Immediate Postoperative Evaluation of Bilateral Carpal Tunnel Syndrome Release Augmented with Human Amniotic Membrane and Secretome: A Case Report
Made Bramantya Karna
Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
Benedictus Anindita Satmoko *
Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
Kuni Zakiyyah Sumargo
Faculty of Medicine, Universitas Negeri Gorontalo/Prof. Dr. H. Aloei Saboe General Hospital, Gorontalo, Indonesia.
Gede Ricky Ananta Herryadi
Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Carpal tunnel release is an established surgical treatment for carpal tunnel syndrome; however, postoperative pain, scar formation and perineural adhesion may affect functional recovery in some patients. This case report describes the early clinical and functional outcome of simultaneous bilateral open carpal tunnel release augmented with human amniotic membrane, with additional secretome application on one side. A 50-year-old woman with bilateral carpal tunnel syndrome underwent bilateral open carpal tunnel release under general anaesthesia. Both median nerves were decompressed by division of the transverse carpal ligament. Human amniotic membrane was applied bilaterally. Secretome was additionally applied around the right median nerve, whereas the left median nerve received human amniotic membrane with 0.9% saline; therefore, the left hand should not be interpreted as an untreated or standard-care-only control. Clinical and functional outcomes were assessed using the Visual Analogue Scale, Boston Carpal Tunnel Questionnaire Symptom Severity Scale, Boston Carpal Tunnel Questionnaire Functional Status Scale, QuickDASH score and grip strength before surgery and at 3 months postoperatively. Preoperatively, both hands showed comparable impairment, including a Visual Analogue Scale score of 5, Symptom Severity Scale score of 4.0, Functional Status Scale score of 3.5, QuickDASH score of 54.5 and grip strength of 10.5 kg. At 3 months, both hands showed clinical and functional improvement. The right hand showed a Visual Analogue Scale score of 0, Symptom Severity Scale score of 1.0, Functional Status Scale score of 1.0, QuickDASH score of 2.3 and grip strength of 27.5 kg. The left hand showed a Visual Analogue Scale score of 3, Symptom Severity Scale score of 2.5, Functional Status Scale score of 2.0, QuickDASH score of 22.7 and grip strength of 23.5 kg. The observed difference between hands is an associative finding from a single, non-randomised bilateral case and cannot establish the superiority or efficacy of secretome augmentation. This case is hypothesis-generating and supports the need for larger prospective studies with standardised biologic material characterisation and longer follow-up.
Keywords: Carpal tunnel syndrome, carpal tunnel release, human amniotic membrane, secretome, Boston Carpal Tunnel Questionnaire, QuickDASH, case report.