Risk factors related to complications of the fingers and hand after arthroscopic rotator cuff repair - carpal tunnel syndrome, flexor tenosynovitis, and complex regional pain syndrome

Mikio Harada; Masatoshi Takahara; Nariyuki Mura; Issei Yuki; Daisaku Tsuruta; Michiaki Takagi

doi:10.1016/j.jseint.2021.07.001

Risk factors related to complications of the fingers and hand after arthroscopic rotator cuff repair - carpal tunnel syndrome, flexor tenosynovitis, and complex regional pain syndrome

JSES Int. 2021 Aug 30;5(6):1077-1085. doi: 10.1016/j.jseint.2021.07.001. eCollection 2021 Nov.

Authors

Mikio Harada¹, Masatoshi Takahara¹, Nariyuki Mura², Issei Yuki³, Daisaku Tsuruta⁴, Michiaki Takagi³

Affiliations

¹ Department of Orthopedic Surgery, Izumi Orthopedic Hospital, Sendai, Japan.
² Yamagata Prefectual University of Health Sciences, and Department of Orthopedic Surgery, Yoshioka Hospital, Yamagata, Japan.
³ Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
⁴ Okitama Public General Hospital, and Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Higashiokitamagun, Japan.

Abstract

Hypothesis/background: Complications involving the fingers and hand after arthroscopic rotator cuff repair (ARCR) include complex regional pain syndrome, carpal tunnel syndrome (CTS), and flexor tenosynovitis (TS). The aims of this study were to diagnose the complications after ARCR and investigate the risk factors that could predispose individuals to these finger and hand complications.

Methods: Fifty patients (50 shoulders) who underwent ARCR participated in this study. The patients' ages ranged from 36 to 84 years (mean, 63 years). Before ARCR, we determined the disease history of the fingers and hand (CTS or TS) and subjectively assessed their symptoms using a questionnaire that included a scale ranging from 1 (no symptoms or no disability) to 5 (the worst symptoms or severest disability). ARCR was performed in all patients using suture anchors. The mean observation period after surgery was 15.5 months (range, 12-48 months). We diagnosed complications involving the fingers and hand after ARCR and investigated the preoperative, intraoperative, and postoperative risk factors that could predispose patients to these complications using univariable and multivariable analyses.

Results: After ARCR, 20 patients (20 hands) (40%) had complications of the fingers and hand. Among them, the diagnosis was CTS in 2 hands, TS in 15 hands, and both CTS and TS in 3 hands. None of the hands exhibited complex regional pain syndrome. These complications occurred at an average of 1.8 months (range, 0.1-4 months) after ARCR. In the 47 patients who did not have symptoms just before the operation, both univariable and multivariable analyses between the complication group (n = 17) and the no-complications group (n = 30) showed a significant difference in the presence of a past history of CTS or TS (complication frequency: past history: 88%, no past history: 25%) (P < .05) and the preoperative subjective assessment for edema of the fingers and hand (complication frequency: edema ≥ 2 points: 89%, edema < 2 points: 24%) (P < .05). There were no relationships between the other candidate intraoperative and postoperative factors and complications.

Conclusion: In all 20 hands with complications of the fingers and hand after ARCR, the diagnosis was CTS or TS. Complications of the fingers and hand after ARCR easily occurred in patients with a past history of CTS or TS and in patients with edema as per a subjective assessment. We speculate that the ARCR triggered the occurrence of CTS and TS postoperatively in patients who had subclinical CTS or TS before surgery.

Keywords: Arthroscopic rotator cuff repair; Carpal tunnel syndrome; Complex regional pain syndrome; Finger; Flexor tenosynovitis; Hand; Shoulder; Trigger finger.