Journal of Hand Surgery-American Volume最新文献

{"title":"Efficacy of a Modified Bilhaut-Cloquet Procedure Using a Neurovascular Island Flap for Treatment of Radially Deviated Thumb Polydactyly With Hypoplasia.","authors":"Sheng Cheng, Guangyao Li, Xianhui Ma, Weiyang Gao, Jian Ding, Anyuan Wang","doi":"10.1016/j.jhsa.2024.10.020","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.10.020","url":null,"abstract":"<p><strong>Purpose: </strong>Baek's modified Bilhaut-Cloquet procedure is indicated for patients with symmetric bifid thumbs in Wassel type II or III polydactyly. The radially deviated type of thumb polydactyly with asymmetric bifid thumbs was previously contraindicated for this procedure. The objective of the study was to describe the results of our modified Bilhaut-Cloquet procedure using a neurovascular island flap of the radial duplicate for radially deviated type of thumb polydactyly with hypoplasia.</p><p><strong>Methods: </strong>Twelve thumbs of 12 patients with a radially deviated type of thumb polydactyly underwent our modified Bilhaut-Cloquet procedure using a neurovascular island flap of the radial duplicate and were followed up for an average of 38.4 months. Functional and cosmetic assessments were made using the Japanese Society for Surgery of the Hand scoring system.</p><p><strong>Results: </strong>All neurovascular island flaps survived, and the thumb size was restored close to that of the unaffected contralateral side in all cases. According to the Japanese Society for Surgery of the Hand scoring system, 8 cases achieved good results, and 4 achieved fair results. In terms of functional and aesthetic results, all cases were considered acceptable by the patient's parents.</p><p><strong>Conclusions: </strong>Our technique using a neurovascular island flap of the radial duplicate in conjunction with the modified Bilhaut-Cloquet procedure was effective for the treatment of radially deviated type of thumb polydactyly with hypoplasia. This technique is an option for the treatment of radially deviated type of thumb polydactyly with hypoplasia.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Comparison of Suture Caliber and Number of Passes in Epitendinous Repair.","authors":"David Cardenas, Anca Dogaroiu, Muhammad Harirah, Andrew Y Zhang, Andrei Odobescu, Douglas M Sammer","doi":"10.1016/j.jhsa.2024.11.021","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.11.021","url":null,"abstract":"<p><strong>Purpose: </strong>The epitendinous suture is a critical part of flexor tendon repair. In addition to smoothing the repair site, it augments repair strength and increases gap resistance. This study aimed to determine whether increasing the number of passes or increasing suture caliber would improve the strength (primary outcome), 2 mm gap resistance, or stiffness of a simple running epitendinous suture.</p><p><strong>Methods: </strong>A total of 30 flexor pollicis longus (FPL), flexor digitorum profundus (FDP), and flexor digitorum superficialis (FDS) tendons were harvested from three cadavers, and transverse tendon lacerations were produced. Tendons were repaired with only an epitendinous suture (no core suture) in three groups: 6-0 Prolene with six passes, 5-0 Prolene with six passes, or 5-0 Prolene with six passes. Epitendinous repair strength was tested using a materials testing machine.</p><p><strong>Results: </strong>The use of eight passes had significantly greater ultimate tensile strength than six passes (21 +/- 7 N vs 14 +/- 5 N). Although 5-0 suture had a higher average ultimate tensile strength than 6-0 suture, this difference was not statistically significant (14 N +/- 5 vs 10 N +/- 3). Failure mode for all groups was most often suture tear-through.</p><p><strong>Conclusions: </strong>A simple epitendinous suture using eight passes provides almost 50% more epitendinous repair strength and greater 2 mm gap resistance than six passes when using 5-0 Prolene.</p><p><strong>Clinical relevance: </strong>When performing a simple running epitendinous repair to augment a core flexor tendon repair, the surgeon should consider the additional strength and gap resistance provided by eight passes compared to six.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal CME Questions","authors":"","doi":"10.1016/j.jhsa.2024.12.020","DOIUrl":"10.1016/j.jhsa.2024.12.020","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Page 215"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143298432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI for Scaphoid Nonunion: Utilization Rates, Factors Associated With Utilization, and Subsequent Vascularized Bone Graft Use","authors":"Lauren M. Shapiro MD, MS ,&nbsp;Emily A. Schultz BS ,&nbsp;Jessica Welch BS ,&nbsp;Thompson Zhuang MD, MBA ,&nbsp;Robin N. Kamal MD, MBA","doi":"10.1016/j.jhsa.2024.10.008","DOIUrl":"10.1016/j.jhsa.2024.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>The use of magnetic resonance imaging (MRI) for evaluation of scaphoid nonunion may be an example of low-value imaging for the treatment of scaphoid nonunion. The purpose of this study was to investigate variation in MRI use for scaphoid nonunion, the association of MRI with a vascularized bone graft (VBG) and to develop consensus on MRI use for scaphoid nonunion.</div></div><div><h3>Methods</h3><div>We identified patients &gt;18 years of age who underwent scaphoid nonunion surgery between 2010 and 2019 using a claims database. Patients who had, and did not have, an MRI within 90 days prior to their diagnosis of scaphoid nonunion were included and a multivariable analysis was performed to evaluate variation in MRI and VBG use. Subsequently, a literature review was performed, and a preliminary consensus statement was developed pertaining to the routine use of MRI for scaphoid nonunion. A consortium of nine hand surgeons evaluated the importance, feasibility, usability, and scientific acceptability of the statement through a modified RAND Coroporation/University of California, Los Angeles Delphi. Panelists evaluated the statement in two voting rounds with an intervening face-to-face discussion.</div></div><div><h3>Results</h3><div>We identified 1,324 eligible patients with surgical repair of a scaphoid nonunion. Two hundred and sixty-three (19.9%) underwent an MRI within 90 days prior to surgery. Differences in age, insurance type, and comorbidity burden existed between patients who received MRI and those who did not. The MRI cohort was more likely to receive VBG (10.6%) compared to those without an MRI (4.7%). Panelists agreed on the voting domains of the consensus statement and therefore the statement, “There is no benefit of routine MRI/MRA in the treatment of scaphoid nonunion with or without presumed avascular necrosis,” was considered valid.</div></div><div><h3>Conclusions</h3><div>MRI use within 90 days of surgical repair of scaphoid nonunion varies, is associated with greater rates of VBG use, and may represent low-value imaging given the lack of sufficient evidence on this topic.</div></div><div><h3>Clinical relevance</h3><div>As MRI use for scaphoid nonunion varies and may represent low-value imaging, a validated consensus statement may help guide the evaluation of patients with scaphoid nonunion.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Pages 182-187"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Hand Therapy Associated With a Delay in Surgical Treatment in Thumb Carpometacarpal Arthritis?","authors":"Daniel A. Portney MD ,&nbsp;Quinn A. Stillson BS ,&nbsp;Jason A. Strelzow MD ,&nbsp;Jennifer Moriatis Wolf MD, PhD","doi":"10.1016/j.jhsa.2023.05.019","DOIUrl":"10.1016/j.jhsa.2023.05.019","url":null,"abstract":"<div><h3>Purpose</h3><div>Thumb carpometacarpal (CMC) osteoarthritis<span> (OA) causes functional disability and an increased health care burden in the aging population. The role of therapy in thumb CMC OA has been minimally analyzed in the literature. We hypothesized that patients treated with therapy for thumb CMC OA would demonstrate reduced rates of surgery for this diagnosis.</span></div></div><div><h3>Methods</h3><div>We queried a national insurance dataset for all patients with an International Classification of Diseases<span>, Ninth Revision, or International Statistical Classification of Diseases, Tenth Revision, code for thumb CMC OA, with a minimum of 2 years of follow-up. A 2:1 propensity-matched cohort of patients with CMC OA who did not receive therapy versus a therapy cohort was created, with a minimum of two sessions of hand therapy for inclusion. The primary outcome was the rate of thumb CMC OA surgery occurring within 2 years of diagnosis; time to surgery and use of thumb CMC injections were secondary outcomes. Multivariable logistic regression analysis was used to identify the risk factors for undergoing surgical treatment.</span></div></div><div><h3>Results</h3><div>After matching, the therapy cohort comprised 14,548 patients, with a matched group of 28,930 patients who did not undergo therapy. In the overall sample, the rate of surgery within 2 years was 22.5%. Two-year surgical treatment rates were significantly higher for those who did not undergo therapy when compared with those who did (29.3% vs 13.1%). Patients treated with therapy had a significantly longer time to surgery, with no difference in the rate of surgery after one year. In multivariable regression of all included variables, lack of therapy intervention had the highest odds of surgery for thumb CMC OA (odds ratio 4.3).</div></div><div><h3>Conclusions</h3><div>We present the findings of a large insurance database evaluating the association of therapy with rates of surgical treatment for thumb CMC arthritis. On average, those treated with therapy had longer times to surgery, and the 2-year surgery rates for patients diagnosed with thumb CMC arthritis were significantly higher in those who did not undergo therapy treatment.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Pages 234.e1-234.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9889992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 ASSH Presidential Address: Making Space","authors":"Steven L. Moran MD","doi":"10.1016/j.jhsa.2024.11.003","DOIUrl":"10.1016/j.jhsa.2024.11.003","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Pages 123-129"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Congenital Upper-Limb Anomalies in Southern Taiwan Based on the Updated Oberg, Manske, and Tonkin Classification: A Series of 1,335 Anomalies in 1,188 Patients","authors":"Jui-Po Yeh MD ,&nbsp;Pao-Jen Kuo MD ,&nbsp;Tsan-Shiun Lin MD ,&nbsp;Yuan-Cheng Chiang MD","doi":"10.1016/j.jhsa.2023.05.016","DOIUrl":"10.1016/j.jhsa.2023.05.016","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to investigate the relative frequency of congenital upper-limb anomalies (CULAs) in southern Taiwan using the 2020-updated the Oberg, Manske, and Tonkin (OMT) classification system and evaluate the practicality of the new classification system.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients with CULAs from 1987 to 2021 at a referral center in southern Taiwan. All patients were analyzed based on medical records<span>, photographs, and radiographs, and the anomalies were classified according to the 2020 OMT classification system.</span></div></div><div><h3>Results</h3><div><span><span><span><span>A total of 1,188 patients with 1,335 CULAs were retrospectively reviewed. The results demonstrated that the most common type of CULA was malformations (1,092 cases), followed by </span>dysplasias (144 cases), syndromes (51 cases), and deformations (48 cases). Among the malformations, radial </span>polydactyly was the most common anomaly (732 cases), followed by simple </span>syndactyly (66 cases). Among the dysplasias, </span>camptodactyly<span><span> was the most common anomaly (52 cases), followed by thumb-in-palm deformity (45 cases) and vascular tumors (17 cases). In the deformations, </span>constriction ring<span> sequence accounted for all cases. Poland syndrome (21 cases) occurred most often in the category of syndromes.</span></span></div></div><div><h3>Conclusions</h3><div>The results of this study show that radial polydactyly (732 cases, 55%) is the most common CULA in southern Taiwan, followed by simple syndactyly (66 cases, 5%) and then camptodactyly (52 cases, 4%).</div></div><div><h3>Clinical relevance</h3><div>The OMT classification system is reasonably practical for precise classification of CULAs and enables easy comparison of studies over different time periods. However, continually updating the OMT classification system is required to better categorize the highly variable presentations of CULAs.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Pages 231.e1-231.e10"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9889989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximity of the Ulnar Neurovascular Structures in Endoscopic Carpal Tunnel Release Surgery: A Cadaveric Study","authors":"Bryan A. Hozack MD ,&nbsp;Benjamin R. Campbell MD ,&nbsp;Justin M. Kistler MD ,&nbsp;Jonas L. Matzon MD ,&nbsp;Christopher M. Jones MD ,&nbsp;Michael Rivlin MD","doi":"10.1016/j.jhsa.2023.06.019","DOIUrl":"10.1016/j.jhsa.2023.06.019","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the proximity of the ulnar neurovascular structures to the endoscopic blade during endoscopic carpal tunnel release (CTR).</div></div><div><h3>Methods</h3><div>Ten fresh-frozen cadaver hands were used to perform endoscopic CTR using devices from two manufacturers. The skin was excised from the palm, and the endoscopic carpal tunnel blade was deployed at the distal edge of the transverse carpal ligament (TCL). The blade’s proximity to the ulnar neurovascular bundle, deep ulnar motor branch, superficial palmar arch, and median nerve was recorded. Following release of the TCL, the device was turned ulnar to the maximal extent to determine if direct injury to the ulnar neurovascular bundle was possible.</div></div><div><h3>Results</h3><div>The average longitudinal distance from the end of the TCL to the superficial palmar arch was 13.3 mm (range, 8.4–20.9) and to the ulnar motor branch was 10.8 mm (range, 4.0–15.0). The average transverse distance from the end of the TCL to the ulnar neurovascular bundle was 5.9 mm (range, 3.1–7.8) and to the median nerve was 3.3 mm (range, 0–6.5). In two of our specimens, the median nerve subluxated volarly over the cutting device. When placing the blade at the distal edge of the TCL, injury to the deep motor branch of the ulnar nerve, ulnar neurovascular bundle, or superficial palmar arch was not possible in any specimens using the tested devices, even when turning the blade directly toward these structures.</div></div><div><h3>Conclusions</h3><div>There is a low likelihood of direct injury to the ulnar neurovascular bundle during endoscopic CTR.</div></div><div><h3>Clinical relevance</h3><div>These results suggest that injury to the ulnar neurovascular bundle is unlikely during endoscopic CTR if the distal aspect of the transverse carpal ligament can be clearly identified prior to release. Control of the median nerve is also important to prevent subluxation over the cutting device.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Pages 237.e1-237.e6"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9921084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Median Nerve Release in Complex Regional Pain Syndrome Type 1 of the Hand: A Prospective Case Series","authors":"Francisco del Piñal MD, Dr Med","doi":"10.1016/j.jhsa.2024.09.024","DOIUrl":"10.1016/j.jhsa.2024.09.024","url":null,"abstract":"<div><h3>Purpose</h3><div>Pain, allodynia, and stiffness in complex regional pain syndrome (CRPS) greatly affects social, vocational, and community engagement. The aim of this study was to evaluate the effect of isolated median nerve releases on the outcome of CRPS 1 of the hand.</div></div><div><h3>Methods</h3><div>In this prospective case series, people of any age diagnosed with and treated for CRPS 1 of the upper limb attending the author’s practice were consecutively recruited. All were self-referrals dissatisfied with the treatment provided previously. Only patients who had been treated with nerve release to control their symptoms were included. Primary outcome measures were pain and Disabilities of the Arm, Shoulder, and Hand score. A secondary outcome was withdrawal from pain medication. Full resolution was defined as 0 pain, on a scale of 0–10, and total withdrawal from pain medication at the latest follow-up.</div></div><div><h3>Results</h3><div>Between January 2018 and December 2022, 82 participants with CRPS 1 of the hand for an average of 20 months were evaluated. Eighty-five nerve releases were performed. As per protocol, carpal tunnel release was performed in all, and three patients also received an endoscopic pronator release. Minor procedures unrelated to the pain were carried out concomitantly in 17 patients. Significant improvements were observed in pain score (mean 8.9 ± 1.2 at baseline vs 0.6 ± 1.8 at 35 months) and in Disabilities of the Arm, Shoulder, and Hand score (82 ± 13 vs 13 ± 20) for the same period. Five patients (6%) were considered failures. In contrast, 65 patients (79%) had full resolution of their symptoms.</div></div><div><h3>Conclusions</h3><div>This study demonstrates that a large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release. Future research is needed to understand the pathophysiology and the failures.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Pages 130-137"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Reported Improvement After Carpal Tunnel Release in Patients With Motor Axonal Loss","authors":"Nicholas Livingston BA ,&nbsp;Eric Jiang MD ,&nbsp;Logan Hansen MD ,&nbsp;Alisha Williams BS ,&nbsp;Mitchell Wu MS ,&nbsp;Jonathan Carrier DO ,&nbsp;Charles S. Day MD, MBA","doi":"10.1016/j.jhsa.2024.10.010","DOIUrl":"10.1016/j.jhsa.2024.10.010","url":null,"abstract":"<div><h3>Purpose</h3><div>Electrodiagnostic studies can identify evidence of sensory and motor axonal loss (AL) in carpal tunnel syndrome (CTS) patients. However, the impact of sensory and motor AL on outcomes following carpal tunnel release (CTR) remains unclear. We hypothesize that patients with no evidence of sensory and motor AL will experience greater improvement following CTR compared to those with evidence of AL.</div></div><div><h3>Methods</h3><div>Patients undergoing open and endoscopic CTR by four fellowship-trained orthopedic hand surgeons were identified. Sensory and motor AL were identified using preoperative electromyography and nerve conduction studies. Patients completed the following before surgery and 3-month postoperative patient-reported outcomes: Patient-Reported Outcomes Measurement Information System Upper Extremity (UE) and Pain Interference (PI) as well as Disabilities of the Arm, Shoulder, and Hand (<em>Quick</em>DASH [QD]). Preoperative and postoperative scores, changes in scores, and rates of achieving the minimally clinically important difference (MCID) were compared between patients with and without sensory and motor AL.</div></div><div><h3>Results</h3><div>One hundred and seventy-five patients were included. Of these, 91 exhibited sensory AL and 98 exhibited motor AL. Demographic matched analysis of patients with and without sensory AL showed no differences in before surgery, after surgery, difference, or proportion meeting MCID for UE, PI, or QD. Matched analysis revealed no difference in preoperative PROMs between patients with and without motor AL. Patients with motor AL had increased postoperative UE (better function), decreased postoperative PI (less PI) and QD (less disability), increased changes in PI and QD, as well as a greater proportion meeting MCID for QD compared to those without motor AL.</div></div><div><h3>Conclusions</h3><div>There was no difference in post-CTR improvement between patients with and without sensory AL. However, contrary to our hypothesis, motor AL patients experienced greater postoperative improvement according to QD. These findings suggest surgery should be recommended for severe CTS patients with evidence of AL. These results can better inform physicians and patients as they discuss expectations of CTR outcomes.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognosis II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Pages 188-196"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}