Endoscopic Release of the Carpal Ligament for Carpal Tunnel Syndrome: Long-term Results Using the Chow Technique

Abstract OBJECTIVE The long-term efficacy of dual-portal endoscopic release of the transverse ligament in carpal tunnel syndrome is still being debated. In this study, the authors present 94 endoscopic carpal tunnel surgery cases with long-term follow-up data. METHODS The study includes 72 patients aged 17 to 86 years (mean age, 53.4 years); bilateral surgery was performed in 22 of these patients. Seventy-two hands of female patients and 22 hands of male patients were included. All procedures were performed with a dual-portal set according to the Chow technique. All patients were examined 2 to 3 months after surgery. The long-term follow-up evaluation was based on telephone interviews 5 to 12 years (mean, 8.2 years) after surgery. RESULTS From a cohort of 214 cases that were treated surgically between 1995 and 2002, 94 cases (44%) could be evaluated for long-term follow-up. Four of these patients had to be excluded from long-term follow-up because of a switch to an open technique and early open revision (3–6 months after the first surgery), owing to persistent symptoms. A good to optimal postoperative outcome with improvement of neurological signs and subjective patient satisfaction was observed in 84 (93.3%) of the remaining 90 cases. There were no recurrences. CONCLUSION The study shows that dual-portal endoscopic release of the transverse ligament in carpal tunnel syndrome is a valuable technique that produces very good long-term results and high patient satisfaction and does not result in a significant recurrence rate.

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Good long-term results for surgical treatment of carpal tunnel syndrome

Nature Clinical Practice Rheumatology ◽

10.1038/ncprheum0388 ◽

2007 ◽

Vol 3 (2) ◽

pp. 66-66

Keyword(s):

Surgical Treatment ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Long Term Results ◽

Tunnel Syndrome

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The Effect Of Tenosynovectomy On Patient Outcome In Carpal Tunnel Syndrome Surgery

İstanbul Kanuni Sultan Süleyman Tıp Dergisi ◽

10.5222/iksstd.2021.78055 ◽

2021 ◽

Author(s):

Ahmet Levent Aydın ◽

Melih Üçer

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Large Scale ◽

Long Term Results ◽

Vascular Elements ◽

Tunnel Syndrome ◽

Subsynovial Connective Tissue

INTRODUCTION: Carpal tunnel syndrome (CTS) is estimated to be the most frequently seen mononeuropathy, needing surgical intervention. Its prevalence is known to range between 1, and 3 percent. The components contained in this tunnel are the median nerve, four deep digital flexor tendons, as well as four superficial flexors and the tendon of flexor pollicis longus. Between the tendons and bursae an anatomical structure is present called subsynovial connective tissue (SSCT). SSCT absorbs and transmits stress between tendons and the median nerve and it functions as a scaffold for vascular elements. To find out the role of compression or pathologic proliferation of SSCT in the pathogenesis of CTS, we aimed to conduct a study about the surgical technique of this pathology and compared the long- term results of patients operated with or without SSCT excision in our neurosurgery clinic. METHODS: Between 2003 and 2019 we operated 1279 patients at our neurosurgery clinic. Among them 250 patients who had SSCT excision (syn+) were chosen and they were compared with other 250 patients operated without SSCT excision (Syn-). RESULTS: All patients were evaluated preoperatively and 12 months postoperatively based on the results of Boston Carpal Tunnel Syndrome Questionnaire. When pre-, and post-operative results were compared, we didn’t observe a statistically significant intergroup difference. DISCUSSION AND CONCLUSION: Although our primary goal in patients in whom we performed excision of tenosynovium is to relieve the median nerve by increasing decompression, we observed that there was no difference between the two groups in this large-scale study. We think that only liberation of the transverse carpal ligament during surgery will be sufficient.

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Does Recurrence of Carpal Tunnel Syndrome (CTS) after Complete Division of the Transverse Ligament Really Exist?

Journal of Clinical Medicine ◽

10.3390/jcm10184208 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4208

Author(s):

Fatma Kilinc ◽

Bedjan Behmanesh ◽

Volker Seifert ◽

Gerhard Marquardt

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Surgical Intervention ◽

Clinical Signs ◽

Signs And Symptoms ◽

Long Term Results ◽

Transverse Ligament ◽

Tunnel Syndrome ◽

Clinical Signs And Symptoms

The aim of this study was to evaluate whether recurrent carpal tunnel syndrome (CTS) after complete and sufficient division of the transverse ligament really exists. Another goal was to analyze the underlying reasons for recurrent CTS operated on in our department. Over an observation period of eleven years, 156 patients underwent surgical intervention due to CTS. The records of each patient were analyzed with respect to baseline data (age, gender, affected hand), as were clinical signs and symptoms pre- and postoperatively. To assess long-term results, standardized telephone interviews were performed using a structured questionnaire in which the patients were questioned about persisting symptoms, if any. Of the 156 patients, 128 underwent first surgical intervention due to CTS in our department. In long-term follow-up, two-thirds of these patients had no symptoms at all; one-third of the patients described mild persisting numbness. None of the patients experienced a recurrence of CTS. The 28 patients who received their first operation outside of our department were operated on for recurrent CTS. The cause of recurrence was incomplete division of the distal part of the transverse carpal ligament in all cases. The results suggest that recurrent CTS after complete and sufficient division of the transverse ligament is very unlikely.

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Long-Term Results of Carpal Tunnel Release

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(05)80155-x ◽

1995 ◽

Vol 20 (4) ◽

pp. 470-474 ◽

Cited By ~ 56

Author(s):

M. P. NANCOLLAS ◽

C. A. PEIMER ◽

D. R. WHEELER ◽

F. S. SHERWIN

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Long Term Results ◽

Significant Morbidity ◽

Surgical Scar ◽

Internal Neurolysis ◽

Maximum Improvement ◽

Tunnel Syndrome

To determine the long-term results of carpal tunnel release, we retrospectively reviewed 60 cases, an average of 5.5 years after surgery. 87% reported a good or excellent overall outcome; the average time to maximum improvement of symptoms was 9.8 months. However, 30% reported poor to fair strength and long-term scar discomfort, and 57% noted a return of some pre-operative symptoms, most commonly pain, beginning an average of 2 years after surgery. We found no correlation between pre-operative symptoms or extent of surgical dissection (internal neurolysis) and outcome. Carpal tunnel syndrome was job related in 42%; of these, 26% changed from heavy to lighter work following surgery. Although occupational cases were slower to improve and remained off work longer, the long-term subjective results were the same for both groups. We found significant morbidity from the surgical scar and decreased strength, and often considerable delay until ultimate improvement, especially in patients with job-related carpal tunnel syndrome.

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Steroid Injection for Carpal Tunnel Syndrome

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(05)80202-5 ◽

1996 ◽

Vol 21 (3) ◽

pp. 355-357 ◽

Cited By ~ 28

Author(s):

L. R. Irwin ◽

R. Beckett ◽

R. K. Suman

Keyword(s):

Carpal Tunnel Syndrome ◽

Predictive Factors ◽

Carpal Tunnel ◽

Steroid Injection ◽

Signs And Symptoms ◽

Long Term Results ◽

Tunnel Syndrome

We studied the medium- to long-term results of steroid injection into the carpal tunnel of women with the carpal tunnel syndrome (CTS). Of 45 hands, only 11 had lasting relief of symptoms and 22 had no relief whatsoever. There was no correlation of the typical signs and symptoms of CTS with outcome. Other series have offered various predictive factors for the outcome of injection but we found little or no correlation between these factors and outcome.

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Long-term outcome of carpal tunnel syndrome after conservative treatment

International Journal of Clinical Practice ◽

10.1111/j.1368-5031.2004.00028.x ◽

2004 ◽

Vol 58 (4) ◽

pp. 337-339 ◽

Cited By ~ 21

Author(s):

A.C.F. Hui ◽

S.M. Wong ◽

A. Tang ◽

V. Mok ◽

L.K. Hung ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Conservative Treatment ◽

Carpal Tunnel ◽

Term Outcome ◽

Long Term Outcome ◽

Tunnel Syndrome

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Carpal tunnel syndrome: long-term nerve conduction studies in 261 hands

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000100017 ◽

2009 ◽

Vol 67 (1) ◽

pp. 69-73 ◽

Cited By ~ 8

Author(s):

Dante Guilherme Velasco Hardoim ◽

Guilherme Bueno de Oliveira ◽

João Aris Kouyoumdjian

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Sensory Nerve ◽

Nerve Conduction Studies ◽

Sensory Nerve Action ◽

Tunnel Syndrome ◽

The Mean ◽

Compound Action

OBJECTIVE: To compare a long-term carpal tunnel syndrome (CTS) on nerve conduction studies (NCS) in hands treated non-surgically. METHOD: We retrospectively selected 261 symptomatic CTS hands (166 patients), all of them confirmed by NCS. In all cases, at least 2 NCS were performed in an interval greater than 12 months. Cases with associated polyneuropathy were excluded. NCS parameters for CTS electrodiagnosis included a sensory conduction velocity (SCV) <46.6 m/s (wrist to index finger, 14 cm) and distal motor latency (DML) >4.25 ms (wrist to APB, 8 cm). RESULTS: 92.8% were women; mean age was 49 years (20-76); the mean interval between NCS was 47 months (12-150). In the first exam, the median sensory nerve action potential (SNAP) and the compound action muscular potential were absent in 9.8% and 1.9%, respectively. In the second/last exam, SCV worsened in 54.2%, remained unchanged in 11.6% and improved in 34.2%. SNAP amplitude worsened in 57.7%, remained unchanged in 13.1% and improved in 29.2%. DML worsened in 52.9%, remained unchanged in 7.6% and improved in 39.5%. Overall, NCS parameters worsened in 54.9%, improved in 34.3% and remained unchanged in 10.8%. CONCLUSION: Long-term changing in NCS of CTS hands apparently were not related to clinical symptomatology and could lead to some difficulty in clinical correlation and prognosis. Aging, male gender and absent SNAP were more related to NCS worsening, regardless the mean interval time between the NCS.

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