Carpal Tunnel Syndrome: correlation between preoperative clinical findings and intraoperative findings

Soran Salahuddin  Raoof; Omer Ali Rafiq  Barawi; Rebwar Abdalla  Allaf

doi:10.56056/amj.2020.126

Authors

Soran Salahuddin Raoof M.B.Ch.B., KHCMS. Orthopedics trainee. Shar Teaching Hospital
Omer Ali Rafiq Barawi M.B.Ch.B., F.I.C.M.S. Orthopaedic, M.D.O.A. the Netherlands, Prof. orthopedic surgeon. School of Medicine/Sulaimani University, Sulaymaniyah, Kurdistan Region, Iraq
Rebwar Abdalla Allaf M.B.Ch.B., H.D. Ortho, H.D. Hand Surgery, ASSH membership 2016, Orthopedic & Hand Surgeon. Sulaymaniyah Teaching Hospital

DOI:

https://doi.org/10.56056/amj.2020.126

Keywords:

Carpal tunnel syndrome, Intraoperative findings, Preoperative clinical findings

Abstract

Background and objectives: Carpal tunnel syndrome is a puzzling and disabling condition which can be diagnosed on clinical bases only. The aim of this study is to find the correlation between specific clinical findings and intraoperative findings to help us define which clinical finding is the most dependable.

Methods: Sixty-five patients (72 hands) with carpal tunnel syndrome were enrolled in this study. Seven clinical findings (pain & parasthesia, touch sensation, two-point discrimination, weak thumb abduction test, Phalen test, Tinel test & Durkan test) were correlated with 3 intraoperative findings (hour-glass deformity, fibrosis & vascular interruption).

Results: Pain and paresthesia was present in all 65(100%) of the cases, of this 47(72.3%) had hourglass formation, while fibrosis was present in 58(89.3%) and in both conditions; their correlation was highly significant. Decreased 2 point discrimination was present in 50(76.9%) of the cases, of this 41(63.1%) had hourglass formation and fibrosis was present in 47(72.3%) and in both conditions; their correlation was highly significant. Vascular interruption was present in 41(63.1%) and the correlation was highly significant too.

Conclusions: Most clinical findings were associated with specific intraoperative findings. Of all; pain & parasthesia with 2-point discrimination were associated with 2 and 3 of 3 intraoperative findings respectively and regarded as the most relevant clinical findings when positive.

Downloads

Download data is not yet available.

References

Kandhan T, Gayathri R, VishnuPriya V. Awareness of carpal tunnel syndrome – a survey. Int. J. Pharm. Sci. Rev. Res. 2017; 44(1): 24-6.

Kim PS, Kwon WK, Kim JH, Park YK, Moon HJ. The Use of Arm Tourniquet in Unilateral Carpal Tunnel Release: Does It Actually Have Advan- tage on Surgical Time & Clinical Outcome? . The Nerve. 2016;2(2):38-41.

Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: A review of the recent literature. Open Orthop J. 2012;6:69-76.

Karaca S, Akpolat AO, Oztermeli A, Bildik C, Erdem MN, Saygi B. Comparison of local versus general anaesthesia for carpal tunnel release. Austin J Musculoskelet Disord. 2017;4(2):1043.

Yazdanpanah P, Aramesh S, Mousavizadeh A, Ghaffari P, Khosravi Z, Khademi A. Prevalence and severity of carpal tunnel syndrome in women. Iranian J Publ Health. 2012;41(2):105.

Tiftikci U, Serbest S. Is epineurectomy necessary in the surgical management of carpal tunnel syndrome? Niger J Clin Pract. 2017;20(2):211- 4.

Aroori S, Spence RAJ. Carpal tunnel syndrome. Ulster Med J. 2008; 77, (1) 6-17.

Yücel H, Seyithano lu H. Choosing the most efficacious scoring method for carpal tunnel syndrome. Acta Orthop Traumatol Turc. 2015;49(1):23- 9.

Amirfeyz R, Clark D, Parsons B et al. Clinical tests for carpal tunnel syndrome in contemporary practice. Arch Orthop Trauma Surg. 2011;131(4):471-4.

Britz GW, Haynor DR, Kuntz C, Goodkin R, Gitter A, Kliot M. Carpal tunnel syndrome: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery. 1995;37(6):1097-103.

Cheng CJ, Mackinnon-Patterson B, Beck JL, Mackinnon SE. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. J Hand Surg Am. 2008;33(9):1518-24.

Rivlin M, Kachooei AR, Wang ML, Ilyas AM. Electrodiagnostic grade and carpal tunnel release outcomes: a prospective analysis. J Hand Surg Am. 2018;43(5):425-31.

D’Arcy CA, McGee S. Does this patient have carpal tunnel syndrome? JAMA. 2000;283(23):3110-7.

Middleton SD, Anakwe RE. Carpal tunnel syndrome. BMJ. 2014;349: g6437.

Tuncali D, Barutcu AY, Terzioglu A, Aslan G. Carpal tunnel syndrome: comparison of intraoperative structural changes with clinical and electrodiagnostic severity. Br J Plast Surg. 2005;58(8):1136-42.

Nau HE, Lange B. Relationships between Preoperative Symptoms, Electrophysiological and Intraoperative Findings, and the Outcome in Patients with Carpal Tunnel Syndrome. In Peripheral Nerve Lesions 1990 (pp. 273-7). Springer, Berlin, Heidelberg.

Leblanc KE, Cestia W. Carpal tunnel syndrome. Am Fam Physician. 2011;83(8):952-8.

Rhoades CE, Mowery CA, Gelberman RH. Results of internal neurolysis of the median nerve for severe carpal tunnel syndrome. J Bone Joint Surg Am. 1985;67(2):253-6.

Phalen GS. The Carpal-Tunnel Syndrome: Seventeen years’ experience in diagnosis and treatment of six hundred fifty-four hands. JBJS. 1966;48(2):211-28.

Tanzer RC. The carpal tunnel syndrome: a clinical and anatomical study. JBJS. 1959;41(4):626-34.

Langloh ND, Linscheid RL. Recurrent and unrelieved carpal tunnel syndrome. Clin Orthop 1972;83:41–7.