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Residual problems may occur from neuroma despite surgery. In a 12-month follow-up study using national register data, symptoms, and disabilities related to surgical methods and sex were evaluated in patients surgically treated for a neuroma. Among 196 identified patients (55% men; lower age; preoperative response rate 20%), neurolysis for nerve tethering/scar formation was the most used surgical method (41%; more frequent in women) irrespective of affected nerve. Similar preoperative symptoms were seen in patients, where different surgical methods were performed. Pain on load was the dominating symptom preoperatively. Women scored higher preoperatively at pain on motion without load, weakness and QuickDASH. Pain on load and numbness/tingling in fingers transiently improved. The ability to perform daily activities was better after nerve repair/reconstruction/transposition than after neurolysis. Regression analysis, adjusted for age, sex, and affected nerve, showed no association between surgical method and pain on load, tingling/numbness in fingers, or ability to perform daily activities. Neuroma, despite surgery, causes residual problems, affecting daily life. Choice of surgical method is not strongly related to pre- or postoperative symptoms. Neurolysis has similar outcome as other surgical methods. Women have more preoperative symptoms and disabilities than men. Future research would benefit from a neuroma-specific ICD-code, leading to a more precise identification of patients.

Ulnar nerve entrapment at the elbow (UNE) is the second most common compression neuropathy in the upper limb. Immediate return-to-work (RTW) after surgery is seldom possible due to restrictions and recovery demands. We aimed to explore RTW after UNE surgery and investigate factors contributing to variations. A prospective study with patients undergoing primary UNE surgery was conducted. Treatment decisions were based on a novel five-grade clinical scale. In total, 65 patients (25 women and 40 men) with a mean age of 51 ± 16 years were included. Simple decompression was the predominant procedure (n = 57, 88%). Manual laborers (n = 28, 43%) had the longest sick leave (7 weeks, IQR [3]) within the working population (n = 49) compared to non-manual laborers (4 weeks, IQR [6]; p = 0.003). Manual labor, smoking, and preoperative pain (evaluated with the Swedish version of the Patient-Rated Ulnar Nerve Evaluation, PRUNE-S) predicted prolonged sick leave. The type of surgery did not predict RTW variations in the multivariate linear model itself but modified the impact of other predictors. In conclusion, patients with surgically treated UNE have varying sick leave needs, influenced by individual and work-related factors. Incorporating biopsychosocial aspects should be a focus of further research in UNE management.

Cold sensitivity is common following nerve injuries in the upper extremity, but is less well studied in carpal tunnel syndrome (CTS). We investigated cold sensitivity in CTS and its effects on surgical outcome. A search of the Swedish National Registry for Hand Surgery (HAKIR) for open carpal tunnel releases (OCTR) from 2010–2016 identified 10,746 cases. Symptom severity questionnaires (HQ-8; HAKIR questionnaire 8, eight Likert-scale items scored 0–100, one item on cold sensitivity) and QuickDASH scores before and after surgery were collected. Patient mean age was 56 ± SD 16 years, and 7,150/10,746 (67%) were women. Patients with severe cold sensitivity (defined as cold intolerance symptom severity score > 70; n = 951), scored significantly higher on QuickDASH at all time points compared to those with mild cold sensitivity (cold intolerance symptom severity scores ≤ 30, n = 1,532); preoperatively 64 [50–75] vs. 40 [25–55], at three months 32 [14–52] vs. 18 [9–32] and at 12 months 25 [7–50] vs. 9 [2–23]; all p < 0.0001. Severe cold sensitivity predicted higher postoperative QuickDASH scores at three [12.9 points (95% CI 10.2–15.6; p < 0.0001)] and at 12 months [14.8 points (11.3–18.4; p < 0.0001)] compared to mild cold sensitivity, and adjustment for a concomitant condition in the hand/arm, including ulnar nerve compression, did not influence the results. Cold sensitivity improves after OCTR. A higher preoperative degree of cold sensitivity is associated with more preoperative and postoperative disability and symptoms than a lower degree of cold sensitivity, but with the same improvement in QuickDASH score.

We aimed to investigate the association between psychotropic drug use (proxy for psychological health) and Complex Regional Pain Syndrome (CRPS) type 1 and type 2 in upper and lower limbs. We also assessed the impact of demographic and socioeconomic factors. From a national record linkage database [4,706,821 individuals (25–64 years); CRPS type 1 = 809; type 2 = 225], prevalence ratios (PR), absolute risk (AR), and AR difference (ARD) [95% confidence intervals (CI)] were estimated by logistic and Cox regressions with constant time at risk. About 36% of CRPS individuals consumed psychotropic drugs (reference: general population 15%). Unadjusted PRs were two times higher in nerve injuries/disorders without CRPS [PR = 1.78; 95% CI: 1.73–1.82] and CRPS type 1 [2.33 (2.07–2.62)] and almost three times higher in CRPS type 2 [2.79 (2.27–3.42)]. Higher ARDs were observed in type 2, independent of level of income, and were higher for the high-income category. In type 2, ARDs were higher for middle-high/high occupational status levels. Higher ARDs were observed in nerve injuries/nerve disorders, CRPS type 1, and type 2 in immigrants, especially high for type 2. Regarding most age intervals, ARDs were higher for individuals with CRPS type 2. Individuals with CRPS, especially type 2, have high risk of impaired psychological health.

Peripheral nerve tumours, most commonly schwannomas and neurofibromas, might present significant challenges by eliciting physical symptoms and emotional distress. We aimed to explore patients’ expectations, perceptions, and experiences regarding their diagnosis and the surgical treatment of a nerve tumour in the upper limb. Fourteen adults (10 women, 4 men; age range 35–85) from two Swedish hand surgery clinics participated in semi-structured interviews. Data saturation was reached. The interviews were transcribed verbatim and analysed following a conventional content analysis approach. Three main categories emerged. Causal Reasoning and Anticipations included explanatory thoughts of tumour aetiology, expectations of surgery, and concerns for the future. Anxiety and Adaptation comprised psychological strain, but also how to overcome challenges in daily life. Course of Care encompassed uncertainty and waiting time, interaction with health care and decision making on whether or not to have surgery. Recognising the interplay between physical symptoms and psychological responses underscores the need for personalised communication and patient-centred strategies, such as clear and empathetic information and shared decision-making, to reduce uncertainty and support individuals facing peripheral nerve tumours in the upper limb.

Pain, and disabilities after neuroma surgery, using patient reported outcome measurements (PROMs), were evaluated by QuickDASH and a specific Hand Questionnaire (HQ-8). The 69 responding individuals (response rate 61%; 59% women; 41% men; median follow up 51 months) reported high QuickDASH score, pain on load, cold sensitivity, ability to perform daily activities and sleeping difficulties. Individuals reporting impaired ability to perform daily activities and sleeping problems had higher scores for pain, stiffness, weakness, numbness/tingling, cold sensitivity and QuickDASH. Only 17% of individuals reported no limitations at all. No differences were observed between sexes. Surgical methods did not influence outcome. Symptoms and disabilities correlated moderately-strongly to each other and to ability to perform regular daily activities as well as to sleeping difficulties. Pain, cold sensitivity, sleeping difficulties and limitation to perform daily activities were associated to higher QuickDASH. A weak association was found between follow up time and QuickDASH score as well as pain on load, but not cold sensitivity. A major nerve injury was frequent among those with limitations during work/performing other regular daily activities. Despite surgical treatment, neuromas cause residual problems, which affect the capacity to perform daily activities and ability to sleep with limited improvement in long-term.

The pathophysiology behind Complex Regional Pain Syndrome (CRPS) is not fully understood and associated factors and triggers for developing the condition are debated. We aimed to study such factors and long-term outcome in a descriptive cross-sectional study with a well-defined population with CRPS in the upper limb and related to sex and CRPS type. In retrospectively collected data from medical records, 149 subjects [women n = 104 (70%); type 1 CRPS, n = 108 (72%); type 2 CRPS, n = 41 (28%); follow-up time 21 [8-43] months] were identified and analysed (Chi-squared test, Mann-Whitney U-test, and multiple linear regression). A majority were manual workers, and a larger proportion of subjects were smokers and had less post-secondary education than a reference population (p < 0.001 and p < 0.008). Men were younger, more frequently smoked, had higher BMI, and had lower education levels than women (p = 0.044, p = 0.007, p < 0.001, and p = 0.016, respectively). Subjects with CRPS type 2 were younger and had a longer time from symptoms until diagnosis, longer follow-up time, and more follow-up visits, indicating worse outcome (p = 0.016, p = 0.0012, p = 0.003, and p = 0.004, respectively). Among CRPS, 32% had a prior pain disorder and 7% had previously visited a pain management clinic. While there was no significant difference in mental illness occurrence before CRPS diagnosis compared to a reference population, mental illness increased by 76% after diagnosis. Factors such as CRPS type 2, older age, and delayed diagnosis were associated with longer follow-up periods. Additionally, 45% were on sick leave for over 12 months, and 20% were permanently unable to work. Socioeconomic deprivation is an associated factor in developing CRPS, in which a variety of triggers exist. Subjects with CRPS, particularly type 2, are at high risk of severe remaining symptoms, including mental illness and risk of never returning to work.

Knowledge about risks for overuse of psychoactive analgesics in patients having primary surgery for carpal tunnel syndrome (CTS) or ulnar nerve entrapment (UNE), or both, is limited. We investigated if patients with those nerve entrapment disorders have a higher risk of overuse of psychoactive analgesics (i.e., opioids and gabapentinoid drugs) before, after, and both before and after surgery than observed in the general population after accounting for demographical and socioeconomic factors. Using a large record linkage database, we analysed 5,966,444 individuals (25–80 years), residing in Sweden December 31st, 2010–2014, of which 31,380 underwent surgery 2011–2013 for CTS, UNE, or both, applying logistic regression to estimate relative risk (RR) and 95% confidence interval (CI). Overall, overuse of the psychoactive analgesics was low in the general population. Compared to those individuals, unadjusted RR (95% CI) of overuse ranged in patients between 2.77 (2.57–3.00) with CTS after surgery and 6.21 (4.27–9.02) with both UNE and CTS after surgery. These risks were only slightly reduced after adjustment for demographical and socioeconomic factors. Patients undergoing surgery for CTS, UNE, or both, have a high risk of overuse of psychoactive analgesics before, after, and both before and after surgery.

The study aimed to investigate socioeconomic factors in patients with carpal tunnel syndrome (CTS) and to evaluate their impact on outcome following open carpal tunnel release (OCTR). Data from the National Quality Register for Hand Surgery were combined with socioeconomic data (marital status, education level, earnings, migrant status, occupation, sick leave, unemployment, and social assistance) from Statistics Sweden to evaluate OCTRs performed from 2010 to 2016 (total 10,746 OCTRs). Patients completed QuickDASH (short version of Disabilities of Arm, Shoulder and Hand) questionnaires preoperatively (n = 3597) and at three (n = 2824) and 12 months (n = 2037) postoperatively. The effect of socioeconomic factors on QuickDASH scores was analyzed with linear regression analysis. Socioeconomically deprived patients scored higher on the QuickDASH on all occasions than patients with higher socioeconomic status. Being widowed, having a low education level, low earnings, immigrant status, frequent sick leave and dependence on social assistance all increased the postoperative QuickDASH score at 12 months. The change in total score for QuickDASH between preoperative and 12 months postoperatively did not vary between the groups. We conclude that such factors as being widowed, having a lower education level, low earnings, immigrant status, frequent sick leave and social assistance dependence are associated with more symptoms both before and after OCTR for CTS, but these factors do not affect the relative improvement in QuickDASH.

Surgery for benign nerve tumours is performed for pathoanatomical diagnosis and symptomatic relief, but might cause residual problems. We aimed to assess patient-reported symptoms and disability before and after surgery at a national level. In total, 206 cases surgically treated for a benign peripheral nerve tumour 2010–2019 registered in the Swedish Quality Registry for Hand Surgery (HAKIR; response rates 22–34%) were analysed. Surgery reduced overall disability in the affected limb (QuickDASH 18/100 [IQR 5–36] preoperatively and 5/100 [IQR 0–22] 12 months postoperatively), improved ability to perform daily activities (HQ-8; 11/100 [IQR 0–50] preoperatively and 0/100 [IQR 0–20] 12 months postoperatively) and decreased three evaluated pain modalities: pain at rest (HQ-8; 20/100 [IQR 0–40] preoperatively and 0/100 [IQR 0–10] 12 months postoperatively), pain on motion without load (HQ-8; 20/100 [IQR 0–40] preoperatively and 0/100 [IQR 0–10] 12 months postoperatively), and pain on load (HQ-8; 24/100 [IQR 1–69] preoperatively and 1/100 [IQR 0–30] 12 months postoperatively). Cold sensitivity was a minor problem both before and after surgery (HQ-8; 0/100 [IQR 0–30] preoperatively and 1/100 [IQR 0–40] 12 months postoperatively). We conclude that surgery for benign peripheral nerve tumours provides good symptomatic relief with low risk for residual problems.