Symptoms may return after carpal tunnel surgery

Article Abstract:

Carpal tunnel syndrome is a common, painful disorder of the wrist and hand, caused by nerve compression. Surgery has been the standard treatment, but up to one-third of patients may suffer weakness and scar pain two years after surgery. A retrospective study of 60 cases has found that painful scars were more common among patients receiving worker's compensation than among patients covered by private insurance. Those receiving worker's compensation also lost significantly more time from work, and were less likely to return to the same job. Similar results were also reported in another study of 105 operations. After five and a half years of follow-up, 30 percent of the patients who had undergone surgery rated the results as poor or fair, and over half reported the return of some postoperative symptoms, usually pain, beginning about two years after surgery. Only one patient had repeat surgery. Transient pains were reported by 42 percent, numbness of the fingers by 32 percent, and tingling by 35 percent. The endoscopic method of repair, which uses a tube inserted through a small incision, is not always successful. There have been cases of cutting the digital nerve or arteries with this technique. When experienced surgeons entered a trial using 13 fresh-frozen cadavers, only five of the operations were successful, leading a hand surgery specialist to comment that it would have been better for the patients of these surgeons if the cadaver study had been done first. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Carpal tunnel syndrome

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Prognosis, diagnosis, or who knows? Time to learn what gene tests mean

Article Abstract:

Standards and safeguards may be necessary to ensure the appropriate use of genetic testing and to protect patient confidentiality. Genetic tests are used to identify genes associated with an increased risk of disease. People with positive test results may or may not eventually develop the disease. As this technology diffuses from research centers into the primary care setting, physicians, nurses, and social workers will assume the role of explaining genetic testing. These professionals must receive proper training to equip them with an understanding of complex genetic tests. Health care workers must recognize that testing may impact people's reproductive decisions and may affect members of their families. In addition, health insurance carriers may terminate coverage if the insured person has a positive genetic test. Proposals to deal with the revolution in genetic medicine include formal physician and patient education and a regulatory system that stipulates the transition of genetic tests from research into practical use.

Standards, Innovations, Services, Medical personnel, Genetic screening, Genetic testing, Medical genetics

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