Hypothenar fat pad flap surgery for end stage and recurrent carpal tunnel syndrome

A retrospective chart review for the period between 1998 and 2006 was conducted to evaluate microneurolysis combined with a hypothenar fat pad flap (HTFPF) for patients at Mayo Clinic, Scottsdale, Arizona, who were being treated for recurrent carpal tunnel syndrome. After exclusion of patients with incomplete release of the transverse carpal ligament at the time of the original operation, 28 consecutive patients were identified. Their average age was 68.5 years (range 43–89 years). The average interval between the original carpal tunnel release and reexploration was 82 months (range 5–298 months). The average follow-up was 10.5 months (range 3–48.4 months). The preoperative two-point discrimination tests averaged 7 mm (range 5–12 mm). At surgery, all patients were found to have fibrosis surrounding the median nerve with adherence of the nerve to the radial leaf of the transverse carpal ligament. After surgery, the Tinel sign disappeared in 26 of 28 patients and two-point discrimination improved to an average of 6 mm (range 4–8 mm). Postoperative grip strength averaged 20 kg, compared with 11 kg preoperatively. Pain completely disappeared in 83% of patients (average improvement 93%, range 5–100%). Numbness completely disappeared in 42% of patients (average improvement 82.9%, range 5–100%). Tingling disappeared in 50% of patients (average improvement 84.7%, range 5–100%). No patient reported being worse after reoperation. These results suggest that the combination of microneurolysis and HTFPF can restore median nerve gliding and provide soft-tissue coverage, improving symptoms in patients with recurrent carpal tunnel syndrome.

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Factors Affecting Carpal Tunnel Syndrome in End Stage Renal Disease with Maintenance Hemodialysis: A Systematic Review

World Journal of Current Medical and Pharmaceutical Research ◽

10.37022/wjcmpr.vi.164 ◽

2021 ◽

pp. 05-12

Author(s):

Dary Gunawan ◽

Theodore Dharma Tedjamartono

Keyword(s):

Carpal Tunnel Syndrome ◽

Renal Disease ◽

Carpal Tunnel ◽

End Stage Renal Disease ◽

Maintenance Hemodialysis ◽

Number Of Patients ◽

Tunnel Syndrome ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Introduction: The number of patients with End Stage Renal Disease (ESRD) is increasing every year, as well as those who have to undergo hemodialysis. Most hemodialysis must be undertaken in a long time. Long term hemodialysis is known to be associated with the incidence of Carpal Tunnel Syndrome (CTS). Method: This study aimed to systematically review factors contributing in the mentioned problem. Literature research was done using three search engines, consist of Google Scholar, Pubmed and ProQuest. Journals used are limited to the last 5 years or those deemed to be relevant. The studies obtained were further read and and appraised critically. Result and Discussion: From a total of 423 journals, 4 articles were selected based on inclusion and exclusion criteria. The prevalence of CTS was found to be higher in ESRD patients undergoing maintenance hemodialysis (MHD). Age, Gender, MHD Duration, β2-Microglobulin are factors that have long been known to play a role. Several other factors such as serum prealbumin, serum albumin, Blood Lead Levels, hepatitis infection, wrist injury, predialytic urea serum and BMI have been implicated in the incidence of CTS in ESRD patients undergoing MHD in some literatures. Conclusion: The factors mentioned earlier were found to have different roles and it is interesting for further reviewed. However, unfortunately there is still very little research that discuss these matters and more research needs to be done related to the factors above.

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