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Journal of Hand Surgery (European Volume) Journal of Hand Surgery (European Volume) http://jhs.sagepub.com/ Pre- and post-operative comorbidities in idiopathic carpal tunnel syndrome: cervical arthritis, basal joint arthritis of the thumb, and trigger digit J.H. Kim, H.S. Gong, H.J. Lee, Y. H. Lee, S.H. Rhee and G.H. Baek J Hand Surg Eur Vol 2013 38: 50 originally published online 2 May 2012 DOI: 10.1177/1753193412445441 The online version of this article can be found at: http://jhs.sagepub.com/content/38/1/50 Published by: http://www.sagepublications.com On behalf of: British Society for Surgery of the Hand Additional services and information for Journal of Hand Surgery (European Volume) can be found at: Email Alerts: http://jhs.sagepub.com/cgi/alerts Subscriptions: http://jhs.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav >> Version of Record - Dec 19, 2012 OnlineFirst Version of Record - May 2, 2012 What is This? Downloaded from jhs.sagepub.com at UNIV PRINCE EDWARD ISLAND on October 27, 2014 JHS38110.1177/1753193412445441Kim et al.Journal of Hand Surgery (European Volume) 4454412012 JHS(E) Full length article The Journal of Hand Surgery (European Volume) Pre- and post-operative comorbidities 38E(1) 50 –56 © The Author(s) 2012 Reprints and permissions: in idiopathic carpal tunnel syndrome: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1753193412445441 cervical arthritis, basal joint arthritis jhs.sagepub.com of the thumb, and trigger digit J.H. Kim Department of Orthopaedic Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea H.S. Gong, H.J. Lee, Y. H. Lee Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea S.H. Rhee Department of Orthopaedic Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea G.H. Baek Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea Abstract We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain’s disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain’s disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome. Keywords Basal joint arthritis of the thumb, cervical arthritis, de Quervain’s disease, idiopathic carpal tunnel syndrome, trigger digit Date received: 7th October 2011; revised: 18th March 2012; accepted: 22nd March 2012 Introduction Carpal tunnel syndrome is the most common com- pain. Double crush syndrome is a general term that pressive neuropathy of the upper extremity. It fre- refers to the coexistence of dual compressive lesions quently affects women in the fifth or sixth decade of along the course of a nerve. The most common clinical life (Dawson, 1993; Mondelli et al., 2002). Trigger digit example of the double crush hypothesis is an is another common clinical disorder. The concurrence increased predisposition to carpal tunnel syndrome in of carpal tunnel syndrome and trigger digit has been patients with cervical radiculopathy. Several authors previously reported (Assmus, 2000; Harada et al., 2005; Hayashi et al., 2005; Hombal and Owen, 1970; Rottgers et al., 2009). Corresponding author: Goo Hyun Baek, Department of Orthopaedic Surgery, Seoul Cervical arthritis is a relatively common degenera- National University College of Medicine, 28 Yongon-dong, tive condition of the cervical spine that can cause sev- Chongno-gu, Seoul 110-744, South Korea eral symptoms such as neck, shoulder, and radiating Email: [email protected] Downloaded from jhs.sagepub.com at UNIV PRINCE EDWARD ISLAND on October 27, 2014 Kim et al. 51 (Bednarik et al., 1999; Hurst et al., 1985; Kwon et al., checked. X-ray images were assessed by two radiolo- 2006; Upton and McComas, 1973) have reported the gists and two orthopaedic surgeons with more than concurrence of cervical arthritis and carpal tunnel 10 years of experience. They graded the degree of syndrome. apophyseal joint damage and intervertebral disc After the distal interphalangeal joint, the basal degeneration at every consecutive level of the cervi- joint of the thumb is the second most common site of cal spine from C2 to T1 according to the classification osteoarthritis in the hand. Basal joint arthritis of the system developed by Kellgren and Lawrence (1957). thumb usually occurs in patients over 50 years of age They also graded the degree of basal joint arthritis and has a female predominance. Armstrong et al. according to the classification described by Eaton and (1994) reported that the prevalence of basal joint Littler (1973). An assessment of whether patients had arthritis of the thumb in postmenopausal women trigger digit or de Quervain’s disease was also done. was 33%. The coexistence of basal joint arthritis and All operations were carried out by a single orthopae- carpal tunnel syndrome has also been reported dic surgeon using an open surgical technique under (Burton, 1986; Florack et al., 1992; Melone et al., local anaesthesia. Patients were routinely followed 1987; Sless and Sampson, 2007). up at 2 weeks, 6 weeks, 3 months, 6 months, and 12 In the present study, patients with idiopathic carpal months after surgery, and yearly thereafter. At every tunnel syndrome who underwent open carpal tunnel follow-up, an assessment was made for new cases of release were retrospectively reviewed. The objective trigger digit or de Quervain’s disease. Median dura- of the study was to evaluate the pre-operative occur- tion of follow-up was 36 (range 24–96) months. rence of cervical degenerative arthritis or basal joint arthritis of the thumb and the pre- and post-operative Statistical methods occurrence of trigger digit or de Quervain’s disease in patients with idiopathic carpal tunnel syndrome. The Chi-squared test was used to analyze differences in the post-operative occurrence rate of trigger digit or de Quervain’s disease according to age (< 60 or ≥ Methods 60), sex, and pre-operative presence of trigger digit or Demographic data de Quervain’s disease. A p value of < 0.05 was consid- ered statistically significant. We included all patients with idiopathic carpal tunnel syndrome who underwent open carpal tunnel release at our hospital between August 1999 and July 2009. Results The Institutional Review Board of our hospital reviewed and approved this study. The inclusion crite- We enrolled 362 patients (633 hands) who had idio- ria were (1) a diagnosis of idiopathic carpal tunnel pathic carpal tunnel syndrome. Cervical degenerative syndrome on the basis of history, physical examina- arthritis was found in 253 patients (70%) on simple tion, and electrophysiological study, (2) open carpal radiographs. Among the 253 patients, cervical arthri- tunnel release, and (3) follow-up of more than 2 years. tis at one level was observed in 80 patients (32%) and Patients who had underlying diseases such as diabe- multilevel arthritis was found in 173 patients (68%). tes, hypothyroidism, rheumatoid arthritis, tuberculo- Among the 253 patients who had cervical degenera- sis, and neurologic diseases were excluded. Patients tive arthritis, 19 patients (7.5%) had neck pain and 115 who had malunited fractures of the distal radius were patients (46%) had radiating pain to the upper extrem- also excluded. ities. Cervical arthritis was most commonly observed Three hundred and sixty-two patients (37 men and at the C5-C6 level (Figure 1). Also, in nine patients 325 women) were enrolled in the present study. The electrophysiological studies were compatible with average age at time of surgery was 56.4 (SD 9.1) cervical radiculopathy. If the patient had cervical years. There were 271 patients (75%) with bilateral radiculopathy after carpal tunnel release, we first involvement and 91 patients (25%) with unilateral recommended physical therapy and medications such involvement. as nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose tricyclic antidepressants, or gabapentin. If Clinical assessment the radiculopathy was refractory to the conservative treatments, we then recommended computed tomog- The presence of degenerative arthritis in the cervical raphy (CT) or magnetic resonance imaging (MRI), and spine and basal joint of the thumb was routinely referred the patient to the spine surgeon. Figure 2 assessed. Electrophysiological studies and simple shows the typical findings of cervical degenerative radiographs of the wrist, cervical spine, and basal arthritis at the C5-C6 level on simple radiographs and joint of the thumb taken pre-operatively were CT. Of the 362 patients, CT was done in 10 patients Downloaded from jhs.sagepub.com at UNIV PRINCE EDWARD ISLAND on October 27, 2014 52 The Journal of Hand Surgery (Eur) 38(1) Figure 1. Number of the 362 patients with cervical arthritis according
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