Mujadzic Tarik, Friedman Harold I, Mujadzic Mirza M, Gober Charles, Chen Elliot, Atwez Abdelaziz, Durkin Martin, Mujadzic Mirsad M
From the Prisma Health/University of South Carolina School of Medicine, Columbia SC.
Saint Louis University, St Louis, MI.
Ann Plast Surg. 2021 Jun 1;86(6S Suppl 5):S503-S509. doi: 10.1097/SAP.0000000000002885.
Pillar pain is a frequent postoperative complication of carpal tunnel release (CTR). The precise definition of pillar pain is lacking, but most authors describe it as diffuse aching pain and tenderness in the thenar and hypothenar area. The etiology of pillar pain is unclear. However, the most prevalent theory is the neurogenic theory, which attributes the pain to the damage of small nerve branches of palmar cutaneous branches of median nerve after surgical incision, with resulting entrapment of the nerves in the scar tissue at the incision site. We postulated that a main source of pillar pain is sensory neuromas along the incision site.In this article, we describe a simple modification of the standard CTR technique with intent to decrease neuroma formation and thus minimizing pillar pain.
This is a retrospective study comparing the incidence and duration of pillar pain between patients who underwent standard CTR (SCTR, n = 53) versus the minimizing pillar pain CTR technique (n = 55). Based on duration of pillar pain, the groups were placed into 3 subgroups (<3, 3-6, and >6 months). Presence and duration of pillar pain in each group were recorded along with return to work (RTW), complications, and patient satisfaction.
The SCTR group had a total of 17 patients with pillar pain (32.1%), 5 of which resolved within 3 months, 7 within 3 to 6 months, and 5 in more than 6 months. The group that underwent the minimizing pillar pain technique had a total of 4 patients with pillar pain (7.2%). Three resolved within 3 months, 1 resolved within 3 to 6 months, and there were no patients with pillar pain lasting more than 6 months. Average RTW time for minimization of pillar pain CTR (MPPCTR) was 34.9 days. Average RTW time for SCTR was 54.8 days. Satisfaction was higher among patients who underwent surgery with MPPCTR.
Based on these results, we concluded that MPPCTR compared with SCTR had equal complication rate, however, significantly lower incidence and duration of pillar pain, higher rate of satisfaction, and earlier RTW.
柱状痛是腕管松解术（CTR）常见的术后并发症。目前对柱状痛尚无确切定义，但大多数作者将其描述为大鱼际和小鱼际区域的弥漫性酸痛和压痛。柱状痛的病因尚不清楚。然而，最流行的理论是神经源性理论，该理论认为疼痛是由于手术切口后正中神经掌皮支的小神经分支受损，导致神经在切口部位的瘢痕组织中受压。我们推测柱状痛的一个主要来源是沿切口部位的感觉神经瘤。在本文中，我们描述了一种对标准CTR技术的简单改良，旨在减少神经瘤形成，从而将柱状痛降至最低。
这是一项回顾性研究，比较了接受标准CTR（SCTR，n = 53）与最小化柱状痛CTR技术（n = 55）的患者之间柱状痛的发生率和持续时间。根据柱状痛的持续时间，将两组患者分为3个亚组（<3个月、3 - 6个月和>6个月）。记录每组患者柱状痛的存在情况和持续时间，以及恢复工作（RTW）情况、并发症和患者满意度。
SCTR组共有17例患者出现柱状痛（32.1%），其中5例在3个月内缓解，7例在3至6个月内缓解，5例在6个月以上缓解。接受最小化柱状痛技术的组共有4例患者出现柱状痛（7.2%）。3例在3个月内缓解，1例在3至6个月内缓解，没有患者的柱状痛持续超过6个月。最小化柱状痛CTR（MPPCTR）的平均RTW时间为34.9天。SCTR的平均RTW时间为54.8天。接受MPPCTR手术的患者满意度更高。
基于这些结果，我们得出结论，与SCTR相比，MPPCTR的并发症发生率相同，但柱状痛的发生率和持续时间显著更低，满意度更高，RTW更早。
