Short-Term Outcomes of Carpal Tunnel Release in Patients with CRPS-Like Symptoms

Öz

ABSTRACT Introduction Some patients diagnosed with complex regional pain syndrome (CRPS) may have an underlying peripheral nerve trigger, including mechanical irritation of the median nerve within the carpal tunnel. This study evaluated the short-term outcomes of carpal tunnel release in adults with persistent CRPS-like symptoms and suspected irritative carpal tunnel syndrome. Methods This retrospective case series included adult patients who underwent mini-open carpal tunnel release after failing at least three months of medical treatment and hand therapy. Patients were assessed preoperatively and six weeks postoperatively using the visual analog scale (VAS), Patient-Specific Functional Scale (PSFS), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, grip strength, and tripod pinch strength. Preoperative and postoperative values were compared using the two-sided exact Wilcoxon signed-rank test. Results There were eight patients with a mean age of 55 ± 13.2 years. The median VAS score decreased from 8 to 0, the median PSFS score increased from 2.9 to 8.1, and the median DASH score decreased from 64.5 to 16.5 at six weeks postoperatively (p = 0.008 for all comparisons). Median grip strength increased from 8.3 to 10.2 kg, and median tripod pinch strength increased from 2.9 to 3.7 kg. Conclusions Carpal tunnel release was associated with significant short-term improvements in pain and patient-reported hand function in selected adults with persistent CRPS-like symptoms and suspected irritative carpal tunnel syndrome. Median nerve irritation should be considered as a potentially treatable peripheral contributor in patients who do not improve with conventional CRPS treatment. Larger prospective studies with longer follow-up are needed. Keywords: complex regional pain syndrome; irritative carpal tunnel syndrome; carpal tunnel release; median nerve; neuropathic pain

Anahtar Kelimeler

• Carpal Tunnel Release
• irritative carpal tunnel syndrome
• Complex regional pain syndrome (CRPS)
• neuropathic pain
• median nerve

KBAS benzeri semptomları olan hastalarda karpal tünel gevşetme ameliyatının erken dönem sonuçları

Öz

ÖZET Giriş Kompleks bölgesel ağrı sendromu (KBAS) tanısı konmuş bazı hastalarda, bu semptomların (karpal tünel içindeki median sinirin mekanik irritasyonu gibi) altta yatan bir periferik sinir tetikleyicisi olabilir. Bu çalışmada, kalıcı CRPS benzeri semptomları olan ve irritatif karpal tünel sendromundan şüphelenilen yetişkinlerde karpal tünel gevşetme ameliyatının erken dönem sonuçlarını değerlendirildi. Yöntemler Bu retrospektif vaka serisi, en az üç ay süren tıbbi tedavi ve el terapisinden fayda görmeyen ve mini-açık karpal tünel gevşetme ameliyatı geçiren yetişkin hastaları içermektedir. Hastalar ameliyat öncesi ve ameliyat sonrası altıncı haftada görsel analog skala (VAS), Hastaya Özgü Fonksiyonel skala (PSFS), Kol, Omuz ve El Engellilikleri (DASH) anketi, kavrama gücü ve üç parmak pinç gücü değerlerine bakılarak değerlendirildi. Ameliyat öncesi ve sonrası değerler, two-sided exact Wilcoxon signed-rank test kullanılarak karşılaştırıldı. Sonuçlar Ortalama yaş 55 ± 13,2 yıl olan sekiz hasta değerlendirildi. Ameliyat sonrası altı haftada ortalama VAS skoru 8'den 0'a düştü, ortalama PSFS skoru 2,9'dan 8,1'e yükseldi ve ortalama DASH skoru 64,5'ten 16,5'e düştü (tüm karşılaştırmalar için p = 0,008). Ortalama kavrama gücü 8,3 kg'dan 10,2 kg'a, ortalama üç parmak pinç gücü ise 2,9 kg'dan 3,7 kg'a yükseldi. Sonuç ve Öneriler Karpal tünel gevşetme ameliyatı, inatçı KBAS benzeri semptomları olan ve irritatif karpal tünel sendromundan şüphelenilen seçilmiş yetişkinlerde ağrı ve hasta tarafından bildirilen el fonksiyonlarında erken dönemde önemli iyileşmeler sağlamaktadır. Median sinir irritasyonu, geleneksel KBAS tedavisiyle iyileşme göstermeyen hastalarda potansiyel olarak tedavi edilebilir bir periferik etken olarak değerlendirilmelidir. Daha uzun takip süresi olan daha büyük prospektif çalışmalara ihtiyaç vardır. Anahtar kelimeler: kompleks bölgesel ağrı sendromu; irritatif karpal tünel sendromu; karpal tünel gevşetme; median sinir; nöropatik ağrı

Anahtar Kelimeler

• Karpal tünel gevşetme
• İrritatif karpal tünel sendromu
• Kompleks bölgesel ağrı sendromu (KBAS)
• Nöropatik ağrı
• Median sinir

Kaynakça

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