HOW DO BOARD-CERTIFIED HAND SURGEONS MANAGE CARPAL TUNNEL SYNDROME? A NATIONAL SURVEY

Aldo Okamura, Bruna Calvi Guidetti, Raphael Caselli, Jonas Aparecido Borracini, Vinicius Ynoe DE Moraes, João Carlos Belloti, Aldo Okamura, Bruna Calvi Guidetti, Raphael Caselli, Jonas Aparecido Borracini, Vinicius Ynoe DE Moraes, João Carlos Belloti

Abstract

Objective: To evaluate tendencies in the planning, diagnosis, and treatment of carpal tunnel syndrome (CTS) by Brazilian hand surgery specialists.

Methods: This cross-sectional study was performed at the 36th Brazilian Hand Surgery Congress. We prepared a questionnaire about preferences in the management of CTS, and board-certified hand surgeons that attended the congress were asked to fill out the questionnaires. A total of 174 questionnaires were analyzed.

Results: Electromyography examination is used by most surgeons. Night splinting is the most commonly used conservative treatment option. Half of the surgeons utilized prophylactic antibiotics. Most of the interviewees conduct inpatient surgery in the operating room and prefer intravenous regional anesthesia. Most of surgeons use the standard open technique associated with proximal release of the antebrachial fascia and do not perform neurolysis. Compressive dressings are most commonly used for 7 days.

Conclusion: The approach to CTS among Brazilian hand surgeons with regard to pre-, intra-, and post-operatory conduct is consistent with the international literature. However, there is a need to reflect and conduct new studies on non-surgical treatment involving local corticosteroid injection, use of prophylactic antibiotics, hospital admission, and type of anesthesia in order to provide more cost-effective approach to surgical treatment for CTS. Level of Evidence V; Expert opinion.

Keywords: Carpal tunnel syndrome; Cross-sectional studies; Epidemiology; Questionnaire; Therapy.

Conflict of interest statement

All authors declare no potential conflict of interest related to this article.

Figures

Figure 1. Distribution of responders.
Figure 1. Distribution of responders.
Figure 2. Responders practice time in hand…
Figure 2. Responders practice time in hand surgery speciality.
Figure 3. Use of electrodiagnostic test in…
Figure 3. Use of electrodiagnostic test in CTS.
Figure 4. Anesthesia preference for CTS surgery.
Figure 4. Anesthesia preference for CTS surgery.
Figure 5. Preference regarding to median nerve…
Figure 5. Preference regarding to median nerve neurolysis.
Figure 6. CTS postoperative care preferences.
Figure 6. CTS postoperative care preferences.

References

    1. Keith MW, Masear V, Chung KC, Maupin K, Andary M, Amadio PC. American Academy of Orthopaedic Surgeons Clinical Practice Guideline on diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2009;91(10):2478–2479.
    1. Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. 2008;8(4):CD001552–CD001552.
    1. Zuo D, Zhou Z, Wang H, Liao Y, Zheng L, Hua Y, Cai Z. Endoscopic versus open carpal tunnel release for idiopathic carpal tunnel syndrome a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2015;10:12–12.
    1. Leinberry CF, Rivlin M, Maltenfort M, Beredjiklian P, Matzon JL, Ilyas AM, et al. Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: a 25-year perspective. J Hand Surg Am. 2012;37(10):1997–2003.e3.
    1. O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003;(1):CD003219–CD003219.
    1. Page MJ, O'Connor D, Pitt V, Massy-Westropp N. Exercise and mobilization interventions for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;13(6):CD009899–CD009899.
    1. Blazar PE, 4th Floyd WE, Han CH, Rozental TD, Earp BE. Prognostic indicators for recurrent symptoms after a single corticosteroid injection for carpal tunnel syndrome. J Bone Joint Surg Am. 2015;97(19):1563–1570.
    1. Atroshi I, Lyrén PE, Ornstein E, Gummesson C. The six-item CTS symptoms scale and palmar pain scale in carpal tunnel syndrome. J Hand Surg Am. 2011;36(5):788–794.
    1. Sears ED, Swiatek PR, Hou H, Chung KC. Utilization of preoperative electrodiagnostic studies for carpal tunnel syndrome: an analysis of national practice patterns. J Hand Surg Am. 2016;41(6):665–672.
    1. Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand the Dalhousie Project clinical phase. J Hand Surg Am. 2005;30(5):1061–1067.
    1. Leblanc MR, Lalonde DH, Thoma A, Bell M, Wells N, Allen M. Is main operating room sterility really necessary in carpal tunnel surgery A multicenter prospective study of minor procedure room field sterility surgery. Hand (N Y) 2011;6(1):60–63.
    1. Robles DS, Esteves S, Liça M, Lopes D, Lima S, Sousa C. Tratamento da síndrome do túnel cárpico anestesia geral versus local. Rev Port Ortop Traum. 2015;23(3):217–224.
    1. Harness NG, Inacio MC, Pfeil FF, Paxton LW. Rate of infection after carpal tunnel release surgery and effect of antibiotic prophylaxis. J Hand Surg Am. 2010;35(2):189–196.
    1. Meireles LM, Santos JBG, Santos LL, Branco MA, Faloppa F, Leite VM. Avaliação do questionário de Boston aplicado no pós-operatório tardio da Síndrome do Túnel do Carpo operados pela técnica de retinaculótomo de Paine por via palmar. Acta Ortop Bras. 2006;14(3):126–132.
    1. Paryavi E, Zimmerman RM, Means KR., Jr Endoscopic compared with open operative treatment of carpal tunnel syndrome. JBJS Rev. 2016;4(6)
    1. Phalen GS. The carpal-tunnel syndrome Seventeen years' experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am. 1966;48(2):211–228.
    1. Cobb TK, Dalley BK, Posteraro RH, Lewis RC. Anatomy of the flexor retinaculum. J Hand Surg Am. 1993;18(1):91–99.
    1. Okutsu I, Hamanaka I, Tanabe T, Takatori Y, Ninomiya S. Complete endoscopic carpal tunnel release in long-term haemodialysis patients. J Hand Surg Br. 1996;21(5):668–671.
    1. Mackinnon SE, McCabe S, Murray JF, Szalai JP, Kelly L, Novak C. Internal neurolysis fails to improve the results of primary carpal tunnel decompression. J Hand Surg Am. 1991;16(2):211–218.
    1. Ritting AW, Leger R, O'Malley MP, Mogielnicki H, Tucker R, Rodner CM. Duration of postoperative dressing after mini-open carpal tunnel release a prospective, randomized trial. J Hand Surg Am. 2012;37(1):3–8.

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