Appropriate Indications of Opponensplasty in Carpal Tunnel Syndrome
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Transcript of Appropriate Indications of Opponensplasty in Carpal Tunnel Syndrome
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Appropriate Indications of Opponensplasty
in Carpal Tunnel Syndrome
Yuki Hara, Yasumasa Nishiura, Yoshiko Nakajima, Naoyuki Ochiai
Depertment of Orthopaedic Surgery
University of Tsukuba, JAPAN
The authors have no financial conflicts of interest to disclose concerning the presentation.
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Background
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Questionnaire about the treatment of idiopathic carpal tunnel syndrome (2008)
Subjects : 471 of the JSSH members
【 Reasons for performing a tendon transfer in cases of thumb opposition dysfunction 】
Yuki Hara et al, 51st JSSH meeting, 2008
Patient’s complaint or request 46.8 %
Severeatrophy 18.1%
Not perform primary opponensplasty 26.1%
Needle EMG 9.0%
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Investigation of natural course of muscle strength of severe atrophic APB after carpal tunnel release only
To clarify appropriate indications for opponensplasty in idiopathic carpal tunnel syndrome
Purpose of this study
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Methods
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Our methods
Diagnosis of CTS Clinical examination Electrophysiological examination Motor distal latency and MCV of forearm SCV of finger to wrist and forearm APB-CMAP(-) ⇒ Needle EMG
Surgery : Open carpal tunnel release
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Study periods: April 2001 ~ March 2012
Subject : 44 patients 49 hands Pre-op MMT of APB was 【 1 】 or 【 0 】 Diagnosed by needle EMG Underwent carpal tunnel release only
Evaluations ・ Age at surgery, gender, dominant or nondominant ・ Symptomatic duration ・ Complaint about thumb dysfunction ・ APB muscle strength at one year after surgery
・
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Results
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MUP(+) group 35 patients 39 hands♂ 16 hands ♀ 23 handsDominant / Non 16 / 23 handsMean age: 64.1 y.o.Mean duration: 5.1 yrsThumb complaint (+)/(-) 27 / 12 hands
MUP(-) group 9 patients 10 hands♂ 5 hands ♀ 4 handsDominant / Non 3 / 7 handsMean age: 74.6 y.o.Mean duration: 4.4 yrsThumb complaint (+)/(-) 7 / 2 hands
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APB muscle strength at one year after surgery
MUP(+) group
Recovery rate tohigher than MMT 【 3 】 = 100 %
0-1
MMT grade
(n)
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If a voluntary contraction of the APB muscle is
observed pre-operation,
the patients will be able to acquire useful
thumb function within a year after carpal
tunnel release.
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APB muscle strength at one year after surgery
MUP(-) group
Recovery rate tohigher than MMT 【 3 】 = 44 %
(n)
0-1
MMT grade
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What were poor prognostic factors of pre-op MUP(-) group?
Patient’s details
Age Sex Side Duration Comorbidity MMT SCV71 ♂ Lt 6m 3 24.149 ♂ Lt 3y 4 36.155 ♀ Rt 4y 4 26.174 ♂ Lt 8m Diabetes 3 24.675 ♀ Rt 6y 4 35.2
54 ♀ Rt 2yC.
Myelopathy
0-1 24.9
54 ♀ Lt 2yC.
Myelopathy
0-1 25.3
79 ♂ Lt 6y 0-1 8.267 ♂ Lt 7y 0-1 -93 ♀ Rt 10y 2 -
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Discussions
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Result of needle EMG study of APB muscle predicted..
Motor unit potential (+) → All patients
(-) → One half of patients
will acquire useful thumb function within a year after CTR
Primary opponensplasty Not required
Primary opponensplastyRequired in some cases
Which patients? → Next task
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Needle EMG study for severe CTS patients
Drawbacks Benefit Pain Predictable surgery Invasive outcome
but its invasion and risk are less than opponensplasty!
Surgeons should show all choices and their likely clinical outcome to patients
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・ Primary opponensplasty produces good clinical results and patients satisfaction (Terrono AL:1993, Wan SH: 2007, Park IJ: 2010, Uemura T: 2010, Kang SW: 2012, Naeem R:2013)
・ Opponensplasty permits patients functional recovery immediately
・ Some patients had no complaint about thumb dysfunction even if their APB were severe atrophy Primary opponensplasty should be performed accordingto patient’s demands and results of EMG studies
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Conclusion
Needle EMG is very useful for deciding
the necessity of opponensplasty
in carpal tunnel syndrome