Jorge Raduan Neto

Evaluation of patients with carpal tunnel syndrome treated by endoscopic technique

Objective: To evaluate the postoperative results of patients with carpal tunnel syndrome by the endoscopic release technique with single portal. Methods: 78 patients (80 wrists) were evaluated preoperatively and postoperatively at 1, 3 and 6 months by the Boston questionnaire, the visual analogue scale (VAS) for pain, monofilament test sensitivity, grip strength, lateral pinch, pulp to pulp pinch and tripod pinch. Results: Statistical analysis was significant (p <0.05) in the progressive decline of pain and improved function (Boston) during follow-up. The sensitivity significantly improved comparing the data pre and postoperatively. The grip strength, lateral pinch, pulp to pulp pinch and tripod pinch decreased in the first month after surgery, returning to preoperative values around the third month postoperatively. Conclusion: The technique proved to be safe and effective in improving pain, function, and return sensitivity and strength. Level of Evidence II, Prospective study

Corticoid injection as a predictive factor of results of carpal tunnel release

OBJECTIVE: To evaluate whether the symptoms relief after local corticoid injection correlate with better results of surgical treatment in carpal tunnel syndrome. METHODS: Between February 2011 and June 2013, 100 wrists of 88 patients were included in the study. All patients were subjected to corticoid injections in the carpal tunnel and evaluated before and after infiltration and surgery. The following parameters were evaluated: visual analog scale (VAS) for pain, Boston questionnaire, sensitivity and strength. RESULTS: Only 28 out of 100 wrists subjected to injection were symptom-free after six months follow up. Sixty out of the 72 patients who did not present relief or relapse symptoms were treated surgically. Surgical results were better regarding VAS, Boston questionnaire and sensitivity in a specific group of patients, which had a longer relief of symptoms after the corticoid injection, with statistical significance. CONCLUSION: Longer relief of symptoms after corticoid injection correlated with better results of surgical treatment. Level of Evidence II, Prognostic Study.

Translation and Cultural Adaptation of the Brief Michigan Hand Questionnaire to Brazilian Portuguese Language

PurposeThe use of patient-reported outcome questionnaires is recommended in orthopedic studies. However, validated tools are necessary to ensure the comparability of results across different studies, centers, and countries. The Brief Michigan Hand Questionnaire (BMHQ) can be used for outcome measures in self-evaluation after carpal tunnel release. This study aimed to translate the BMHQ to Portuguese to permit cross-cultural adaptation to Brazilians patients.MethodsWe translated the Brief Michigan Hand Questionnaire from the original version (English) to Brazilian Portuguese. The translation and cultural adaptation of the content of this tool consisted of six stages, according to the methodology proposed by medical literature: (1) initial translation of the questionnaire by two independent translators; (2) synthesis of translations and reconciliation; (3) back-translation to English of the reconciled version; (4) verification of the cultural equivalence process by an expert committee; (5) pre-testing in a sample of patients to verify understanding of the items; and (6) development of a final version of the BMHQ.ResultsThe pre-final version of the tool was applied to 43 patients to verify its understanding. Pre-testing showed that the questions and options were satisfactorily understood. The number of items from the original English version was maintained in the Brazilian Portuguese version of BMHQ.DiscussionThe Brazilian Portuguese version of the BMHQ is easily understood by patients and will be useful to clinicians and researchers.

Acute Finger Injuries

The high demands placed on the upper extremity in athletic ball sports make the hand susceptible to a great variety of injuries. Fractures of the metacarpals frequently result in lost time off play and altered playing performance. Mechanisms of injury usually involve low-energy forces, resulting in simple fracture patterns and minimal soft tissue injury. With the increasing demands of today’s society and the financial significance of professional athletes’ performance and playing time, the physician may be pressured to alter management of hand fractures in the athlete. The physician should have a variety of methods available to him or her and make treatment decisions that keep the patient’s overall athletic career and future hand performance in mind [1].

PRWE application in distal radius fracture: comparison and correlation with established outcomes

Objective The study aimed to evaluate the correlation between the PRWE score with other measurements that are already widely used. Methods This was a prospective, cross-sectional, single-center study. Sixty-eight consecutive patients underwent surgical treatment for distal radius fractures (internal fixation by locked volar plate or transarticular external fixation). They were evaluated independently by PRWE, DASH, VAS range of motion, strength, and radiographic criteria, in one year of follow up. The Mann–Whitney test was used to compare continuous variables and the Spearman correlation to correlate the outcomes of interest. Results PRWE correlated significantly with DASH (p < 0.001) and VAS (p < 0.001). There were no significant correlations with other outcome measures. Conclusion PRWE presents significant moderate correlation only with DASH and VAS. Range of motion, strength, and radiographic criteria do not interfere in the PRWE outcome.

Arthroscopic Resection of Dorsal Wrist Ganglion: Results and Rate of Recurrence Over a Minimum Follow-up of 4 Years

Background: Dorsal wrist ganglia are the most common soft tissue tumor type of the upper limb. Surgical resection, open or arthroscopic, is one of the most frequent procedures performed by hand surgeons. This study sought to perform an objective evaluation of the outcomes of arthroscopic resection of dorsal wrist ganglia and their recurrence rates over 4 years. Patients treated with arthroscopic resection were expected to have favorable outcomes and low complication rates after 4 years of follow-up. Methods: We evaluated 34 cases of dorsal wrist ganglia in patients who underwent arthroscopic resection. The patients were evaluated using the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) for pain, range of motion of the wrist, palmar grip strength, rates of recurrence, and complications. Results: During the postoperative period, the QuickDASH score averaged 2.3 points, the mean residual pain by VAS was 0.54, full range of wrist movement was recovered by all patients, and the mean palmar grip strength was 29.4 kgf; there was 1 case with recurrence. There were no severe postoperative complications throughout the follow-up period. Conclusions: The outcomes, recurrence, and complications rates after 4 years of follow-up presented in this study support the use of arthroscopy as a treatment for dorsal wrist ganglion.

Translation and Cross-Cultural Adaptation of the 6-Item Carpal Tunnel Syndrome Symptoms Scale and Palmar Pain Scale Questionnaire Into Brazilian Portuguese

Background: There are several medical questionnaires to evaluate the quality of life of carpal tunnel syndrome patients. However, most measures are only available in English. We chose to translate and culturally adapt to Portuguese the Six-Item Carpal Tunnel Syndrome Symptoms Scale and Palmar Pain Scale (CTS-6) questionnaire because it provides objective assessment using a small number of questions. Methods: The translation and cultural adaptation were carried out according to the medical literature and consisted of five steps: (1) initial translation by two translators fluent in both languages, (2) association of initial translations, (3) back translation to Portuguese by two native speakers of English, (4) association of back translation and (5) comparison with the original version. Results: The Portuguese version was administered to patients with carpal tunnel syndrome and difficulties were noted concerning the comprehension and completion of the translated questionnaire. Patients had difficulty in understanding the horizontal layout of the response choices. Without altering the content, we changed the response choices to a vertical layout and re-administered the questionnaire to a new sample of patients followed up in the same ambulatory care service. We noted a substantial improvement in comprehension and completion of the questionnaire after the modifications. Conclusions: Availability of a Portuguese version of the Six-Item Carpal Tunnel Syndrome Symptoms Scale and Palmar Pain Scale (CTS-6) questionnaire will allow an objective evaluation of the treatment of a syndrome that is very prominent in medical practice.

Triggering of Carpal Tunnel Syndrome Symptoms in Patients Using Urban Public Transportation

Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy found in clinical practice. Recent studies evaluated which external factors could be involved in the CTS symptoms, including prolonged exposure to vibration, especially in the upper limb. This study investigated signs and symptoms in patients with CTS after using urban transport on (1) both upper limbs, (2) how long before these symptoms appear, and (3) the hands position or body reaction during the act of pressing the safety bars. Methods: The study was conducted from July 2012 to April 2013. A total of 205 (178 women and 27 men) patients were evaluated. CTS was diagnosed in 285 hands. All participants answered a questionnaire formulated by the authors. The questionnaire was applied by researchers who were single-blinded and not involved in the research. Results: Most of the participants (87%) were women, but there was no statistical significance in age between groups (women = 51.24 ± 8.47 years, men = 51.10 ± 6.52 years, P > .05). The symptoms appeared significantly in the first 15 minutes after boarding when compared with patients who had no symptoms during the journey. There was no difference between hands position along the journey and the onset of symptoms. Conclusions: The onset of symptoms in patients with CTS using urban public transportation most commonly occurred in the first 15 minutes after boarding. Public transport vibration seems to be, at least in part, directly related to the development of symptoms. Questionnaires for the assessment of paresthesia symptoms during the use of public transport may be useful for CTS diagnosis.