scholarly journals A study on variations of branching patterns of median nerve in the carpal tunnel

2017 ◽  
Vol 06 (03) ◽  
pp. 193-197
Author(s):  
Krishna Kanta Biswas ◽  
Rupak Jyoti Baishya ◽  
Kunjalal Talukdar
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Detailed Knowledge ◽  
Medical College ◽  
Palmar Surface ◽  
Branching Patterns ◽  
Tunnel Syndrome ◽  
Muscular Branch ◽  
Ethical Clearance

Abstract Background & aims: The carpal tunnel, located on the palmar surface of the wrist, is a common site of median nerve compression. The median nerve, on passing through the carpal tunnel, divides into lateral and medial branches. The lateral branch then gives off proper palmar digital branches to the thumb and the radial aspect of the index finger, and a recurrent muscular branch to the thenar muscles. The recurrent muscular branch shows different types of variations of the median nerve. Also, there are other variations of the median nerve in the carpal tunnel. These variations greatly influence the symptoms, as well as the treatment of the carpal tunnel syndrome. So, the present work is carried out to study the variations of branching patterns of median nerve in the carpal tunnel. Materials and methods: 40 wrists [20 right and 20 left] from 20 formaldehyde fixed human perinatal fetuses of 34 - 38 weeks of gestation were dissected in the Department of Anatomy, Gauhati Medical College and Hospital, Guwahati. Due ethical clearance was obtained from the Institutional Ethical Committee, Gauhati Medical College and Hospital, Guwahati. Results: In the present study, 24 [66.7%] hands [11 right and 13 left] showed extraligamentous and 12 [33.3%] hands [8 right and 4 left] showed transligamentous variety of thenar branch of median nerve. Also, 4 [10%] hands showed accessory thenar branch of median nerve, all of which took origin within the flexor retinaculum. The comparisons of numbers of variations of thenar branch of median nerve between right and left hands were found to be statistically non significant [P > 0.05]. Conclusion: A detailed knowledge of the median nerve variations in the carpal tunnel is required for successful diagnosis and treatment of the carpal tunnel syndrome and its complications.

scholarly journals Localization of paresthesia in patients with carpal tunnel syndrome

2019 ◽  
Vol 65 (4) ◽  
Author(s):  
Piotr Puchalski ◽  
Urszula Abramczyk ◽  
Dawid Dziubiński ◽  
Wojciech Jedut ◽  
Andrzej Żyluk
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Palmar Surface ◽  
Tunnel Syndrome ◽  
Typical Distribution ◽  
Baseline Examination ◽  
Atypical Manifestation ◽  
Little Finger

Introduction: Paresthesia (numbness, tingling, “pins and needles” sensation) and pain in the hand comprise a typical set of symptoms of carpal tunnel syndrome. Most authors consider a typical occurrence of these features within the palmar surface of digits I–IV, innervated by a compressed median nerve. Observations of patients by various authors show that some patients feel paresthesia in all digits of the affected hand and within the forearm. The objective of this study was investigation of the distribution of paresthesia in patients diagnosed with carpal tunnel syndrome, and verification of the hypothesis that this occurrence in areas beyond the innervation by the median nerve is an atypical manifestation of the syndrome.Materials and methods: Questionnaires and notes filled out during baseline examination of 276 patients admitted to authors’ institution for carpal tunnel release over a period of 1 year were reviewed. The group consisted of 211 women (76%) and 65 men (24%) at a mean age of 59 years.Results: Two hundred seventy-four patients (99%) reported feeling paresthesia within the involved extremity, and 2 did not, but complained of pain and reduced sensation. Most patients – 140 (51%) – felt paresthesia on the palmar surface of all 5 digits, including the little finger. Seventy-eight persons (28%) reported a “typical” distribution of paresthesia within digits I–IV and 31 (11%) in digits I–III. As many as 152 patients (55%) felt paresthesia in the little finger, most of them being cases with numbness and tingling present in all 5 digits. The feeling of paresthesia in the midhand, close to the involved digits was reported by 158 patients (57%).Conclusion: We found that the distribution of symptoms in carpal tunnel syndrome does not closely match the anatomy of the median nerve and this presentation should no longer be considered atypical

scholarly journals POS0584 ULTRASONOGRAPHY OF THE MEDIAN NERVE IN PATIENTS WITH RHEUMATOID ARTHRITIS UNDER SUSPICION OF CARPAL TUNNEL SYNDROME

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 525.1-525
Author(s):  
S. Tsiami ◽  
E. Ntasiou ◽  
C. Krogias ◽  
R. Gold ◽  
J. Braun ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction Velocity ◽  
Sectional Area ◽  
Cross Sectional ◽  
Spearman's Rho ◽  
Spearman’S Rho ◽  
Tunnel Syndrome

Background:Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome and a common extra-articular manifestation of rheumatoid arthritis (RA). Different causes of CTS are known, among them inflammatory and non-inflammatory pathologies. Electroneurography (ENG) of the median nerve, the method of choice to diagnose CTS, measures impairment of nerve conduction velocity without explaining its underlying cause. However, because the electrical stimulation is often not well tolerated, ENG results may come out inconclusive. Using greyscale ultrasonography (GS-US) provides anatomic information including a structural representation of the carpal tunnel.Objectives:To investigate the performance of nerve GS-US in the diagnosis of CTS in patients with RA.Methods:Consecutive patients with active RA under suspicion of CTS presenting to a large rheumatologic center were included. Both hands were examined by an experienced neurologist including ENG and a GS-US (ML linear probe with 6-15 Hz) of the median nerve. An established grading system for ENG (1), and an established system for GS-US based on cut-offs for the nerve cross sectional area (CSA) [mild: 0,11-0,13cm2, moderate: 0,14-0,15 cm2, severe: > 0,15 cm2 CTS (2)] were used. In addition, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) was used to assess CTS symptoms (3).Results:Both hands of 58 patients with active RA (n=116) and clinical suspicion of CTS (in 38 cases bilaterally) were included. After clinical examination, CTS was suspicious in 96 hands (82.8%), and 59 of all hands had a final diagnosis of CTS (50.9%). Of the latter, 43 hands (72.9%) had a positive ENG and 16 (27.1%) a positive GS-US finding only, while 30 hands (50.8%) were positive in both examinations.There was a good correlation of the cross-sectional area (CSA) as well as the CSA-ratio to the ENG findings: the larger the CSA, the more severe was the CTS as assessed by ENG (Spearman’s rho=0.554; p<0.001). The more severe the GS-US findings of CTS were, the more definite were the distal motor latency (Spearman’s rho=0.554; p<0.001) and sensible nerve conduction velocity of the median nerve (Spearman’s rho=-0.5411; p<0.001).In the 46 hands positive in GS-US, tenosynovial hypertrophy of the flexor tendons was detected in 19 hands (41.3%), 7 of which (36.8%) also showed an additional cystic mass. In these 19 patients, clinical complains were more severely present than in patients with non-inflammatory CTS, as assessed by the BCTSQ with a total score of 68.8±13.4 vs. 59.3±13.7, respectively (p=0.007).Conclusion:In patients with active RA and clinical complains of CTS, ultrasound examinations provide additional information about inflammation which is helpful for a diagnosis of CTS. Thus, ENG and nerve GS-US should be used complementary for a diagnostic workup of CTS in RA patients with a suspicion of CTS. Power-Doppler may further improve the diagnostic performance of GS-US.References:[1]Padua L et al. Acta Neurol Scand 1997; 96:211–217[2]El Miedany et al., Rheumatology (Oxford). 2004 Jul; 43(7):887-895[3]Levine DW et al. J Bone Joint Surg Am 1993; 75: 1585-1592Figure 1.BCTSQ scores in patients with diagnosis of CTS and absence or presence of RA-related tenosynovial hypertrophyDisclosure of Interests:None declared

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 First Lumbrical Muscle Flap for Recurrence of Carpal Tunnel Syndrome: Anatomical Study and Surgical Technique

2021 ◽  
Vol 49 (01) ◽  
pp. 079-087
Author(s):  
Esther Fernández Tormos ◽  
Fernando Corella Montoya ◽  
Blanca Del Campo Cereceda ◽  
Montserrat Ocampos Hernández ◽  
Teresa Vázquez Osorio ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Revision Surgery ◽  
Muscle Flap ◽  
Anatomical Study ◽  
Physical Barrier ◽  
Adjacent Structures ◽  
Tunnel Syndrome ◽  
Lumbrical Muscle

AbstractRecurrence of carpal tunnel syndrome implies the reappearance of symptoms after release surgery. If the cause of recurrence is not an incomplete release, but a traction neuritis, the tendency is to add to the revision surgery of the carpal tunnel the use of flaps to cover the median nerve. These flaps establish a physical barrier between the nerve and the rest of the adjacent structures, preventing adhesions, and providing neovascularization and better nerve sliding.In the present work, we detail a revision surgery in which the first lumbrical muscle is used as a covering flap. This flap has two benefits. Firstly, it acts as a vascularized coverage for the median nerve (avoiding the formation of fibrosis and favoring its sliding); secondly, a structure that takes up space is removed from the carpal tunnel, thus reducing the pressure within it.Along with the explanation of the technique, the present article provides a detailed description of the anatomical variability of the first lumbrical muscle and its vascularization, as well as the results of a cadaveric study on the location of the vascular pedicle of the first lumbrical muscle.

Bilateral clinical neurophysiological assessment of median nerve in carpal tunnel syndrome patients

1998 ◽  
Vol 21 (2) ◽  
pp. 264-265 ◽  
Author(s):  
Luca Padua ◽  
Mauro LoMonaco ◽  
Bruno Gregori ◽  
Vincenzo Di Lazzaro ◽  
Roberto Padua ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Tunnel Syndrome ◽  
Neurophysiological Assessment
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