Response to “The severity of carpal tunnel syndrome, symptom duration, and surgical technique can affect the treatment response in carpal tunnel syndrome”

2021 ◽  
Author(s):  
T. Civi Karaaslan ◽  
O. Berkoz ◽  
E. Tarakci
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Surgical Technique ◽  
Treatment Response ◽  
Carpal Tunnel ◽  
Symptom Duration ◽  
Tunnel Syndrome ◽  
Syndrome Symptom

scholarly journals When is needle examination of thenar muscle necessary in the evaluation of mild and moderate carpal tunnel syndrome?

2021 ◽  
Vol 67 (4) ◽  
pp. 518-525
Author(s):  
Zuhal Özişler ◽  
Müfit Akyüz
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Spontaneous Activity ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Sensory Nerve ◽  
Symptom Duration ◽  
Thenar Muscle ◽  
Distal Motor Latency ◽  
Motor Latency ◽  
Tunnel Syndrome

Objectives: This study aims to evaluate the predictors of standard nerve conduction study (NCS) parameters in determining the presence of axonal loss by means of spontaneous activity in patients with mild and moderate carpal tunnel syndrome (CTS). Patients and methods: Between May 2015 and April 2018, a total of 118 patients (11 males, 107 females; mean age: 52.3±10.6 years; range, 27 to 79 years) who underwent electrophysiological studies and were diagnosed with CTS were included. Demographic data of the patients including age, sex, and symptom duration were recorded. Electrodiagnostic studies were performed in all patients. All the needle electromyography (EMG) findings were recorded, but only the presence or absence of spontaneous EMG activities was used as the indicator of axonal injury. Results: In 37 (31.4%) of the patients, spontaneous activity was detected at the thenar muscle needle EMG. No spontaneous activity was observed in any of 43 (36.4%) patients with normal distal motor latency (DML). There were significant differences in DMLs, compound muscle action potential (CMAP) amplitudes, sensory nerve action potentials amplitudes, and sensory nerve conduction velocities between the groups with and without spontaneous activity (p<0.05). The multiple logistic regression analysis revealed that DML was a significant independent risk variable in determining presence of spontaneous activity. The most optimal cut-off value for median DML was calculated as 4.9 ms. If the median DML was >4.9 ms, the relative risk of finding spontaneous activity on thenar muscle needle EMG was 13.5 (95% CI: 3.6-51.2). Conclusion: Distal motor latency is the main parameter for predicting the presence of spontaneous activity in mild and moderate CTS patients with normal CMAP. Performing needle EMG of the thenar muscle in CTS patients with a DML of >4.9 ms may be beneficial to detect axonal degeneration in early stages.

Hand Therapy for Carpal Tunnel Syndrome Part II: Pre-Operative Considerations Surgical Technique and Post operative Therapy

2002 ◽  
Vol 7 (2) ◽  
pp. 50-54 ◽  
Author(s):  
Jo Ellis ◽  
Helen Mckenna ◽  
Frank D Burke
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Surgical Technique ◽  
Carpal Tunnel ◽  
Operative Therapy ◽  
Hand Surgery ◽  
Operative Management ◽  
Hand Therapy ◽  
Operative Care ◽  
Operative Complications ◽  
Tunnel Syndrome

Carpal tunnel decompression has become one of the most common procedures in hand surgery. This second paper on carpal tunnel decompression describes the pre-operative management of patients undergoing surgery, the procedure and the immediate post-operative care. It outlines the possible interventions for the minority of patients with post-operative complications.

scholarly journals ‘INSIGHT-PRECISION’: a new, mini-invasive technique for the surgical treatment of carpal tunnel syndrome

2019 ◽  
Vol 48 (1) ◽  
pp. 030006051987808
Author(s):  
José Dinis Carmo
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Surgical Technique ◽  
Minimally Invasive ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Invasive Technique ◽  
Electrodiagnostic Testing ◽  
Surgical Tool ◽  
Tunnel Syndrome

Objective To describe a new mini-invasive surgical technique for carpal tunnel release and to present clinical findings associated with using this technique. Methods Patients with idiopathic carpal tunnel syndrome without prior surgical treatment, who underwent a new minimally-invasive surgical technique using a specific surgical tool-kit developed by the author, were included. Prospective data were collected, including preoperative electrodiagnostic testing. The subjective condition of all patients was evaluated pre- and postoperatively with a five-level Likert-type scale (LS) and muscular strength was tested using a JAMAR dynamometer and pinch gauge. Results A total of 116 patients (157 hands/cases) underwent surgery performed by the author, and were followed for a mean of 40 months (range, 6 months–7 years). Of these, preoperative electrodiagnostic testing was performed in 112 patients (96.6%). No significant complications were reported. By three months, patients reported that they were satisfied or very satisfied in 147/149 cases (98.7%; LS grade I and II). Strength recovery at three months, based on the average of four measures, was 99.17% (range, 97.43–100.97%). Conclusions The described technique is minimally invasive, safe and simple to perform, and provides good results.

scholarly journals Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysis

2018 ◽  
Vol 38 (02) ◽  
pp. 91-114 ◽  
Author(s):  
Diony Klokkari ◽  
Ioannis Mamais
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Qualitative Analysis ◽  
Carpal Tunnel ◽  
Meta Analysis ◽  
Sensory Nerve ◽  
Mean Difference ◽  
Symptom Duration ◽  
Tunnel Syndrome

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Treatment options include physiotherapy, splinting, steroid injections or surgery.Objective: To compare the effectiveness of surgical versus conservative treatment for CTS for symptom and functional improvement and improvement of neurophysiological parameters.Methods: Systematic searches of PubMed and EBSCO host were conducted to identify the studies published between 1990 and 2016, comparing any surgical treatment to any conservative treatment. Participants were adults with a diagnosis of CTS, with symptom duration ranging from 8 months to 3 years. A meta-analysis and a qualitative analysis were conducted to summarize the results of the included studies and establish any agreement between the two.Results: A total of 15 studies were included in the study and 10 were included in the meta-analysis, involving 1787 wrists. The qualitative and quantitative analyses were consistent with the results of both indicating that surgical treatment leads to a greater improvement of symptoms at six months (mean difference: 0.52, 95%CI 0.27 to 0.78) and a greater improvement of neurophysiological parameters [distal motor latency (mean difference: 0.31, 95%CI 0.06 to 0.56), sensory nerve conduction velocity (mean difference: 3.71 m/s, 95%CI 1.94 to 5.49)]. At 3 months and 12 months, the results were not significant in favor of surgery or conservative treatment.Conclusion: Conservative treatment for CTS should be preferred for mild and short-term CTS. Surgery is more effective than conservative in CTS, and should be considered in persisting symptoms, taking into account the complications, which are more severe after surgery. Further research should focus on the field of manual therapy and compare it to surgical treatment for CTS.

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