Journal of Hand Surgery Global Online最新文献

{"title":"Association Between Insurance Status and Recommendation for Surgery for Distal Radius Fractures","authors":"Emma T. Smolev MD ,&nbsp;Rafa Rahman MD, MPH ,&nbsp;Amy Z. Lu BS ,&nbsp;Jarred Chow BS ,&nbsp;Rosie McColgan MD ,&nbsp;Jeremy Abolade MD ,&nbsp;Sanjum Singh MD ,&nbsp;Isabel Wolfe MD ,&nbsp;Troy B. Amen MD, MBA ,&nbsp;Duretti T. Fufa MD","doi":"10.1016/j.jhsg.2025.100890","DOIUrl":"10.1016/j.jhsg.2025.100890","url":null,"abstract":"<div><h3>Purpose</h3><div>Disparities continue to impact patient care within orthopedics. Distal radius fractures (DRFs) are extremely common, with variability in surgical indications allowing for potential treatment disparities. The study sought to determine whether (1) insurance status and (2) geographic socioeconomic disadvantage is associated with surgeon treatment recommendation for dorsally angulated DRF.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used institutional data from 2016 to 2021 to assess associations between patient demographics and socioeconomic variables of interest, including geographic socioeconomic disadvantage (Area Deprivation Index), insurance status, and likelihood of operative recommendation. Multivariable logistic regression adjusted for potential confounders including fracture severity based on degree of dorsal angulation (mild, ≥0° and ≤10°; moderate, &gt;10° and &lt;20°; severe ≥20°), radial inclination, ulnar variance, presence of an ulnar styloid fracture, sex, age, and Elixhauser Comorbidity score (α = 0.05).</div></div><div><h3>Results</h3><div>In total, 891 patients were included, with a mean age of 55 years (range 18–62), 78% women (n = 699), and 79.4% White non-Hispanic (n = 707), 2.9% Black non-Hispanic (n = 26), 6.9% Hispanic (n = 61), and 10.9% Other (n = 97). In total, 31% (n=280) of all patients presented with mild DRF, 29% (n = 258) moderate, and 40% (n = 353) severe. Overall, 77% (n = 688) of patients were recommended surgery, and 74% (n = 660) underwent operative management. Public health insurance was associated with lower likelihood of recommendation for surgery. There was no significant difference in treatment recommendation based on Area Deprivation Index.</div></div><div><h3>Conclusions</h3><div>Public health insurance was found to be significantly associated with lower likelihood of recommendation for DRF surgery, even after controlling for fracture severity and individual-level confounding variables. This suggests variability in DRF management based on individual patient factors.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic III</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100890"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on “A Comparison of Artificial Intelligence Platforms in the Utility of Answering Frequently Asked Questions About Carpal Tunnel Syndrome”","authors":"Amnuay Kleebayoon PhD ,&nbsp;Viroj Wiwanitkit MD","doi":"10.1016/j.jhsg.2025.100884","DOIUrl":"10.1016/j.jhsg.2025.100884","url":null,"abstract":"","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100884"},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adults Closed Distal Radial Fractures: Current Concepts in Treatment Selection and Complication Prevention","authors":"Sang Anh Nguyen MD, MSc ,&nbsp;Anh Hoang Dang MD, PhD ,&nbsp;Doanh Quoc Tran MD, PhD","doi":"10.1016/j.jhsg.2025.100886","DOIUrl":"10.1016/j.jhsg.2025.100886","url":null,"abstract":"<div><h3>Purpose</h3><div>Closed distal radial fractures (DRFs) are among the most common adult fractures with high socioeconomic impact. Clinical decision-making remains challenging, particularly in low- and middle-income countries (LMICs), because of the heterogeneous nature of evidence and resource constraints. This study aimed to develop a risk-stratified framework for treatment selection and the prevention of complications.</div></div><div><h3>Methods</h3><div>A structured literature search was conducted in Pubmed, Scopus, and Embase databases from January 2015 to August 2025. Eligible studies included randomized controlled trials, cohort studies, systematic reviews, and guidelines addressing closed DRF management in adults. Two reviewers independently screened titles, abstracts, and full texts.</div></div><div><h3>Results</h3><div>Fifteen studies met the inclusion criteria: three randomized controlled trials, five systematic reviews/meta-analyses, three cohort studies, two cadaveric/technical imaging studies, one guideline summary, and one narrative review. Radiographic thresholds of radial shortening &gt;3 mm, dorsal tilt &gt;10°, and intra-articular step-off &gt;2 mm were supported as surgical indications in younger or high-demand adults, but not consistently in older low-demand patients. Instability predictors, such as Lafontaine criteria, were cited frequently; however, no single factor reliably predicted redisplacement. Volar locking plate (VLP) fixation yielded earlier functional recovery in unstable or high-demand patients, but long-term outcomes converged across techniques. The SAFE-VLP checklist (safe plate position, appropriate screw length, fixation stability, and early rehabilitation) emerged as a practical tool to reduce complications related to tendon, nerve, and complex regional pain. For LMICs, pragmatic pathways emphasize high-quality casting for low-demand elderly patients, percutaneous pinning as a cost effective alternative for moderate instability, and day-surgery VLP for unstable or working-age patients, supported by tele-rehabilitation strategies.</div></div><div><h3>Conclusions</h3><div>The management of closed DRFs should integrate radiographic criteria, instability predictors, functional demand, and health care context, rather than relying solely on radiographs for decision-making. This review provides a risk-stratified algorithm, a validated safety checklist, and an LMIC-adapted pathway to optimize outcomes and reduce complications.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic V.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100886"},"PeriodicalIF":0.0,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding “Dynamic Tenodesis Technique for Ulnar Drift With Extensor Tendon Subluxation due to Rheumatoid Arthritis” by Oda et al","authors":"Parth Aphale PhD ,&nbsp;Himanshu Shekhar BHMS ,&nbsp;Shashank Dokania BHMS","doi":"10.1016/j.jhsg.2025.100883","DOIUrl":"10.1016/j.jhsg.2025.100883","url":null,"abstract":"","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100883"},"PeriodicalIF":0.0,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Epidemiology and Reimbursement for Nerve Exploration and Reconstruction After Brachial Plexus Injury in the United States From 2009 to 2019","authors":"Thomas J. McQuillan MD ,&nbsp;Kevin Heo MD ,&nbsp;Olivia Jagiella-Lodise BS ,&nbsp;Joseph G. Monir MD ,&nbsp;Eric R. Wagner MD ,&nbsp;Nicole A. Zelenski MD","doi":"10.1016/j.jhsg.2025.100829","DOIUrl":"10.1016/j.jhsg.2025.100829","url":null,"abstract":"<div><h3>Purpose</h3><div>Brachial plexus injury (BPI) is an uncommon peripheral nerve disorder with a multitude of treatments. Given the relative rarity of this condition, it is difficult to estimate the volume of primary and secondary reconstructive procedures in the United States, as well as demographic and geographic trends in treatment.</div></div><div><h3>Methods</h3><div>The study used a large administrative commercial insurance claims database to estimate the total volume of procedures associated with a diagnosis of BPI from the years 2009 to 2019. Unique Current Procedural Terminology codes were tabulated among beneficiaries with a known diagnosis of BPI and stratified by key variables including age, sex, and geographic region to assess for trends in diagnosis and management. Reimbursement data for specific Current Procedural Terminology codes were adjusted for inflation and evaluated over the follow-up period.</div></div><div><h3>Results</h3><div>The incidence rate of nerve procedures for BPI increased over the study period from 1.26 to 1.91 procedures per 100,000 patient-years, as did the incidence rate of unique patients with BPI treated with nerve procedures, from 0.76 to 1.18. More procedures were performed in the age group 18–34 years (35.1%) and the South geographic region (40.6%). The most common codes included brachial plexus neuroplasty (Current Procedural Terminology codes 64713 and 64861; 64% of total). Reimbursement increased for codes related to brachial plexus neuroplasty over the interval of +26% and decreased for both neuroplasty of peripheral nerves (−23.9%) and nerve transfers (−39.7%).</div></div><div><h3>Conclusions</h3><div>The volume of procedures performed for BPI continues to increase with the dissemination of surgical techniques and knowledge. Relative increases in the older adult patient population, among females, and in the South necessitate a patient-specific approach given that historically most treatment has been provided to young, male patients. Declining reimbursement for certain codes necessitates continued advocacy given the complexity of surgery and technical advances in the field.</div></div><div><h3>Type of study/level of evidence</h3><div>Differential diagnosis/symptom prevalence IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100829"},"PeriodicalIF":0.0,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic Structures at Risk With Antegrade Intramedullary Fixation of the First Metacarpal Using Three Start Points: Is There A Safe Zone?","authors":"Mason H. Adams DO ,&nbsp;Thomas B. Lynch MD ,&nbsp;Daniel D. Homeier MD ,&nbsp;David J. Wilson MD ,&nbsp;Jantz J. Arbon MD ,&nbsp;Taylor J. Bates MD","doi":"10.1016/j.jhsg.2025.100850","DOIUrl":"10.1016/j.jhsg.2025.100850","url":null,"abstract":"<div><h3>Purpose</h3><div>Intramedullary fixation of extraarticular first metacarpal fractures using a percutaneous technique may risk injury to important anatomic structures. The purpose of this study is to evaluate potential safe zones for antegrade implant entry of the first metacarpal and describe the anatomical structures at risk.</div></div><div><h3>Methods</h3><div>Ten cadaveric hands were used to evaluate three start points located at the first metacarpal base: volar-radial, dorsal-radial, and dorsal-ulnar. A fluoroscopic imaging system was used to guide percutaneous placement of 0.8 mm × 100 mm guidewires and 2.0 mm diameter screws. After screw placement the guidewires were left in place and soft tissues were dissected to identify at risk anatomic structures.</div></div><div><h3>Results</h3><div>The identified structures at risk were the radial artery, superficial branch of the radial nerve (SBRN), extensor pollicis longus (EPL) tendon, abductor pollicis longus (APL) tendon, and extensor pollicis brevis (EPB) tendon. A volar-radial start point risks injury to the APL tendon (8.3 ± 5.4 mm). A dorsal-radial start point risks injury to the SBRN (2.2 ± 3.4 mm), APL (1.4 ± 1.8 mm), and EPB (1.2 ± 2.1 mm) tendons. A dorsal-ulnar start point risks injury to the SBRN (5 ± 4.2 mm), radial artery (3.5 ± 3.1 mm), and EPL tendon (3.5 ± 2.4 mm).</div></div><div><h3>Conclusions</h3><div>Dorsal-radial and dorsal-ulnar start points risk injuring critical anatomic structures: radial artery, SBRN, EPL, APL, and EPB. A volar-radial start point may risk injury to the APL tendon but presents the lowest risk of injury to neurovascular structures.</div></div><div><h3>Clinical relevance</h3><div>This study identifies key anatomic structures at risk associated with three common percutaneous entry points. The volar-radial start point demonstrated the lowest risk to neurovascular structures and may represent a safe approach for percutaneous intramedullary fixation.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100850"},"PeriodicalIF":0.0,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nerve Transfer for Restoration of Ulnar Fingers Flexion Through Pronator Teres Motor Branch: A Cadaveric Feasibility Study","authors":"Paolo Titolo MD ,&nbsp;Alessandro Crosio MD, PhD ,&nbsp;Andrea Fanecco MD ,&nbsp;Erica Cavalli MD ,&nbsp;Francesca Vincitorio MD ,&nbsp;Julien Teodori MD ,&nbsp;Giulia Colzani MD ,&nbsp;Nathalie Bini MD ,&nbsp;Mario Ronga MD ,&nbsp;Michele Rosario Colonna MD, PhD ,&nbsp;Bruno Battiston MD, PhD ,&nbsp;Davide Ciclamini MD","doi":"10.1016/j.jhsg.2025.100844","DOIUrl":"10.1016/j.jhsg.2025.100844","url":null,"abstract":"<div><h3>Purpose</h3><div>Injury to the ulnar nerve above the elbow or other conditions such as brachial plexus injury or cervical spinal cord injury can also affect the extrinsic finger flexors. Numerous techniques have been described to treat this problem, but no specific nerve transfer has been proposed.</div></div><div><h3>Methods</h3><div>Here, we describe the transfer of the motor branch of the pronator teres (PT) to reinnervate flexor digitorum profundi of the ulnar nerve. Eleven fresh frozen upper limbs were used. The anatomical characteristics of the branches to the flexor digitorum profundus and PT were recorded.</div></div><div><h3>Results</h3><div>In all cases, the superficial branch of the PT resulted as the longest between the two and, therefore, was used as a donor. It was passed under the flexor pronator muscles to reach the ulnar nerve. The recipient motor branch was dissected proximally, and a direct nerve suture was made between the two stumps.</div></div><div><h3>Conclusions</h3><div>In all specimens, a direct tension free neurorrhaphy was possible, located close to the target muscle.</div></div><div><h3>Clinical relevance</h3><div>This specific procedure can be suggested in cases where the hand is partially involved to allow patients to regain or strengthen fingers flexion. Direct clinical application should support and confirm this novel procedure.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100844"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carpal Tunnel Release: A Four-Specialty Comparison Demonstrating Equal Clinical and Economic Efficacy","authors":"Andy M. Liu BS ,&nbsp;Vikranth Mirle MD ,&nbsp;Cody Lee MD ,&nbsp;Jennifer Moriatis Wolf MD, PhD ,&nbsp;Jason Strelzow MD","doi":"10.1016/j.jhsg.2025.100863","DOIUrl":"10.1016/j.jhsg.2025.100863","url":null,"abstract":"<div><h3>Purpose</h3><div>Carpal tunnel release (CTR), the most common hand surgery procedure in the United States, is routinely performed by orthopedic surgeons, neurosurgeons, plastic surgeons, and general surgeons. There is limited literature comparing clinical costs and research utilization among specialties. This study sought to determine treatment utilization, variations in cases, and cost trends among orthopedic, plastic, general, and neurosurgeons.</div></div><div><h3>Methods</h3><div>A national insurance database was queried for patients who underwent open or endoscopic CTR between the years 2007 and 2022. Four cohorts based on provider specialty, orthopedic, plastic, general, and neurosurgery, were matched using the following factors: age, sex, diabetes, obesity, tobacco use, location of procedure, and Elixhauser Comorbidity Index. Average cost by specialty was then calculated and compared. Rates of therapy within 3 months after surgery and EMG and nerve conduction velocity studies within 3 months before the procedure were also compared.</div></div><div><h3>Results</h3><div>The matched cohorts consisted of 13,107 patients each. Plastic surgeons and neurosurgeons had the highest average cost ($2,923.29 and $2,922.58), followed by orthopedic surgeons ($2,765.95), with general surgeons having the lowest cost ($2,607.02). Rates of preoperative EMG and nerve conduction studies were highest with neurosurgeons (28.5%), followed by orthopedics and plastics (22.6% and 23.4%, respectively), with general surgeons ordering the fewest (19.7%). For complications, general surgeons and neurosurgeons had a small but statistically higher infection rate (0.8%, 0.7% respectively) compared with orthopedic and plastic surgeons (0.5%, 0.5%).</div></div><div><h3>Conclusions</h3><div>The current study demonstrates that overall orthopedic, plastic, neurosurgery, and general surgeons perform CTRs with similar overall costs and with similar postoperative complications.</div></div><div><h3>Type of study/level of evidence</h3><div>Economic/decision analysis III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100863"},"PeriodicalIF":0.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training Tomorrow’s Hand Surgeons: Clinical, Leadership, and Structural Trends in Fellowship Education","authors":"Ogonna N. Nnamani Silva MD ,&nbsp;Aaron I. Dadzie BS ,&nbsp;Chinenye Ogbonnah BA ,&nbsp;Lydia A. Helliwell MD, MMSc ,&nbsp;Abhiram R. Bhashyam MD, PhD ,&nbsp;Catherine M. Curtin MD ,&nbsp;Tamara D. Rozental MD ,&nbsp;Krystle R. Tuaño MD","doi":"10.1016/j.jhsg.2025.100871","DOIUrl":"10.1016/j.jhsg.2025.100871","url":null,"abstract":"<div><h3>Purpose</h3><div>Hand surgery fellowships include trainees from orthopedic, plastic, and general surgery. These pathways present an opportunity to examine variations in graduate medical education structures, such as program size, sponsoring department, and leadership composition. Limited research exists on the characteristics of these programs. The purpose of this study is to assess the structural and leadership characteristics of the Accreditation Council of Graduate Medical Education-accredited hand surgery fellowships in the United States. We hypothesized that characteristics (ie, faculty-to-fellow ratios and case volume) vary by specialty sponsorship. Leadership, although shaped by merit-based criteria, faces challenges in achieving broader demographic diversity.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis of 95 US hand surgery fellowship programs was conducted in 2025. Program characteristics were compared by region and specialty sponsorship.</div></div><div><h3>Results</h3><div>Most programs were orthopedic-sponsored (n = 74, 77.9%), followed by plastic surgery (n = 19, 20.0%) and general surgery (n = 2, 2.11%). Programs averaged 2.22 fellows (SD = 1.35), with a faculty-to-fellow ratio of 3.98 (SD = 2.01) and an annual case volume of 846 per fellow (SD = 332). Orthopedic-sponsored programs had more fellows on average, a lower faculty-to-fellow ratio, and were less open to general surgery applicants compared to plastic surgery-sponsored programs. No notable regional differences were found in these characteristics. Program directors were predominantly men (n = 81, 85.3%) and orthopedic-trained (n = 70, 73.7%).</div></div><div><h3>Conclusions</h3><div>Hand surgery fellowships show consistent structural features, with notable differences between orthopedic- and plastic surgery-sponsored programs in enrollment, faculty-to-fellow ratios, and openness to general surgery applicants. Women leadership underrepresentation warrants further evaluation.</div></div><div><h3>Type of study/level of evidence</h3><div>Cross-sectional descriptive study, level IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100871"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concordance Between Subjective Sleep and PSQI/ISI in Carpal Tunnel Syndrome Patients: A Comparative Study Before and After Surgery","authors":"Sang Anh Nguyen MD, MSc ,&nbsp;Doanh Quoc Tran MD, PhD","doi":"10.1016/j.jhsg.2025.100870","DOIUrl":"10.1016/j.jhsg.2025.100870","url":null,"abstract":"<div><h3>Purpose</h3><div>Carpal tunnel syndrome (CTS) is frequently associated with sleep disturbances that considerably impair quality of life. Most studies have focused on either subjective sleep or standardized patient-reported (SPR) measures, but the concordance between these measures before and after surgery remains unclear. We aimed to determine the rates of concordance and discordance, along with the associated factors, ultimately proposing strategies to enhance the assessment process and postoperative care for these patients.</div></div><div><h3>Methods</h3><div>We conducted a single-center observational study including 104 adult CTS patients who underwent carpal tunnel release, divided into retrospective (n = 71) and prospective (n = 33) cohorts. Subjective sleep quality was assessed by patient self-report, whereas SPR included the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Assessments were performed before surgery and at 1, 3, and 12 months after surgery. Concordance between subjective and SPR results was determined at each time point.</div></div><div><h3>Results</h3><div>Before surgery, 100% of patients reported poor sleep, with all having PSQI &gt; 5 and ISI &gt; 7 (full concordance). After surgery, both subjective and SPR sleep quality improved significantly. At 12 months, 95.77% of patients self-reported good sleep; 95.77% had PSQI ≤ 5, and 91.55% had ISI ≤ 7. Concordance between subjective and SPR assessments increased over time, but a minority of patients continued to exhibit discordance, with self-perceived improvement preceding SPR normalization in some cases. Strong positive correlations were found between PSQI and ISI at all time points.</div></div><div><h3>Conclusions</h3><div>Carpal tunnel release leads to substantial improvements in both subjective and SPR sleep quality in CTS patients, with increasing concordance over time. However, persistent discordance in some individuals underscores the need for multidimensional assessment and individualized management.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IIb.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100870"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}