Carpal Tunnel Syndrome
Conditions
Keywords
postoperative dressing, postoperative splint, mini-open carpal tunnel release
Brief summary
The purpose of this study is to determine if any difference exists among 3 different postoperative splinting regimens- no splint, removable splint, and plaster non-removable splint- following mini-open carpal tunnel release (CTR) surgery.
Detailed description
We sought to determine if any significant difference in patient-reported or clinical outcomes existed among 3 different postoperative splinting regimens- no splint, removable splint, and plaster non-removable splint- following mini-open carpal tunnel release (CTR) surgery for symptomatic, isolated, nerve conduction study positive carpal tunnel syndrome (CTS). A total of 249 patients received a mini-open CTR and were subsequently randomized into 1 of the 3 splinting regimens to be removed at the first postoperative visit 10-14 days later. Patient-reported outcomes included QuickDASH surveys, Levine-Katz Symptom Severity Scale (SSS) and Functional Status Scale (FSS) and Pain at Rest and in Action using a Numerical Pain Rating Scale (NPRS). Clinical outcomes included wrist range of motion (ROM), grip and lateral pinch strengths. All outcomes were evaluated bilaterally at 10-14 days, 6 weeks, 3 months, 6 months and 12 months after surgery. Demographic information was obtained preoperatively and complications were observed for and recorded throughout the study
Interventions
OTHERNo Splint
The no splint group received a soft dressing consisting of an occlusive petroleum gauze strip (Xeroform, Mansfield, MA) over the wound, one folded 4x4 gauze, and a single wrap of roll gauze around the hand, and the wrist was placed and secured by a Coban wrap (3M, St. Paul, MN). The dressing permitted wrist and finger motion. Patients were further instructed to remove the dressing at five days and place an adhesive bandage (Band-Aid, Johnson & Johnson, New Brunswick, NJ) over the incision.
OTHERRemovable Splint
The removable splint group received a V-strap Wrist support (Medical Specialties, Inc., Charlotte, NC) placed over the identical soft dressing that was placed on the no splint group. The cock-up wrist splint was designed to keep the wrist fixed in a 20 degree extended wrist position. Patients were instructed to wear the splint for comfort as needed during day and night. While the patient was wearing the cock-up splint, only finger motion was permitted. Wrist motion was permitted when the cock-up splint was removed.
OTHERNon-removable Splint
The plaster non-removable splint group received an occlusive petroleum gauze strip placed over the wound, followed by a 4X4 gauze, and a Webril cotton roll wrap (Covidien, Inc., Covidien, Ireland). A 4- inch, 15-layer thick plaster splint was placed across the volar wrist and molded to keep the wrist in approximately 20 degrees of extension allowing full digital range of motion (ROM). The splint was to be kept dry and not removed by the patient.
Sponsors
University of Illinois at Chicago
Anthony L. Logli
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Patients were required to have failed conservative treatment for symptomatic, isolated, nerve conduction study positive CTS.
Exclusion criteria
*
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Lateral Pinch Strength | 10-14 days postoperatively | Lateral pinch strength was taken with a Preston Pinch Gauge. |
| Grip Strength | 10-14 days postoperatively | Grip strength was taken with a Jamar Dynamometer in the 2nd hand position. |
| Wrist Flexion | 10-14 days postoperatively | — |
| Levine-Katz Symptom Severity Scale (SSS) | 10-14 days postoperatively | The Levine-Katz Symptom Severity Scale (SSS) assesses pain, weakness, and sensation with 11 questions the patient rates on a 5-point scale with 5 indicating the most difficult; the average score is reported. |
| QuickDASH | 10-14 days postoperatively | The Quick Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure was designed in 1998 with the goal of providing a more accurate depiction of the everyday symptoms and handicaps exclusively experienced by a patient with an upper extremity musculoskeletal condition. Designed as a patient-completed questionnaire, the DASH Outcome Measure can be administered multiple times throughout patient care to measure changes in function and symptoms over time |
| Numerical Pain Rating Scale | 10-14 days postoperatively | Patients are asked to describe their level of pain intensity over the last 24 hours. The pain scale anchor points 0 and 10 correspond to no pain and worst imaginable pain, respectively. The NPRS can be used multiple times throughout patient care, but has the greatest value in describing post-operative pain-related morbidity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Complications | 10-14 days postoperatively | Complications were observed for and recorded throughout the study. |
| Demographic Information | Preoperatively | Sex, age, BMI, Smoking Status, Hand Dominance, Workers' Compensation Status |
Other
| Measure | Time frame | Description |
|---|---|---|
| QuickDASH | 6 weeks postoperatively | The Quick Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure was designed in 1998 with the goal of providing a more accurate depiction of the everyday symptoms and handicaps exclusively experienced by a patient with an upper extremity musculoskeletal condition. Designed as a patient-completed questionnaire, the DASH Outcome Measure can be administered multiple times throughout patient care to measure changes in function and symptoms over time |
| Complications | 6 weeks postoperatively | Complications were observed for and recorded throughout the study. |
| Levine-Katz Functional Status Scale (FSS) | 10-14 days postoperatively | The Levine-Katz Functional Status Scale (FSS) has 8 questions self-rated on a 5-point scale on difficulty with 5 meaning so difficult patient is unable to perform the function. |
| Levine-Katz Symptom Severity Scale (SSS) | 6 weeks postoperatively | The Levine-Katz Symptom Severity Scale (SSS) assesses pain, weakness, and sensation with 11 questions the patient rates on a 5-point scale with 5 indicating the most difficult; the average score is reported. |
| Numerical Pain Rating Scale | 6 weeks postoperatively | Patients are asked to describe their level of pain intensity over the last 24 hours. The pain scale anchor points 0 and 10 correspond to no pain and worst imaginable pain, respectively. The NPRS can be used multiple times throughout patient care, but has the greatest value in describing post-operative pain-related morbidity. |
| Grip Strength | 6 weeks postoperatively | Grip strength was taken with a Jamar Dynamometer in the 2nd hand position. |
| Wrist Flexion | 6 weeks postoperatively | — |
| Wrist Extension | 10-14 days postoperatively | — |
| Lateral Pinch Strength | 6 weeks postoperatively | Lateral pinch strength was taken with a Preston Pinch Gauge. |
Outcome results
None listed