Predicting the Outcome of Revision Carpal Tunnel Release

被引:40
作者
Beck, John D. [1 ]
Brothers, Justin G. [1 ]
Maloney, Patrick J. [1 ]
Deegan, John H. [1 ]
Tang, Xiaoqin [1 ]
Klena, Joel C. [1 ]
机构
[1] Geisinger Med Ctr, Dept Orthopaed, Danville, PA 17822 USA
来源
JOURNAL OF HAND SURGERY-AMERICAN VOLUME | 2012年 / 37A卷 / 02期
关键词
Revision carpal tunnel; steroid injection; recurrent carpal tunnel; SURGERY; QUESTIONNAIRE; REOPERATION; RECURRENT;
D O I
10.1016/j.jhsa.2011.10.040
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Purpose To test the hypothesis that the result of steroid injection in the carpal tunnel in a patient with recurrent carpal tunnel symptoms would serve as a good predictor of the outcome of later carpal tunnel release (CTR). Methods We conducted a retrospective review of all patients who underwent revision CTR for recurrent or persistent carpal tunnel syndrome over a 2-year period at our institution. A total of 28 wrists in 23 patients met inclusion criteria. We evaluated patients to determine whether preoperative factors or the result of injection predicted the outcome of revision CTR. We used a multivariate logistic regression analysis to predict surgical success when multiple preoperative findings were considered. Results Of the 23 wrists that had relief from injection, 20 had symptom improvement with surgery. Although they did not reach statistical significance, the sensitivity and positive predictive value for injection alone predicted outcome of revision CTR in 87%. No patient characteristic or physical examination finding predicted successful revision CTR. Multivariate logistic regression analysis combining preoperative injection results with physical examination findings (numbness and/or motor weakness in median nerve distribution, positive Durkin test, and positive Phalen test) provided a sensitivity of 100% and a specificity of 80%. Conclusions In a small group of patients with recurrent carpal tunnel syndrome, cortisone injection into the carpal tunnel was not, by itself, a statistically significant predictor of successful revision surgery. However, relief from injection as a diagnostic test for predicting successful revision CTR was found to have both a high sensitivity and a positive predictive value. Coupled with the components of the physical examination, injection provides a good screening test to establish surgical success with revision CTR. Copyright © 2012 by the American Society for Surgery of the Hand.
引用
收藏
页码:282 / 287
页数:6
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