scholarly journals Long-term Results of Two Different Surgical Techniques Used in Carpal Tunnel Syndrome

2021 ◽  
Author(s):  
Serdar Ercan ◽  
Zeki Serdar Ataizi
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Surgical Intervention ◽  
Long Term Results ◽  
Recurrent Nerve ◽  
Transverse Incision ◽  
Longitudinal Incision ◽  
Tunnel Syndrome

Abstract Objective Carpal tunnel syndrome (CTS), the compression of the median nerve under the carpal ligament, is the most common peripheral nerve entrapment of the upper extremity. While conservative treatment is used for patients with mild and moderate symptoms, surgical treatment is preferred for severe symptoms. The aim of the study is to evaluate the difference between transverse and longitudinal incision by comparing postoperative pain and recurrence rates. Methods The patients were divided into two groups according to the surgical incision type. Surgical intervention was applied to patients in group T (transverse incision) and group L (longitudinal incision) by the same two surgeons in each group. All patients were followed-up with electromyography (EMG) and performance scale before and after surgical treatment. If the postoperative EMG result was similar to the preoperative EMG result, it was accepted as recurrent CTS. Results A total of 418 patients were included to the study. Six patients in the group T with transverse incision, and 18 patients in the group L with longitudinal incision, were reoperated for an average of 6 ± 2 months after the primary surgery. Conclusion Complications are less, and recurrent nerve compression is less in longitudinal approach, since surgical intervention is performed by seeing the median nerve directly.

Ulnar and Median Nerve Abnormalities in Carpal Tunnel Syndrome

2020 ◽  
Vol 22 (5) ◽  
pp. 313-322
Author(s):  
Filip Georgiew ◽  
Andrzej Maciejczak ◽  
Jakub Florek ◽  
Ireneusz Kotela
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Control Group ◽  
Conduction Disturbances ◽  
Tunnel Syndrome ◽  
Sensory Fibers ◽  
American Academy Of Neurology

Background. Nerve compression underlying carpal tunnel syndrome (CTS) results in an increase in the threshold of superficial sensation in the area supplied by the median nerve, which is a mixed nerve dominated by sensory fibres. The distribution of sensory symptoms is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment at wrist level is still unclear. Patho­logical processes leading to median neuropathy in CTS may affect ulnar nerve motor and sensory fibers in the Guyon canal. This may explain the extra-median spread of sensory symptoms in CTS patients. Material and methods. The study involved 88 patients (104 hands), with 70 women (83 hands) and 18 men (21 hands) aged between 25 and 77 years. 50 age- and sex-matched subjects without carpal tunnel syndrome were used as a control group. The diagnosis of carpal tunnel syndrome was made according to the criteria of the American Academy of Neurology 1993 guidelines. Based on the results of an ENG trace evaluating the degree of conduction disturbances in the median nerve, the patients were classified to one of three severity subgroups. The threshold of sensory excitability to pulsed current was determined in a test with single 100 ms rectangular pulses. Conclusions. 1. The threshold of sensation in the fingers innervated by the median and ulnar nerve is significantly lon­ger in patients with CTS than in controls. 2. Surgical treatment decreases the threshold of sensation in the fingers innervated by the median nerve. 3. Surgical treatment does not decrease the threshold of sensation in the fingers innervated by the ul­nar nerve. 4. The preoperative and postoperative threshold of sensation in the fingers innervated by the median and ulnar nerve is significantly longer in patients with severe carpal tunnel than in mild and moderate cases.

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

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.

scholarly journals Carpal tunnel syndrome: assessment of the need for rehabilitation and recovery treatment after endoscopic decompression of the median nerve in the late and long-term postoperative periods

2020 ◽  
Vol 9 (4) ◽  
pp. 34-43
Author(s):  
D. G. Yusupova ◽  
A. A. Zimin ◽  
D. A. Grishina ◽  
N. V. Belova ◽  
A. V. Vershinin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Controlled Study ◽  
Control Group ◽  
Clear Understanding ◽  
Significant Difference ◽  
Tunnel Syndrome

Background. Carpal tunnel syndrome is the most common tunnel neuropathy in which the median nerve is compressed at the level of the wrist in the carpal canal. Treatment of carpal tunnel syndrome can be conservative and surgical. Surgical treatment is indicated in case of ineffective conservative treatment. However, the strategy of managing patients with carpal tunnel syndrome in the postoperative period has not yet been determined; there is no clear understanding of the effectiveness and necessity of rehabilitation in the early and long-term postoperative periods.Aim. Follow-up the patients after decompression of the median nerve in the late (up to 3 weeks after surgery) and long-term (3 weeks after surgery) postoperative periods to assess the effectiveness of different methods of rehabilitation.Materials and methods. A randomized controlled study included 108 cases of idiopathic carpal tunnel syndrome (unilateral and bilateral). After surgery, the patients were divided into three groups: the restorative treatment group using magnetic therapy, the kinesiotherapy group, and the control group. Clinical, neurophysiological and ultrasound monitoring was carried out for six months.Results. Patients of all the groups showed similar improvement in the most of the analyzed parameters, without any significant difference.Conclusion. Thus, according to the results of a comprehensive study, it is evident that early diagnosis of carpal tunnel syndrome and a high-quality surgical decompression of the median nerve with a complete dissection of the flexor retinaculum of the hand guarantee improvement within six months or later after surgical treatment without additional rehabilitation measures.

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

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.

scholarly journals Results of surgical treatment of patients with carpal tunnel syndrome depending on the severity of the disease

2021 ◽  
Vol 27 (1) ◽  
pp. 24-31
Author(s):  
O.M. Semenkin ◽  
◽  
S.N. Izmalkov ◽  
A.N. Bratiichuk ◽  
E.B. Solopikhina ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Functional Improvement ◽  
Group Iii ◽  
Group I ◽  
Tunnel Syndrome ◽  
Wrist Function

Introduction Although surgical treatment of carpal tunnel syndrome (CTS) is known to be highly effective outcomes may not be equally satisfactory for the patients due to severity of clinical presentation and objectifying assessment of the condition. Purpose Provide clinical evaluation of outcomes of surgical treatment of CTS using questionnaires and electroneuromyography (ENMG) findings depending on baseline severity of the condition. Material and methods The review included 161 patients who underwent 189 operations of open decompression of the median nerve using mini-access. The patients were assigned to three groups with mild (Group I), moderate (Group II) and severe (Group III) CTS. Evaluations were produced at 6 weeks, 3, 6 and 12 months following the surgery. Results The majority of patients showed positive dynamics, and delayed recovery of the wrist function was noted in Group III at a 12-month follow-up. Patients of Group III exhibited spasmodic improvement of the wrist function at 6-week-to-3-month follow-up. Conclusion Open decompression of the median nerve performed for patients with CTS using mini-approach facilitated substantial clinical and functional improvement in most cases. However, the most favorable results could be provided for mild and moderate CTS.

scholarly journals Anatomical variation of the median nerve and its thenar branch: Clinical and surgical application in the treatment of carpal tunnel syndrome

2021 ◽  
Vol 09 (03) ◽  
pp. 326-329
Author(s):  
Charaf eddine Elkassimi ◽  
Mustapha Fadili ◽  
Sami Rouadi ◽  
Abdelhak Garch
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Annular Ligament ◽  
Surgical Application ◽  
Tunnel Syndrome ◽  
Open Surgical Treatment

Carpal tunnel syndrome is the most common root canal pathology. The surgical treatment corresponds to a release of the median nerve by incision of the anterior annular ligament of the carpus by open surgical treatment or endoscopy. Knowledge of the normal anatomy and anatomical variations of the median nerve at the wrist is fundamental to avoiding complications in median nerve release in the treatment of carpal tunnel syndrome. Through this work we will show the interest of knowledge of the anatomy of the median nerve as well as its anatomical variations in order to derive the main clinical applications and to avoid the risks associated with open or endoscopic surgery in the treatment of carpal tunnel syndrome.

Effects of physiotherapy after surgical treatment of carpal tunnel syndrome

2019 ◽  
Vol XXIII (1) ◽  
pp. 43-51
Author(s):  
Grzegorz Magoń ◽  
Aneta Strzelec ◽  
Filip Georgiew
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Functional Capacity ◽  
Carpal Tunnel ◽  
Wrist Joint ◽  
Surgical Decompression ◽  
Functional Test ◽  
Tunnel Syndrome ◽  
Positive Effect

The persistence symptoms of carpal tunnel syndrome causes patients to undergo surgical decompression of the median nerve. The resulting dysfunctions require postoperative physiotherapy. The aim of the study was to assess the effects of physiotherapy on pain, ROM of wrist and forearm, the results of the Phalen and Durkan tests, and the strength of the operated hand. Material and method. A group of 30 patients was included in the study, including 28 women and 2 men. The ROM of the wrist joint and forearm was measured with a goniometer, and pain with the VAS scale. Phalen and Durkan tests and functional test were carried out. Results: physiotherapy has a positive effect on reducing the intensity of pain, improve the ROM of the wrist joint and forearm and the functional capacity of the hand in patients after surgical treatment of carpal tunnel syndrome.

scholarly journals Sonographic Appearance of the Median Nerve Following Revision Carpal Tunnel Surgery

2016 ◽  
Vol 6 ◽  
pp. 11
Author(s):  
Shane A Shapiro ◽  
Ashkan Alkhamisi ◽  
George G A Pujalte
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Fat Grafting ◽  
Management Options ◽  
Sonographic Appearance ◽  
Carpal Tunnel Surgery ◽  
Pictorial Essay ◽  
Tunnel Syndrome

The main objective of this pictorial essay is to illustrate the sonographic appearance of the postoperative carpal tunnel and median nerve. Carpal tunnel surgical treatment failures have been shown to occur in up to 19% of a large series requiring re-exploration. Surgical management options for recurrent carpal tunnel syndrome (CTS) include revision release, neurolysis, vein wrapping, and fat grafting procedures. While several descriptions of median nerve entrapment in CTS exist in the ultrasound literature, little is written regarding its postoperative appearance. We report the sonographic changes in the appearance of the median nerve and postoperative carpal tunnel.

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