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RECURRENT AND PERSISTENT CARPAL TUNNEL SYNDROME: A SYSTEMATIC REVIEW OF THE LITERATURE AND 40-YEAR META-ANALYSIS.
Presenter: Ali M Soltani
Co-Authors: Allan BJ; Best MJ; Mir HS; Panthaki ZJ
University of Miami

Recurrent and persistent carpal tunnel syndrome is an uncommon but potentially difficult surgical dilemma. Many surgical treatment options have been described in the literature without definitive data on outcome. We conducted a systematic review of the literature on the surgical treatment of recurrent carpal tunnel syndrome, and performed a meta-analysis of the various techniques with comparison of efficacy on the reported series. A systematic review on recurrent carpal tunnel syndrome was performed for all articles from 1946 to 2012 in MEDLINE, EMBASE, CENTRAL, and hand searched reference lists from all identified papers. We identified a total of 32 papers in the initial review, after exclusion criteria was applied, we identified 23 papers from the time period 1972 to 2012 representing 2 general treatment groups: decompression with flap coverage and repeat open decompression. Each study was independently assessed by 2 reviewers to assess quality and data extraction. Statistical analysis of the data proceeded with both fixed and random effects models, in addition to assessment of publication bias with a funnel plot. In total 294 patients from 14 studies in the flap arm of the meta-analysis had a weighted success rate of 86% and 364 patients from 9 studies in the non-flap arm had a weighted 75% success. Heterogeneity was statistically analyzed and revealed low heterogeneity with the I2 statistic. Forest plots were created and analyzed between sub-groups, and Chi-squared and Fisher s exact test analysis between observed and expected success rates between the groups revealed P-values of 0.001, highly statistically significant. This study is notable for being the first meta-analysis of a systematic review of the various surgical treatments of recurrent or persistent carpal tunnel syndrome. Decompression with the use of vascularized flap coverage appears to have an improved success rate over simple repeat decompression. The relevance of this data is pertinent to all hand surgeons, as it could impact treatment guidelines on this relatively uncommon but problematic condition, but further prospective study is needed.


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