Rodenhouse Andrew J, Dondapati Akhil, Carroll Thomas J, Ketonis Constantinos
Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY.
J Hand Surg Glob Online. 2024 Jul 31;6(5):645-649. doi: 10.1016/j.jhsg.2024.05.011. eCollection 2024 Sep.
Shoulder arthroscopy and arthroplasty are increasingly common procedures used to address shoulder pathologies. This study sought to evaluate the incidence of hand-related pathologies, including carpal tunnel syndrome (CTS), cubital tunnel syndrome (CuTS), trigger finger (TF), de Quervain tenosynovitis, and Dupuytren disease following shoulder arthroscopy and arthroplasty procedures. We hypothesized that patients undergoing shoulder surgery would have a higher incidence of hand-related pathologies within 1 year of surgery compared to controls.
This was a retrospective analysis of 12,179 patients who underwent shoulder arthroscopy or arthroplasty surgery that were subsequently diagnosed with CTS, CuTS, TF, de Quervain tenosynovitis, or Dupuytren disease within 1 year after surgery. Relative risk of having associated hand pathologies following shoulder surgery was compared to controls.
In total, 10,285 patients underwent shoulder arthroscopy procedures during this period, of whom 815 (7.9%) had an associated hand pathology within 1 year from their shoulder procedure. Arthroscopic surgery was associated with an increased likelihood of having a hand pathology (RR 1.65, 95% CI 1.54-1.76), CTS (RR 1.57, 95% CI 1.42-1.73), CuTS (RR 2.25, 95% CI 1.94-2.61), TF (RR 1.76, 95% CI 1.53-2.03), and Dupuytren disease (RR 2.02, 95% CI 1.54-2.65), but was not associated with a higher likelihood of having de Quervain tenosynovitis. In total, 1,894 patients underwent shoulder arthroplasty procedures during this period, of whom 188 (9.9%) had an associated hand pathology within 1 year. Shoulder arthroplasty was associated with an increased likelihood of having a hand pathology (RR 2.04, 95% CI 1.78-2.34), CTS (RR 2.10, 95% CI 1.72-2.57), CuTS (RR 3.29, 95% CI 2.48-4.39), and TF (RR 1.99, 95% CI 1.47-2.70), but was not associated with an increased likelihood of having de Quervain tenosynovitis or Dupuytren disease.
Shoulder arthroscopy and arthroplasty procedures were associated with an increased likelihood of having a CTS, CuTS, or a TF diagnosis made within 1 year of surgery. Only shoulder arthroscopy procedures were associated with a higher likelihood of having Dupuytren disease. Neither shoulder arthroscopy nor arthroplasty procedures were associated with an increased likelihood of a diagnosis of de Quervain tenosynovitis. These associations, however, do not necessarily imply causation, and further investigation is warranted to delineate this relationship.
TYPE OF STUDY/LEVEL OF EVIDENCE: Differential Diagnosis/Symptom Prevalence Study Level 3.
肩关节镜检查和关节成形术是治疗肩部疾病越来越常用的手术。本研究旨在评估手部相关疾病的发生率，包括腕管综合征（CTS）、肘管综合征（CuTS）、扳机指（TF）、桡骨茎突狭窄性腱鞘炎和掌腱膜挛缩症在肩关节镜检查和关节成形术后的发生情况。我们假设与对照组相比，接受肩部手术的患者在术后1年内发生手部相关疾病的发生率更高。
这是一项对12179例接受肩关节镜检查或关节成形术的患者的回顾性分析，这些患者在术后1年内被诊断为CTS、CuTS、TF、桡骨茎突狭窄性腱鞘炎或掌腱膜挛缩症。将肩部手术后发生相关手部疾病的相对风险与对照组进行比较。
在此期间，共有10285例患者接受了肩关节镜检查，其中815例（7.9%）在肩部手术后1年内出现了相关手部疾病。关节镜手术与发生手部疾病（RR 1.65，95% CI 1.54 - 1.76）、CTS（RR 1.57，95% CI 1.42 - 1.73）、CuTS（RR 2.25，95% CI 1.94 - 2.61）、TF（RR 1.76，95% CI 1.53 - 2.03）和掌腱膜挛缩症（RR 2.02，95% CI 1.54 - 2.65）的可能性增加相关，但与桡骨茎突狭窄性腱鞘炎的发生可能性增加无关。在此期间，共有1894例患者接受了肩关节成形术，其中188例（9.9%）在术后1年内出现了相关手部疾病。肩关节成形术与发生手部疾病（RR 2.04，95% CI 1.78 - 2.34）、CTS（RR 2.10，95% CI 1.72 - 2.57）、CuTS（RR 3.29，95% CI 2.48 - 4.39）和TF（RR 1.99，95% CI 1.47 - 2.70）的可能性增加相关，但与桡骨茎突狭窄性腱鞘炎或掌腱膜挛缩症的发生可能性增加无关。
肩关节镜检查和关节成形术与术后1年内诊断为CTS、CuTS或TF的可能性增加相关。仅肩关节镜检查与掌腱膜挛缩症的发生可能性增加相关。肩关节镜检查和关节成形术均与桡骨茎突狭窄性腱鞘炎的诊断可能性增加无关。然而，这些关联并不一定意味着因果关系，有必要进一步研究以明确这种关系。
研究类型/证据水平：鉴别诊断/症状患病率研究3级。
