Carpal Tunnel Oswa Harley Street Video Buttons Page 2 Final Isisisis Isisisisisisisisis...

8/12/2019 Carpal Tunnel Oswa Harley Street Video Buttons Page 2 Final Isisisis Isisisisisisisisis Isisisisisisisisisisisisisis

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SAVE RESET EMAIL PRINT


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ONE STOP WIDE AWAKECARPAL TUNNEL DECOMPRESSIONINTERACTIVE PATIENT CENTRIC

DOCUMENTATION AND CONSENT FORMHARLEY STREET HAND CLINIC

DATE / /

Name: Date Of Birth :

Address Email

Telephone

Occupation Handedness R/ L/ Ambidextrous

Step 1:

Watch OSWA Carpal Tunnel Information Video available on android, youtube & our websites

Step 2:Fill Out This Interactive Carpal Tunnel Assessment Form

Please tick if you have any of the following medical problems and give details ofanything else you wish:

Do you have any allergies?(if yes specify)If female- might you be pregnant?Are you diabetic?Do you have thyroid problems?Do you have any chest/heart problems?Do you have a bleeding disorder?Do you take anticoagulants?Other (please specify)

Please list your current drugs

Tick and inform Mr Bismil if you take any of the following drugs:tricyclic and monoamine oxidase inhibitor antidepressants

digoxinthyroid hormone (thyroxine)sympathomimetics (weight control or attention deficit disorders)stimulant drug abuse, eg, cocaine

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Step 3: Hand Diagram- You Are Suitable For OSWA Care If Your Problemfeels like this:If the problem feels different book a clinic appointment at Harley Street Hand Clinic

Step 4: Please fill out the Carpal Tunnel Questionnaire belowThe assessment centres upon a validated scoring system for carpal tunnel syndromewhich has been published after peer review1,2

Question Score

Has pain in the wrist woken you at night?Yes+1

No0

Has tingling and numbness in your handwoken you during the night?

Yes+1

No0

Has tingling and numbness in your hand beenmore pronounced first thing in the morning?

Yes+1

No0

Do you have/perform any trick movements tomake the tingling or numbness go from yourhands?

Yes+1

No0

Do you have tingling or numbness in yourlittle finger at any time?

Yes0

No+3

Has the tingling and numbness presentedwhen you were reading a newspaper,steering a car or knitting?

Yes+1

No0

Do you have neck pain? Yes-1

No0

Has the tingling and numbness in your handbeen severe during pregnancy?

Yes+1

No-1

N/A0

Has wearing a splint on your wrist helped thetingling and numbness?

Yes+2

No0

N/A0

TOTAL SCORE

Tick hereto confirm that your symptomsare like this

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If score 4 or less book a clinic appointment 00 44 7581 369 015, wear asplint to keep the wrist straight (in neutral) and commence these exercises

Figure 1 Cycle through these positions holding each for 3 seconds

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Figure 2 Cycle through these positions holding each for 3 seconds

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If score 5 or more continue with One Stop Wide Awake Pathway and signand print here:

I understand that the surgery offered is Limited Open Carpal Tunnel

decompression3

I realise that there are three possible courses of treatment- exercise, surgeryand injections.

By continuing I confirm I have tried:o exerciseso and also tried splinting the wrist

in a neutral position eg. at night

If I prefer an exercise approach I will advise

Mr Bismil immediately

I can contact Mr Bismilo who will facilitate this is if appropriate.

I understand that the scientific logicof this pathway is that:

o CTS is a clinical syndromeo It cannot be proven or disproven

by tests such as nerve conduction studieso My own subjective assessment (completed above) and the surgeons

confirmation of this and further clinical tests will add weight to thediagnosis of CTS which has been made above

o I am proceeding because on balance I would like to consider surgicaltreatment

o I understand at surgery the transverse carpal ligament is divided andthe pressure on the nerve is relieved and thereforefurther damage tothenerve due to the CTS should be prevented

o Before I attend for my OSWA care I will read the surgical consent formcarefully and sign this form prior to surgery

Patient Signature

Print Name

Date

References For Carpal Tunnel Assessment And Patient Education

1. Kamath V, Stothard J. J Hand Surg Br. 2003 Oct;28(5):455-9.2. Bridges MJ, Robertson DC, Chuck AJ. Hand Surg. 2011;16(1):39-42.

3. Crpar M, Ar M, Trker M, Ekiolu MF, Cetik O. Eklem Hastalik Cerrahisi.[The efficacy and safety of limited incision technique in carpal tunnel release].[Article in Turkish] 2011;22(1):33-8.

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SURGEONS ASSESSMENT PAGE TO BE COMPLETED BY SURGEON AT OSWA

Date:

I have scrutinized the above document and the patient is suitable for OSWA carpal

tunnel care.

The patient complains of sensori-motor symptoms emanating from themedian nerve in the form of pain tingling and numbness

I have explained to the patient the only absolute contraindication is localanaesthetic allergy which is rare and on the basis of the patient historythere are no concerns regarding this. Rather than true allergy patients aremore likely to experience fainting or to react to adrenaline (either their

own or administered- adrenaline is a beta-1 adrenergic agonist.). In ourexperience with wide awake hand surgery 15 years we have notencountered a patient who was confirmed to have local anaesthetic allergy.

THE PATIENT DOES NOT GIVE A PAST HISTORY OF RELEVANT ORCONFOUNDING ALLERGY / CONTRAINDICATION TO WAHS

RIGHT LEFT

Sensory deficit mediannerve CTS?

Yes / No Yes / No

Motor deficit median nerveCTS ?

Weakness APB/Wasting APB/Other (specify)

Weakness APB/Wasting APB/Other (specify)

Tinels test Carpal Tunnel? Positive / negative Positive / negativeScratch collapse testCarpal?

Positive / negative Positive / negativeBiro test Carpal? Positive / negative Positive / negativeEvidence of double crush? Yes / No Yes / No

ANY OTHER INFORMATIONEg. Nerve conduction studies performed/ results

There is no clinical evidence of treatable or non-surgical problem such aspregnancy, hypothyroidism or diabetes.

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DIAGNOSIS

Median nerve entrapment:

site:

carpal tunnel

Severity

left /right /bilateral

Mild /Moderate / SevereDiagnosis and risks versus benefits of treatment options fully discussed. Ihave explained to the patient that limited open wide awake carpal tunnelrelease is offered for moderate-severe CTS:

a. clinically confirmed moderate-severe carpal tunnel syndrome (tick)b. with objective evidence of neurological dysfunction of all three

components of nerve dysfunction:a. Motori. thenar weakness and/orii. thenar wasting (tick)

b. Sensory (objective sensory deficit) (tick)c. Autonomic (biro test) (tick)

I have discussed with the patient the management plan including anystaged treatment (specify)

Injection and exercise treatment has been offered as an alternative if CTSis mild or if the patient on the balance of pros and cons and risks andbenefits wishes to avoid surgery in the first instance and understands thepros and cons and risks and benefits of injection detailed overleaf.

Overall, I have explained to the patient that with limited open carpal tunneldecompression: [ ]s carpal tunnel syndromehas [ ]chance of significant improvement versus a [ ]%riskofworsening after surgery and the balance as no improvement.

Signature Of Surgeon

Date

MR QMK BISMIL

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Name:

90%

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Corticosteroid Injection InformationSide Effects of Corticosteroid Injection-to be minimised by using minimum effective doseLocal side effects:

1. pain flare post-injection 10-20% range, (controlled with simple analgesia andactivity modification)2. Skin/fat changesa. the skin can change colour or the fatty tissue may atrophy 4%3. Less common local side effects (around 1% level or less) for significant problems:a. Bruising/bleeding- usually minorb. Steroid chalk-paste- as it sounds; not harmful as far as we are awarec. Soft-tissue calcification- as it sounds; not normally painful or problematicd. Steroid arthropathy- inflammation and wear of joints due to steroid. A study byRoberts et al published in the Journal of Rheumatology in 1996 concluded that

corticosteroid injection in rheumatoid arthritis does not increase the rate of jointreplacement. As at 2013, there is little good quality convincing evidence that steroidcauses significant arthritis in joints.4. Tendon rupture and atrophy- uncommon, well below 1%; doctors should notinject directly into tendons.5. Delayed healing of soft-tissues- doctors will not routinely use these injections inacute injuries6. Infection- very low risk with aseptic technique- summary of published literature1/17000 range7. Rare local side effects (significantly less than 1%) such as nerve injury, bloodvessel injury or needle fractureSystemic Side Effects(significant side effects 1 % level or less unless specified)-to be minimised by doctor using minimum effective dose of corticosteroidCushings syndrome is the medical term applied to how the body will respond tosystemic high levels of cortisol/corticosteroid. It is very rare for a minimum effectivedose local corticosteroid injection to cause this syndrome, and because of the smalldoses injected locally this should be a transient problem. On the basis of a literaturesearch as at 2013: the possibility of local minimum effective dose musculoskeletalcorticosteroid injection, used sparingly, causing significant and long-lasting systemiceffects is very low- in the 0.1% region or less.Rare systemic side effects-0.1% region or less (on the basis of Pubmed search):

Analphylaxis/ Cataracts/ Complex Regional Pain Syndrome /Myopathy /Pancreatitis/Psychosis

Patient To Sign And Date Here If They Wish To Proceed With InjectionTreatment For CTS Before Any Surgical Treatment

Signature Of Patient

Countersign By Surgeon

Date

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Name:


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PATIENT AGREEMENT TO LIMITED OPEN CARPAL TUNNEL DECOMPRESSION

Date: Name: Date Of Birth

NAME OF PROCEDURE CARPAL TUNNEL DECOMPRESSION

RIGHT /

LEFT

STATEMENT OF WIDE AWAKE HAND SURGEON AND PATIENT:

The Wide Awake Hand Surgeon has explained the risks and cons and potential prosand benefits of the procedure to the patient as above and below; and the patienthas signed above and below to enter into this care contract with the treating

surgeon.

The intended benefits:

To relieve entrapment of the median nerve in the carpal tunnel.

To improve/reduce the symptoms of your carpal tunnel syndrome.

Improve the function of your hand as much as possible.

Serious or frequently occurring risks:1

If the median nerve has been compressed for a long time some of the nervefibres may have been severely damaged and hence there will be eitherpartial recovery or possibly no recovery.

It may take several months for the nerve to make the optimal recovery.

There is a 1-2% chance of established infection.

The scar may be painful for several months in some patients depending on how thebody reacts to surgery.

The most severe form of scarring is a keloid scar which is a possibility after this orany surgery.

Furthermore there is a 48-7%2chance of pain due to the division of the deep tissue(pillar pain) ; which should improve with time and rehabilitation (exercise) but maybe permanent.

There is a 5-10% chance of short-medium term recurrence (condition comingback); which is a separate issue from failure of an already damaged nerve to returnto normal (see above)

There is a less than 1% chance of nerve damage, tendon damage, bleeding ordamage to any local structures.

In addition to the complications above there are other possible complications whichare not common (less than 1%) in one stop wide awake carpal tunnel practice1 e.g.

Complex Regional Pain Syndrome

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And other reported complications3of carpal tunnel surgery include neuroma ofthe palmar cutaneous branch of the median nerve, hypertrophic scars,dysaesthesias, joint stiffness, failure to relieve symptoms and neuromas ofthe dorsal sensory branch of the radial nerve.

There is an inherent risk to all surgical treatment. The patient has been advisedpreoperatively and agreed to watch the OSWA Carpal Tunnel Video visit the servicewebsite for a detailed consideration of pros and cons and risks and benefits of thisoperation. In addition to the specific and most relevant risks detailed on thisdocument the consultant has given the patient individualised specialist adviceconcerning treatment of their condition; and by signing this form the patientdeclares that they wish to proceed with surgery on the basis of their perception ofthe balance of pros and cons and risks and benefits in their case.A n o n y m i se d d i g i t a l p h o t o g r a p h s an d / o r v i d e o o f y o u r h a n d s ar e r o u t i n e ly

t a k e n f o r c l i n i ca l a n d e d u c a t i o n s p u r p o s e s i f t h i s is n o t a c ce p t a b l e p l e a s e

i n f o r m t h e d o c t o r a n d t i ck t h i s b o x1. Bismil M, Bismil Q, Harding D, Harris P, Lamyman E, Sansby L. Transition tototal one-stop wide-awake hand surgery service-audit: a retrospective review.JRSM Short Rep. 2012 Apr;3(4):23. Epub 2012 Apr 16.

2. Yung PS, Hung LK, Tong CW, Ho PC. Carpal tunnel release with a limitedpalmar incision: clinical results and pillar pain at 18 months follow-up. HandSurg. 2005 Jul;10(1):29-35.

3. Louis DS, Greene TL, Noellert RC. Complications of carpal tunnel surgery. JNeurosurg. 1985 Mar;62(3):352-6.

We have also discussed what the procedure is likely to involve, the benefitsand risks of any available alternative treatments (including no treatment,injections and exercise) and any particular concerns of those involved.

The patient has completed their stepwise self-assessment document

Signed: MR QMK BISMIL

Date: Consultant Orthopaedic Surgeon

STATEMENT OF PATIENT:

I agree to the procedure described above.

I understand that there is no guarantee of recovery and that reasonablecomplications may occur.

I understand that the procedure will involve local anaesthesia.

Signed:

Name Of Patient (PRINT):

Date:

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OPERATION NOTE Date of Surgery / /

Operating Surgeon Mr QMK Bismil

Signed:

MR QMK BISMIL

Standard Technique As Follows For OSWA Limited Open Carpal TunnelDecompression

Wide Awake Anaesthesia with 5ml 2% Xylocaine with low dose 1:200 000adrenaline

Curvilinear incision over carpal tunnel

Sharp and blunt dissection to site of entrapment

Nerve released in tunnel

No intraoperative complications unless specified below,anyspecific relevant findings also documented here:

Non-dissolving interrupted skin sutures, mepore dressing, wool & crepe.POST-OPERATIVE REGIMEN

1. Elevate/ sling 72 Hours

2. Reduce Dressings After 3 Days3. Post-operative exercises and return to activity explained4. Removal of sutures 10-14 days

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Name:


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