Carpal Tunnel Release: Analysis of Suboptimal Results

1985 ◽  
Vol 10 (3) ◽  
pp. 365-369
Author(s):  
S. Y. EASON ◽  
R. J. BELSOLE ◽  
T. L. GREENE
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Neck Pain ◽  
Carpal Tunnel ◽  
Retrospective Review ◽  
Carpal Tunnel Release ◽  
Signs And Symptoms ◽  
Release Analysis ◽  
Tunnel Syndrome ◽  
Double Crush ◽  
Adequate Decompression

The results of carpal tunnel release are generally good, but not all patients obtain complete and long lasting relief. Persistence of signs and symptoms after adequate decompression of the median nerve is uncommon. Forty-seven suboptimal results in thirty-four patients have been evaluated to determine the reasons for failure. Thirty-eight of the suboptimal results (81%) were associated with the persistent neck pain and/or abnormal cervical radiographs (typically narrowing of C5–6 and/or C6–7 disc spaces). This retrospective review supports a “double crush” phenomenon that influences both the manifestations of carpal tunnel syndrome and the outcome of its treatment.

Trigger Digit Incidence After Carpal Tunnel Release: Reconstruction in Elongated Position Versus Traditional Carpal Tunnel Release

Hand ◽  
2019 ◽  
pp. 155894471989305
Author(s):  
Ignacio Esteban-Feliu ◽  
Irene Gallardo-Calero ◽  
Sergi Barrera-Ochoa ◽  
Núria Vidal-Tarrason ◽  
Jorge Nuñez-Camarena ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Retrospective Review ◽  
Carpal Tunnel Release ◽  
Flexor Retinaculum ◽  
Tunnel Syndrome ◽  
Mean Time ◽  
Reconstruction Group ◽  
Long Term Studies

Background: The development of trigger digit after carpal tunnel syndrome release surgery has been widely reported. Lluch described reconstruction of the flexor retinaculum in elongated position to prevent such complication. Methods: We conducted a retrospective review to determine whether patients who undergo reconstruction in elongated position of the flexor retinaculum have a lower incidence of trigger digit postoperatively. In total, 1050 patients were included, 865 of whom had undergone traditional carpal tunnel release and 185 flexor retinaculum reconstruction. Results: No differences were found in the incidence of trigger digit after surgery (8.7% of the patients who underwent traditional release vs 11.9% in the reconstruction group). Neither difference was found when comparing mean time with the development of trigger digit. Conclusions: In the absence of randomized long-term studies comparing traditional release and reconstruction in elongated position after carpal tunnel release, given our results, we see no reason to favor reconstruction over standard carpal tunnel release as a means to prevent postoperative triggering of digits.

scholarly journals Angiolipoma: A Unique Cause of Carpal Tunnel Syndrome

2021 ◽  
pp. 24-28
Author(s):  
Yi Deng ◽  
Sindy Vrancic ◽  
Adrienne Morey
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Signs And Symptoms ◽  
Surgical Excision ◽  
Unique Case ◽  
Palmar Surface ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release

Carpal tunnel syndrome is one of the most common conditions affecting the hand. The majority of cases are idiopathic, with tumours causing less than 3% of cases. We present a unique case of an angiolipoma overlying the carpal tunnel as a cause of median nerve compression. A 54-year-old female presented with signs and symptoms consistent with carpal tunnel syndrome associated with an enlarging lump overlying the carpal tunnel on the palmar surface of her hand. Nerve conduction studies confirmed median neuropathy. The case was successfully treated by surgical excision of the tumour and open carpal tunnel release. Histopathology confirmed the presence of an angiolipoma. The patient had complete resolution of symptoms at the final 6-week follow-up. This case highlights the importance of considering tumours in the differential diagnosis of carpal tunnel syndrome.

scholarly journals Outcome of Carpal Tunnel Release: a prospective study

2013 ◽  
Vol 1 (1) ◽  
Author(s):  
NMS Pradhan ◽  
JA Khan ◽  
BM Acharya ◽  
P Devkota ◽  
A Rajbhandari
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Prospective Study ◽  
Carpal Tunnel ◽  
Outcome Measurement ◽  
Carpal Tunnel Release ◽  
Signs And Symptoms ◽  
Tunnel Syndrome ◽  
A Prospective Study ◽  
Open Carpal Tunnel Release

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy and is manifested by characteristic signs and symptoms resulting from median nerve compression at the carpal tunnel. The diagnosis is essentially clinical, which is further confirmed by nerve conduction studies. Surgical release of the transverse carpal ligament is advised when conservative treatment fails.  METHODS: This prospective study evaluates the outcome of standard open carpal tunnel release performed at our center* from June 2004 to July 2007. Thirty two patients with idiopathic carpal tunnel syndrome, with failed conservative treatments, either with NSAIDs and/or local infiltration with corticosteroid injections plus night splint, or recurrence after conservative treatment were subjected to open carpal tunnel release after getting approval from the local ethical committee and getting a written and informed consent from the patient. Clinical assessment was done preoperatively and at 6 weeks, 3 months and 6 months following the procedure and included the two-point discrimination test at the tip of the index finger and Boston questionnaires as an outcome measurement of symptoms severity. All the patients were followed up for a period of six months. RESULTS: All the patients presented improvement in the postoperative evaluations in all the analyzed parameters. CONCLUSION: Open carpal tunnel release is a safe and effective method for the treatment of CTS and can be carried out when the conservative means fail to relieve the symptoms. DOI: http://dx.doi.org/10.3126/noaj.v1i1.8129 Nepal Orthopaedic Association Journal Vol.1(1) 2010

Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

2003 ◽  
Vol 8 (4) ◽  
pp. 4-5
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Proper Time ◽  
Carpal Tunnel Release ◽  
Hand Function ◽  
Factors Affecting ◽  
Early Results ◽  
Medical Evaluation ◽  
Nerve Recovery ◽  
Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

scholarly journals Carpal Tunnel Syndrome: A National Survey to Monitor Knowledge and Operating Methods

2021 ◽  
Vol 18 (4) ◽  
pp. 1995
Author(s):  
Valentina Scalise ◽  
Fabrizio Brindisino ◽  
Leonardo Pellicciari ◽  
Silvia Minnucci ◽  
Francesca Bonetti
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Manual Therapy ◽  
Carpal Tunnel ◽  
Signs And Symptoms ◽  
Current Evidence ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Therapeutic Exercises ◽  
Chi Squared ◽  
Tunnel Syndrome

The aim of this article was to investigate the knowledge, management, and clinical practice of Italian physiotherapists concerning patients with carpal tunnel syndrome (CTS). A national cross-sectional survey consisted of 24 questions was administered from December 2019 until February 2020. A Chi-squared independence test was run to study any difference between subgroups of the sample and responses to the questionnaire. Five hundred and eight respondents completed the survey. Most respondents (n = 225/508; 44.3%) are under 29 years old, female (n = 256/508; 50.4%) and have been working as physiotherapists for less than 5 years (n = 213/508; 41.9%). Most of respondents correctly knows about the cause (n = 455/508, 89.6%), main signs and symptoms of CTS (n = 415/508, 81.70%) and administer education, manual therapy, myofascial techniques and therapeutic exercises (n = 457/508, 89.88%). Three hundred and sixty-four (71.68%) respondents were aware of the influence of psychosocial factors on the patient’s outcomes. The survey showed greater adherence to evidences by physiotherapists holding a master’s degree. The results are mostly comparable with other surveys structured all over the world on the same topic. Italian physiotherapists management of the CTS was not always in line with current evidence. Interventions such as education, manual therapy, therapeutic exercise, nerve and tendon glide techniques are widely used, while the orthotic is only offered by half of the sample.

Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

2021 ◽  
pp. 175319342110017
Author(s):  
Saskia F. de Roo ◽  
Philippe N. Sprangers ◽  
Erik T. Walbeehm ◽  
Brigitte van der Heijden
Keyword(s):  
Systematic Review ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Open Release ◽  
Flap Coverage ◽  
Tunnel Syndrome

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

scholarly journals Ultrasound-Guided Surgery for Carpal Tunnel Syndrome: A New Interventional Procedure

2018 ◽  
Vol 35 (04) ◽  
pp. 248-254 ◽  
Author(s):  
Antoine Hakime ◽  
Jonathan Silvera ◽  
Pascal Richette ◽  
Rémy Nizard ◽  
David Petrover
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Interventional Procedure ◽  
Carpal Tunnel Release ◽  
Ultrasound Guided ◽  
Recent Contribution ◽  
Invasive Approach ◽  
Guided Surgery ◽  
Tunnel Syndrome ◽  
Meta Analyses

AbstractCarpal tunnel syndrome (CTS) may be treated surgically if medical treatment fails. The classical approach involves release of the flexor retinaculum by endoscopic or open surgery. Meta-analyses have shown that the risk of nerve injury may be higher with endoscopic treatment. The recent contribution of ultrasound to the diagnosis and therapeutic management of CTS opens new perspectives. Ultrasound-guided carpal tunnel release via a minimally invasive approach enables the whole operation to be performed as a percutaneous radiological procedure. The advantages are a smaller incision compared with classical techniques; great safety during the procedure by visualization of anatomic structures, particularly variations in the median nerve; and realization of the procedure under local anesthesia. These advantages lead to a reduction in postsurgical sequelae and more rapid resumption of daily activities and work. Dressings are removed by the third day postsurgery. Recent studies seem to confirm the medical, economic, and aesthetic benefits of this new approach.

The Relationship of the Double Crush to Carpal Tunnel Syndrome (An Analysis of 1,000 Cases of Carpal Tunnel Syndrome)

1985 ◽  
Vol 10 (2) ◽  
pp. 202-204
Author(s):  
LAWRENCE C. HURST ◽  
DAVID WEISSBERG ◽  
ROBERT E. CARROLL
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Surgery ◽  
Significant Incidence ◽  
Tunnel Syndrome ◽  
Relationship Of ◽  
The Relationship ◽  
Double Crush ◽  
Double Crush Syndrome ◽  
Bilateral Carpal Tunnel Syndrome

In this series of 1,000 cases of carpal tunnel syndrome (888 patients) there is a statistically significant incidence of bilaterality in patients with cervical arthritis. There is also a statistically significant increase in the incidence of diabetes mellitus over the general population. These findings lend further support to Upton’s Double Crush hypothesis. Further, the double crush syndrome predisposes to bilateral carpal tunnel syndrome and may be an important prognostic factor. It may also be an explanation for some of the failures following carpal tunnel surgery and lead surgeons to look for other associated systemic diseases or mechanical blocks, when attempting to alleviate recalcitrant symptoms.

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