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1st CMC arthroplasty combined with radial approach for carpal tunnel release procedure – Follow up and Outcome
Xueyuan Li, PHD; Tsu-Min Tsai, MD; Silvia Aviles; Saad Elrahmany; University of Louisville
Kleinert and Kutz , Louisville, KY, USA

Purpose: Arthritis of the 1st Carpal metacarpal joint arthritis combined w ith carpal tunnel syndrome is a common condition, especially in elder populations. We present here intermediate to short term follow up in a series of 69 patients who presented with both conditions, that was treated at our center with both arthroplasty and radial approach carpal tunnel release. Methods£ºFrom 2009 to 2011, patients who presented with both 1st CMC arthritis and CTS underwent radial approach carpal tunnel release and 1st CMC arthroplasty with LRTI using partial FCR. We have followed up on 69 patients and have focused on the three month follow up time point. There were 52 female and 17 male with an average age of 59 years. Data was collected on Pre and postoperative disabilities of the arm, shoulder, and hand (DASH) scores, visual analog scale scores, Grip strength, pinch strength, Levine and Function score. Results: After surgery, the mean grip strength was 49.34¡À25.36 Lbs, improved 15.83Lbs. 34.41%. We found the treated hand had 77% of the strength of the contra lateral side. The mean Key Pinch strength was 9.5 lb. we found that the treated hand had 62.5% of key pinch strength of the untreated hand. But key pinch strength has no significant change comparing with preoperative in both groups. The mean DASH score decreased from 53.64 to 27.01 postoperatively, the mean VAS score was 6.95; and post 3 month mean VAS score was 2.2. Both DASH score and VAS score were significantly decreased postoperatively in both groups. Levine and function score decreased from 3.57 to 2.01 and 3.04 to 2.28. But only Levine score showed significant decrease in both groups. Of these 69 patients, 2 have two years of follow up and report excellent function and pain relief. Complications included mild pain over incision 6 cases, Reflex Sympathetic Dystrophy in 1 case, and tendon extruded in 1 case. Conclusion: In our study, 1st CMC arthroplasty combined with radial approach for carpal tunnel release as routine procedure for patient who has both CTS and 1st CMC joint arthritis was proved to be safe and efficient with obvious pain relief as well as satisfactory functions, the second incision over the carpal tunnel is avoided.


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