Purpose
Few comparisons have been performed between the outcomes of surgical techniques for
recurrent carpal tunnel syndrome. Using a meta-analysis, this study aimed to compare
the outcomes of different surgical techniques using the Boston Carpal Tunnel Questionnaire
(BCTQ) and visual analog scale (VAS) for pain as outcomes.
Methods
The following categories were used to define the study’s inclusion criteria: population,
intervention, comparator, outcomes, and study design. Studies were examined by 2 reviewers,
and the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines
were followed. The studies were assigned to 1 of the following treatment groups: decompression
with or without neurolysis, autologous fat transfer, hypothenar fat pad, pedicled
or free flap, and “other.” For our primary outcome, we compared improvement using
the BCTQ and VAS for pain between the treatment groups. For our secondary outcome,
postoperative BCTQ and VAS pain values were compared.
Results
Fourteen studies were included: 5 case series with postoperative data only and 9 pre-post
studies without a control group. With regard to our primary outcome, the studies reported
an average improvement of 1.2 points (95% confidence interval [CI][1.5, 0.9]) on a
scale of 1–5 on the symptoms severity scale (SSS) of the BCTQ, 1.9 points (95% CI
[1.37, 0.79]) on a scale of 1–5 on the function severity scale of the BCTQ, and 3.8
points (95% CI [4.9, 2.6]) on a scale of 1–10 on the VAS for pain. We only found significantly
lesser improvement in the “other” treatment group than in the hypothenar fat pad group
and autologous fat transfer group using the SSS. The hypothenar fat pad group had
the best reported postoperative SSS score of 1.75 (95% CI [1.24, 2.25]), function
severity scale score of 1.55 (95% CI [1.20, 1.90]), and VAS pain score of 1.45 (95%
CI [0.83, 2.07]).
Conclusions
All the techniques showed clinically important improvements in all the outcomes. We
found lesser improvement in the “other” treatment group than in the hypothenar fat
pad group and autologous fat transfer group using the SSS. We found that the hypothenar
fat pad group had the best reported postoperative values in our secondary analysis.
Type of study/level of evidence
Therapeutic IV.
Key words
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References
- Prevalence of carpal tunnel syndrome in a general population.JAMA. 1999; 282: 153-158
- Carpal tunnel release: lifetime prevalence, annual incidence, and risk factors.Muscle Nerve. 2018; 58: 497-502
- Treatment of carpal tunnel syndrome.Muscle Nerve. 2007; 36: 167-171
- Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial.JAMA. 2002; 288: 1245-1251
- Recurrent carpal tunnel syndrome.Hand Clin. 2013; 29: 427-434
- Recurrent carpal tunnel syndrome.Hand Clin. 1996; 12: 731-743
- Revision surgery for persistent and recurrent carpal tunnel syndrome and for failed carpal tunnel release.Plast Reconstr Surg. 2012; 129: 683-692
- Rates of complications and secondary surgeries of mini-open carpal tunnel release.Hand. 2019; 14: 471-476
- Endoscopic versus open carpal tunnel release: a randomized trial.J Hand Surg. 2003; 28: 475-480
- Management of recurrent carpal tunnel syndrome with microneurolysis and the hypothenar fat pad flap.Hand. 2007; 2: 85-89
- Revision surgery after carpal tunnel release—analysis of the pathology in 200 cases during a 2 year period.J Hand Surg. 2006; 31: 68-71
- Self-reported outcomes for patients undergoing revision carpal tunnel surgery with or without hypothenar fat pad transposition.Hand. 2018; 13: 292-295
- Outcome of reoperation for carpal tunnel syndrome.J Hand Surg. 1996; 21: 347-356
- Revision decompression and collagen nerve wrap for recurrent and persistent compression neuropathies of the upper extremity.Ann Plast Surg. 2014; 72: 572-578
- Autologous fat transfer in secondary carpal tunnel release.Plast Reconstr Surg Glob Open. 2015; 3e401
- Hypothenar fat pad flap surgery for end stage and recurrent carpal tunnel syndrome.Hand Surg Rehabil. 2016; 35: 348-354
- Microvascular omental transfer for the treatment of severe recurrent median neuritis of the wrist: a long-term follow-up.Plast Reconstr Surg. 2005; 115: 163-171
- Abductor digiti minimi flap for vascularized coverage in the surgical management of complex regional pain syndrome following carpal tunnel release.Hand. 2017; 12: 546-550
- A systematic review of the literature on the outcomes of treatment for recurrent and persistent carpal tunnel syndrome.Plast Reconstr Surg. 2013; 132: 114-121
- Strickland’s hypothenar fat pad flap for revision surgery in carpal tunnel syndrome: prospective study of 34 cases.Hand Surg Rehabil. 2017; 36: 202-207
- Revision surgery in carpal tunnel syndrome: a retrospective study comparing the Canaletto® device alone versus a combination of Canaletto® and Dynavisc® gel.Hand Surg Rehabil. 2019; 38: 52-58
- New technique for reducing fibrosis in recurrent cases of carpal tunnel syndrome.Hand Surg. 2014; 19: 381-387
- Palmaris longus interposition in revision surgery for recurrent and persistent carpal tunnel syndrome: a case series.J Plast Surg Hand Surg. 2020; 54: 107-111
- Recurrent and persistent carpal tunnel syndrome: predicting clinical outcome of revision surgery.J Neurosurg. 2019; 132: 847-855
- Vascularized hypothenar fat pad flap in revision surgery for carpal tunnel syndrome.J Neurol Surg A Cent Eur Neurosurg. 2015; 76: 438-442
- A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.J Bone Joint Surg. 1993; 75: 1585-1592
- Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale.Pain. 1983; 16: 87-101
Oxford Centre for Evidence-Based Medicine. 2011 Levels of Evidence. Available at: http://www.cebm.net/index.aspx?o=1025#levels. Accessed March 26, 2020.
National Institues of Health. Study quality assessment tools. Available at: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed March 26, 2020.
- Estimating the mean and variance from the median, range, and the size of a sample.BMC Med Res Methodol. 2005; 5: 13
- Meta-analysis and subgroups.Prev Sci. 2013; 14: 134-143
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558
- The use of free fat grafts in recalcitrant carpal tunnel: a retrospective study.Eur J Plast Surg. 2001; 24: 12-17
- Endoscopic revision of carpal tunnel release.Plast Reconstr Surg. 2008; 121: 2029-2034
- Self-reported outcomes for patients undergoing revision carpal tunnel surgery with or without hypothenar fat pad transposition.Hand. 2018; 13: 292-295
- Pedicled fat flap coverage of the median nerve after failed carpal tunnel decompression.J Hand Surg. 2002; 27: 350-353
- Hypothenar fat pad flap surgery for end stage and recurrent carpal tunnel syndrome.Hand Surg Rehabil. 2016; 35: 348-354
- Microvascular omental transfer for the treatment of severe recurrent median neuritis of the wrist: a long-term follow-up.Plast Reconstr Surg. 2005; 115: 163-171
- The power of statistical tests for moderators in meta-analysis.Psychol Methods. 2004; 9: 426-445
- Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP).Arthritis Care Res. 2011; 63: S240-S252
- A systematic review of the psychometric properties of the Boston carpal tunnel questionnaire.BMC Musculoskelet Disord. 2006; 7: 1-9
- Coverage of the median nerve with free and pedicled flaps for the treatment of recurrent severe carpal tunnel syndrome.Scand J Plast Reconstr Surg Hand Surg. 2002; 36: 172-176
- Abductor digiti minimi flap for vascularized coverage in the surgical management of complex regional pain syndrome following carpal tunnel release.Hand. 2017; 12: 546-550
- Treatment of recurrent compressive neuropathy of peripheral nerves in the upper extremity with an autologous vein insulator.J Hand Surg. 2001; 26: 296-302
- The heterogeneity statistic I(2) can be biased in small meta-analyses.BMC Med Res Methodol. 2015; 15: 1-8
Article info
Publication history
Published online: August 03, 2021
Accepted:
May 5,
2021
Received:
July 9,
2020
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
