Patients' Perceptions of Carpal Tunnel and Ulnar Nerve Decompression Surgery

Background:Carpal tunnel syndrome and ulnar nerve entrapment at the elbow are the most common entrapment neuropathies seen in adults. Surgery for nerve decompression is a safe and effective treatment option, and is usually performed under local anesthesia and as an outpatient procedure. This study aimed to explore patients' satisfaction and other aspects of the overall experience with this type of surgery.Methods:Qualitative research methodology was used. Semi-structured, open-ended interviews were conducted with 30 adult patients who had undergone carpal tunnel release or ulnar nerve decompression at the elbow 6-24 months prior. Interviews were digitally audio recorded and transcribed, and the data subjected to thematic analysis.Results:Four overarching themes emerged from the data: (1) most patients did not perceive their condition to be serious; (2) patients were satisfied with the overall surgical experience; (3) the outcome was more important to patients than the process; and (4) majority of patients had a realistic expectation of outcomes.Conclusions:Patients had a positive experience with carpal tunnel and ulnar nerve decompression surgery, although their level of satisfaction was dependent on the surgical outcome. Areas requiring improvement, specifically information about post-operative care and expectations of recovery, will be implemented in the future care of patients.

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Important updates of finger fractures, entrapment neuropathies and wide-awake surgery of the upper extremity

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211029543 ◽

2021 ◽

pp. 175319342110295

Author(s):

Donald Lalonde ◽

Egemen Ayhan ◽

Amir Adham Ahmad ◽

Steven Koehler

Keyword(s):

Ulnar Nerve ◽

Local Anaesthesia ◽

Hand Surgery ◽

Awake Surgery ◽

Decompression Surgery ◽

Entrapment Neuropathies ◽

Fracture Management ◽

Without Tourniquet ◽

Wide Awake ◽

Nerve Decompression Surgery

Hand surgery is rapidly changing. The wide-awake approach, minimum dissection surgery and early protected movement have changed many things. This is an update of some of the important changes regarding early protected movement with K-wired finger fracture management, simplification of nerve decompression surgery, such as elbow median and ulnar nerve releases, and some new areas in performing surgery with wide-awake local anaesthesia without tourniquet.

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Surgical Anatomy of the Medial Antebrachial Cutaneous Nerve: Clinical Application in Ulnar Nerve Decompression Surgery in the Elbow

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0041-1730002 ◽

2021 ◽

Vol 49 (01) ◽

pp. 019-023

Author(s):

Barbara Gomez-Eslava ◽

Luis Alejandro García-González

Keyword(s):

Ulnar Nerve ◽

Surgical Anatomy ◽

Medial Epicondyle ◽

Cutaneous Nerve ◽

Decompression Surgery ◽

Nerve Decompression ◽

Posterior Branch ◽

Cartesian Plane ◽

Nerve Decompression Surgery ◽

Ulnar Tunnel

Abstract Introduction Lesion to the posterior branch of the medial antebrachial cutaneous nerve (MACN) is one of the causes of revision of the ulnar nerve decompression surgery in the elbow.To avoid the morbidity associated with this injury, cadaver dissections were performed to identify this branch in its course through the ulnar tunnel. Methods We included 20 upper extremities of fresh cadaveric specimens. The posterior branch of the MACN was identified proximal to medial epicondyle and followed past the ulnar tunnel. The number of ramifications and their coordinates were recorded in a Cartesian plane, with the medial epicondyle as the central point. Results The posterior branch passed proximal and posterior to the medial epicondyle in all specimens, except one. The average of the adjusted x value is of 30 mm, and of the adjusted y value is -18 mm. Additionally, we determined that the posterior branch passes at an average angle of 30° with respect to the x axis. Conclusion The anatomical descriptions of this branch focused on surgical release of the ulnar nerve in the elbow are limited, and measures are only described in the horizontal plane (from proximal to distal). Schematizing the anatomy of this branch in its course throughout the ulnar tunnel will facilitate its identification during the procedures. However, variability and asymmetry in the branching pattern should be considered.

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The 36-Item Short-Form Health Survey Outcome Evaluation for Multiple Lower-Extremity Nerve Decompressions in Diabetic Peripheral Neuropathy

Journal of the American Podiatric Medical Association ◽

10.7547/0970121 ◽

2007 ◽

Vol 97 (2) ◽

pp. 121-125 ◽

Cited By ~ 7

Author(s):

Scott C. Nelson ◽

Eugene R. Little

Keyword(s):

Lower Extremity ◽

Diabetic Neuropathy ◽

Health Survey ◽

Short Form ◽

Decompression Surgery ◽

Short Form Health Survey ◽

Nerve Decompression ◽

Form Health ◽

Nerve Decompression Surgery ◽

Short Form Health

Background: Diabetic neuropathy can be disabling owing to pain and loss of sensibility. Theoretically, surgical restoration of sensation and relief of pain may prevent these complications and improve quality of life. A study was conducted to perform outcome analysis of patients after these surgical procedures using the 36-Item Short-Form Health Survey. Methods: The 36-Item Short-Form Health Survey was used to evaluate patients with diabetic neuropathy after nerve decompression surgery. These results were compared with those reported in the literature related to diabetic patients without neuropathy, patients with low-back pain, and an age-matched normative population. The pilot study group included six patients with diabetic neuropathy, three of whom underwent multiple nerve decompression surgery bilaterally. Mean follow-up was 6 months. Results: Single-tailed t tests demonstrated that postoperative patients were not statistically significantly different from the other groups in the domains of Physical Functioning, Bodily Pain, General Health, Vitality, Social Functioning, and Mental Health; in the domains of Role-Physical and Role-Emotional, a statistically significant difference was found, with the postoperative patients scoring lower. Conclusions: Although this study is limited by the lack of preoperative administration of the 36-Item Short-Form Health Survey and by its small sample size, we conclude that the survey can evaluate the results of surgical decompression of lower-extremity peripheral nerves and should be added to the traditional assessments of recovery of sensibility and the visual analog scale for pain. (J Am Podiatr Med Assoc 97(2): 121–125, 2007)

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Combined Cubital and Carpal Tunnel Release Results in Symptom Resolution Outside of the Median or Ulnar Nerve Distributions

The Open Orthopaedics Journal ◽

10.2174/1874325001610010111 ◽

2016 ◽

Vol 10 (1) ◽

pp. 111-119 ◽

Cited By ~ 1

Author(s):

Peter C. Chimenti ◽

Allison W. McIntyre ◽

Sean M. Childs ◽

Warren C. Hammert ◽

John C. Elfar

Keyword(s):

Median Nerve ◽

Ulnar Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Symptomatic Improvement ◽

Patient Counseling ◽

Symptom Resolution ◽

Persistent Symptoms ◽

Validated Questionnaires

Background: Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after combined release of the ulnar nerve at the elbow with simultaneous release of the median nerve at the carpal tunnel. Methods: 20 patients with combined cubital and carpal tunnel syndrome were prospectively enrolled. The upper extremity was divided into six zones and the location of pain, numbness, tingling, or strange sensations was recorded pre-operatively. Two-point discrimination, Semmes-Weinstein monofilament testing, and validated questionnaires were collected pre-operatively and at six-week follow-up. Results: Probability of resolution was greater in the median nerve distribution than the ulnar nerve for numbness (71% vs. 43%), tingling (86% vs. 75%). Seventy percent of the cohort reported at least one extra-anatomic symptom pre-operatively, and greater than 80% of these resolved at early follow-up. There was a decrease in pain as measured by validated questionnaires. Conclusion: This study documents resolution of symptoms in both extra-ulnar and extra-median distributions after combined cubital and carpal tunnel release. Pre-operative patient counseling may therefore include the likelihood of symptomatic improvement in a non-expected nerve distribution after this procedure, assuming no other concomitant pathology which may cause persistent symptoms. Future studies could be directed at correlating pre-operative disease severity with probability of symptom resolution using a larger population.

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Biologic Basis of Nerve Decompression Surgery for Focal Entrapments in Diabetic Peripheral Neuropathy

Journal of Diabetes Science and Technology ◽

10.1177/1932296814525030 ◽

2014 ◽

Vol 8 (2) ◽

pp. 412-418 ◽

Cited By ~ 14

Author(s):

John Sessions ◽

D. Scott Nickerson

Keyword(s):

Peripheral Neuropathy ◽

Diabetic Peripheral Neuropathy ◽

Decompression Surgery ◽

Nerve Decompression ◽

Nerve Decompression Surgery ◽

Biologic Basis

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MRI Evaluation of Various Elbow, Forearm, and Wrist Neuropathies: A Pictorial Review

Seminars in Musculoskeletal Radiology ◽

10.1055/s-0041-1729961 ◽

2021 ◽

Vol 25 (04) ◽

pp. 617-627

Author(s):

Rola Husain ◽

Arthi Reddy ◽

Etan Dayan ◽

Mingqian Huang ◽

Idoia Corcuera-Solano

Keyword(s):

Upper Extremity ◽

Ulnar Nerve ◽

Functional Disability ◽

Carpal Tunnel Release ◽

Calcium Pyrophosphate ◽

Sensory Loss ◽

Crystal Deposition ◽

Entrapment Neuropathies ◽

Pictorial Review ◽

Mri Features

AbstractUpper extremity entrapment neuropathies are common and can cause pain, sensory loss, and muscle weakness leading to functional disability. We conducted a retrospective review from January 2007 until March 2020 of the magnetic resonance imaging (MRI) features of intrinsic and extrinsic causes of wrist, forearm, and elbow neuropathies of 637 patients who received a diagnosis of neuropathy by means of clinical and electrodiagnostic testing. We discuss cases with varying intrinsic and extrinsic nerve pathologies, including postoperative examples, affecting the median, radial, and ulnar nerve.Our collection of cases demonstrates a diversity of intrinsic and extrinsic causative factors. Intrinsic pathologies include neuritis as well as tumors arising from the nerve. Extrinsic causes resulting in nerve entrapment include masses, acute and chronic posttraumatic cases, anatomical variants, inflammatory and crystal deposition, calcium pyrophosphate deposition disease, and dialysis-related amyloidosis. Finally, we review postsurgical cases, such as carpal tunnel release and ulnar nerve transposition.Although upper extremity neuropathies tend to have a typical clinical presentation, imaging, particularly MRI, plays a vital role in evaluating the etiology and severity of each neuropathy and ultimately helps guide clinical management.

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