scholarly journals Interfascicular Gliding Dysfunction Relation with Focal Neuropathy in Diabetic Patients with Carpal Tunnel Syndrome

2020 ◽  
Author(s):  
Ahmadreza Afshar ◽  
Ali Tabrizi
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Peripheral Nerves ◽  
Carpal Tunnel Release ◽  
Passive Movement ◽  
Diabetic Patients ◽  
Diabetes Mellitus Type Ii ◽  
Concurrent Use ◽  
Tunnel Syndrome ◽  
Surgical Treatments

AbstractCarpal tunnel syndrome (CTS), a common neuropathy of the upper limb, is highly prevalent in diabetic patients. Recent findings indicate that changes in median nerve elasticity and its gliding characteristics may contribute to the development of CTS. Normally, each nerve should be able to adapt to the positional changes by passive movement relative to the surrounding tissues. This ability is provided by a gliding apparatus around the nerve trunk in the surrounding soft tissue. The fascicles of nerve trunks can also glide against each other (interfascicular gliding). Sonoelastography indicates that nerve elasticity is decreased in patients with CTS compared to healthy patients. Moreover, decreased nerve elasticity in diabetes mellitus type II is associated with increased neuropathy, especially in peripheral nerves. Biomechanical factors, oxidative stress, and microvascular defects are also observed in diabetic neuropathy and account for different complications. A reduction in the elasticity of peripheral nerves may be related to decreased interfascicular gliding because of the biomechanical changes that occur in neuropathy. Surgical treatments, including nerve release and reduction of carpal tunnel pressure, improve peripheral gliding but do not resolve disease symptoms completely. According to the evidence, interfascicular gliding dysfunction is the most important factor in the pathogenesis of CTS in diabetic patients. Available evidence suggests that biomechanical variations affect interfascicular gliding more than peripheral gliding in diabetic patients. Decreased nerve elasticity is strongly correlated with decreased interfascicular gliding. It is further hypothesized that the concurrent use of antioxidants and pharmacological treatment (neuroprotection) such as alpha lipoic acid with carpal tunnel release in diabetic patients may alleviate the interfascicular gliding dysfunction and improve median neve elasticity. Decreased nerve elasticity and interfascicular gliding dysfunction play significant roles in the pathogenesis of CTS in diabetic patients.

Factors Associated with Poor Outcome Following Primary Carpal Tunnel Release in Non-Diabetic Patients

1994 ◽  
Vol 19 (5) ◽  
pp. 622-625 ◽  
Author(s):  
M. M. AL-QATTAN ◽  
V. BOWEN ◽  
R. T. MANKTELOW
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Carpal Tunnel Release ◽  
Diabetic Patients ◽  
Duration Of Symptoms ◽  
Factors Associated ◽  
Poor Outcome ◽  
Strenuous Work ◽  
Tunnel Syndrome

A retrospective study was performed of 112 non-diabetic patients (133 bands) who bad open surgical treatment for carpal tunnel syndrome, to determine the factors associated with poor outcome. None of the patients had a previous carpal tunnel release and all had a positive nerve conduction study to confirm the clinical diagnosis of carpal tunnel syndrome. Outcome was assessed at least 18 months after surgery and classified as excellent, good or poor. Outcome was deemed poor when symptoms were minimally improved, unchanged or worse after surgery. This occurred in 13.5% of treated hands. There was a higher chance of poor outcome in patients with physically strenuous work activities. All these heavy or repetitive manual workers were also involved in compensation and their poor outcome correlated with their inability to return to their original work. Other predisposing factors, associated hand conditions, duration of symptoms prior to surgery, the presence of bilateral or nocturnal symptoms, and the severity of the preoperative nerve conduction deficit did not affect the final outcome after surgery.

A comparison of outcomes of carpal tunnel release in diabetic and non-diabetic patients

2012 ◽  
Vol 38 (5) ◽  
pp. 485-488 ◽  
Author(s):  
A. Zyluk ◽  
P. Puchalski
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Pinch Strength ◽  
Diabetic Patients ◽  
Operative Outcomes ◽  
Tunnel Syndrome ◽  
Diabetes Patients

The coexistence of diabetes might complicate the diagnosis and operative outcomes of carpal tunnel syndrome. We retrospectively compared the results of carpal tunnel release in diabetic and non-diabetic patients. The group included 386 patients, 322 female (83%) and 64 male (17%) with a mean age of 57 years. A total of 41 patients (11%) were diabetic, whereas 345 (89%) did not have diabetes. Patients were followed-up at six months, by assessments that included Levine scores, filament tests, grip and pinch strength. No significant differences in any of the measured variables were found at the six-month assessment. The results of the study show that carpal tunnel release in diabetic and non-diabetic patients are similarly beneficial.

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.

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.

scholarly journals Non-Surgical Management and Post-Surgical Rehabilitation of Carpal Tunnel Syndrome: An Algorithmic Approach and Practical Guideline

2020 ◽  
Vol 11 (3) ◽  
Author(s):  
Mahshid Nazarieh ◽  
Azadeh Hakakzadeh ◽  
Shima Ghannadi ◽  
Faezeh Maleklou ◽  
Zahra Tavakol ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Surgical Management ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Treatment Options ◽  
Operative Management ◽  
Functional Improvement ◽  
Therapeutic Effects ◽  
Multiple Treatment ◽  
Tunnel Syndrome

: One of the most common forms of entrapment neuropathy is Carpal Tunnel Syndrome (CTS). There are various treatment options for CTS. However, there are no clear and structured guidelines. This review classified the existing treatments and developed an algorithm to help physicians to choose the best option for their patients. Treatment options were summarized in three sections: non-surgical management of CTS, post-operative management of CTS, and practical open carpal tunnel release post-op protocol. The physicians can prescribe multiple treatment options to CTS patients. Corticosteroid in oral or injectable form has strong evidence in pain control and functional improvement in the short term. Shockwave therapy and nocturnal wrist splints display moderate therapeutic effects. Post carpal tunnel release rehabilitation can be started a few days after the operation.

scholarly journals Ultrasound Assessment of the Median Nerve Does Not Adequately Discriminate the Carpal Tunnel Syndrome among Patients Diagnosed with Diabetes

Diabetology ◽  
2021 ◽  
Vol 2 (4) ◽  
pp. 226-231
Author(s):  
Carlos Antonio Guillen-Astete ◽  
Monica Luque-Alarcon ◽  
Nuria Garcia-Montes
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Cross Sectional Area ◽  
Diabetic Patients ◽  
Sectional Area ◽  
Cross Sectional ◽  
Patients With Diabetes ◽  
Ultrasound Assessment ◽  
Tunnel Syndrome

Background: Carpal tunnel syndrome is the most prevalent peripheral nerve entrapment condition of the upper limb. Among metabolic risk factors, diabetes is considered the most relevant. Although wrist ultrasound assessment of the median nerve has demonstrated a good correlation with the gold standard for the diagnosis of this syndrome, neurophysiological study, its usefulness in patients with diabetes is questionable because the compressive phenomenon is not the predominant one. Method: We conducted a retrospective study to compare the clinical and median nerve ultrasound features of patients with carpal tunnel syndrome previously diagnosed or not diagnosed with diabetes. Additionally, a linear multivariate regression analysis was performed to determine to what extent the cross-sectional area of the median nerve was dependent on the condition of diabetes by fixing other variables such as sex, age, or time of evolution. Results: We included 303 records of patients (mean age 44.3 ± 11.7 years old, 57.89% female, mean of time of evolution 13.6 ± 8.3 months) from 2012 to 2020. The cross-sectional area of the median nerve was 10.46 ± 1.44 mm2 in non-diabetic patients and 8.92 ± 0.9 mm2 in diabetic patients (p < 0.001). Additionally, diabetic patients had a shorter time of evolution (7.91 ± 8.28 months vs. 14.36 ± 0.526 months, p < 0.001). In the multivariate analysis, the resultant model (fixed R-square = 0.659, p = 0.003) included a constant of the following four variables: the evolution time (Beta coeff. = 0.108, p < 0.001 95% CI 0.091 to 0.126, standardized coeff. = 0.611), the condition of diabetes (Beta coeff. = −0.623, p < 0.001 95% CI −0.907 to −0.339, standardized coeff. = −0.152), the severity (Beta coeff. = 0.359, p = 0.001 95% CI 0.147 to 0.571, standardized coeff. = 0.169), and the masculine sex (Beta coeff. = 0.309, p = 0.003, 95% CI 0.109 to 0.509, standardized coeff. = 0.103). Conclusions: Ultrasound assessment of the median nerve in patients with diabetes is not a useful tool to confirm whether carpal tunnel syndrome should be diagnosed or not diagnosed.

Sign in / Sign up

Export Citation Format

Share Document