. The carpal tunnel syndrome: a retrospective study of iOQ operated patients. Acta Orthop Scand. 1975;46:610-20.
• Kulick MI, Gordillo G, Javidi T, et al. Long-term analysis of patients having surgical treatment for carpal tunnel syndrome. J Hand Surg Am. 1986;11:59-66.
• Verdugo RJ, Salinas RA, Castillo JL, Cea G. Surgical versus non‐surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. 2008;CD001552.
• You H, Simmons Z, Freivalds A, et al. Relationships between clinical symptom severity scales and nerve conduction measures in carpal tunnel syndrome. Muscle Nerve. 1999;22:497-501.
• Burger M, Kriel R, Damon A, et al. The effectiveness of low-level laser therapy on pain, self-reported hand function, and grip strength compared to placebo or “sham” treatment for adults with carpal tunnel syndrome: a systematic review. Physiother Theory Pract. 2017;33:184-97.
• Arroari S, Spence A. Roy, carpal tunnel syndrome. Ulster Med J. 2008;77:6-17.
• Nazari G, Shah N, MacDermid JC, Woodhouse L. The impact of sensory, motor and pain impairments on patient-reported and performance based function in carpal tunnel syndrome. Open Orthop J. 2017;11:1258-67.
• Kürklü M, Türkkan S, Tüzün HY. Carpal tunnel syndrome and other entrapment neuropathies of the median nerve. TOTBİD Dergisi. 2015;14:566-71.
• Keskinöz PC, Ergin G, Bakırhan S, Özden A. Does muscular strength and endurance affect the functions of the upper extremity in patients with carpal tunnel syndrome?. Turkish Journal of Physiotherapy and Rehabilitation. 2020;31:58-65.
• Cellocco P, Rossi C, Bizzarri F, et al. Mini-open blind procedure versus limited open technique for carpal tunnel release: a 30-month follow-up study. J Hand Surg Am. 2005;30:493-9.
• Düger T, Yakut E, Öksüz Ç, et al. Kol, omuz ve el sorunları (disabilities of the arm, shoulder and hand-DASH) anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Fizyoterapi Rehabilitasyon. 2006;17:99-107.
• Hudak PL, Amadio PC, Bombardier C, et al. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head). Am J Ind Med. 1996;29:602-8. Erratum in: Am J Ind Med 1996;30:372.
• Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8:1153-7.
• Shechtman O, Gestewitz L, Kimble C. Reliability and validity of the DynEx dynamometer. J Hand Ther. 2005;18:339-47.
• Sezgin M, İncel NA, Sevim S, et al. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and validity of the Turkish version of the Boston Questionnaire. Disabil Rehabil. 2006;28:1281-5.
• Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018;126:1763-8.
• van den Broeke LR, Theuvenet WJ, van Wingerden JJ. Effectiveness of mini-open carpal tunnel release: an outcome study. Arch Plast Surg. 2019;46:350-8.
• Bai J, Kong L, Zhao H, et al. Carpal tunnel release with a new mini-incision approach versus a conventional approach, a retrospective cohort study. Int J Surg. 2018;52:105-9.
• Muhammed Fazil VV, Surendran S, Karuppal R, et al. Mini-open transverse flexor crease incision versus limited longitudinal palmar incision carpal tunnel release: a short term outcome study. J Orthop. 2022;29:15-21.
• Calleja H, Tsai T-M, Kaufman C. Carpal tunnel release using the radial sided approach compared with the two-incision approach. Hand Surg. 2014;19:375-80.
• Atroshi I, Larsson G-U, Ornstein E, et al. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ. 2006;332:1473.
• Thoma A, Veltri K, Haines T, Duku E. A meta-analysis of randomized controlled trials comparing endoscopic and open carpal tunnel decompression. Plast Reconstr Surg. 2004;114:1137-46.
• Umay E, Karaahmet ZÖ, Avluk Ö, et al. Relationship between the severity of compression and clinical symptoms, physical, functional and quality of life findings in patients with carpal tunnel syndrome. Turk J Phys Med Rehab. 2011;57:193-200.
• Tamburin S, Cacciatori C, Marani S, Zanette G. Pain and motor function in carpal tunnel syndrome: a clinical, neurophysiological and psychophysical study. J Neurol. 2008;255:1636-43.
• Greenslade J, Mehta R, Belward P, Warwick D. Dash and Boston questionnaire assessment of carpal tunnel syndrome outcome: what is the responsiveness of an outcome questionnaire?. J Hand Surg Br. 2004;29:159-64.
• Bakhsh H, Ibrahim I, Khan W, et al. Assessment of validity, reliability, responsiveness and bias of three commonly used patient-reported outcome measures in carpal tunnel syndrome. Ortop Traumatol Rehabil. 2012;14:335-40.
• Akçay İH, Demirdel E. The investigation of the results of clinical evaluation, pain, functional status and sleep quality according to electrodiagnostic test results in females with carpal tunnel syndrome: a pilot study. IGUSABDER. 2022:526-39.
• Singh GK, Srivastava S. Grip strength of occupational workers in relation to carpal tunnel syndrome and individual factors. Int J Occup Saf Ergon. 2020;26:296-302.
• Ise M, Saito T, Katayama Y, et al. Relationship between clinical outcomes and nerve conduction studies before and after surgery in patients with carpal tunnel syndrome. BMC Musculoskelet Disord. 2021;22:882.