Neurolysis of the median nerve in the carpal tunnel as a surgical treatment of kienbockʼs disease

1974 ◽  
Vol 53 (2) ◽  
pp. 246
Author(s):  
Tree Nilubol ◽  
G. Codega ◽  
O. Codega ◽  
H. Kus
Keyword(s):  
Surgical Treatment ◽  
Median Nerve ◽  
Carpal Tunnel

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 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 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 Median nerve decompression in carpal tunnel syndrome: short- and long-term results

2018 ◽  
Vol 10 (3) ◽  
pp. 79-85 ◽  
Author(s):  
A. S. Gilveg ◽  
V. A. Parfenov ◽  
G. Yu. Evzikov
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Long Term Results ◽  
Functional Improvement ◽  
Nerve Decompression ◽  
Group 2 ◽  
Median Nerve Decompression ◽  
Group 1

Objective: to investigate the short- and long-term results of surgical median nerve decompression via classical and minimally invasive approaches in patients with carpal tunnel syndrome (CTS), as well as factors that influence surgical outcomes. Patients and methods. The investigation enrolled 70 patients (13 men and 57 women) aged 36 to 84 years (mean age, 62±10.8 years) who had undergone median nerve decompression. Surgery was performed in the classical way in 35 patients (Group 1) and via a minimally invasive access in the remaining 35 patients (Group 2). The efficiency of treatment was evaluated using the Boston Carpal Tunnel Questionnaire (BCTQ) and a visual analog scale for pain before and 1, 3, 6, and 12 months after surgery, as well as from patient satisfaction with surgical outcomes. Results. No complications of surgical treatment were detected. There was a marked reduction in pain and other neuropathic disorders just 1 month after surgery and a substantial hand functional improvement following 6 months. After 12 months, in Group 1, the mean BCTQ Symptom Severity Scale and Functional Deficit Scale scores decreased from 2.76 to 1.15 (p≤0.01) and from 2.72 to 1.24 (p≤0.01), respectively; in Group 2, these dropped from 2.86 to 1.14 (p≤0.01) and from 2.95 to 1.24 (p≤0.01), respectively. Complete recovery from sensory problems occurred in 24 (69%) patients in Group 1 and in 25 (71%) patients in Group 2; their partial recovery was observed in 11 (31%) and 10 (29%) patients in these groups, respectively. One 1 month following decompression, the patients in Group 1 had more severe pain syndrome than those in Group 2; these differences became statistically insignificant after 6 months. The patients were found to be highly satisfied with surgical treatment. Permanent numbness, subjective weakness, thenar muscle atrophy, stage III CTS, and diabetes mellitus (DM) were predictors for less pronounced improvement in BCTQ scores after surgical treatment (p<0.05). The paper describes a clinical case that achieved full postoperative occupational and home rehabilitation. Conclusion. The patients with CTS were observed to have a marked reduction in pain and other neuropathic disorders just one month after surgical decompression and a substantial hand functional improvement following 6 months. The benefit from a minimally invasive access is less severe pain syndrome at 1 month after surgery. The predictors of less successful results of surgery are age (the older the patient is, the greater likelihood of having a worse result), permanent numbness, subjective hand weakness, thenar muscle atrophy, DM, and stage III 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.

COMPRESSIVE NEUROPATHIES RELATED TO GANGLIONS OF THE WRIST AND HAND

Hand Surgery ◽  
2014 ◽  
Vol 19 (01) ◽  
pp. 113-116 ◽  
Author(s):  
Prakash Jayakumar ◽  
Vijay Jayaram ◽  
David S. Nairn
Keyword(s):  
Surgical Treatment ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Clinical Assessment ◽  
Guyon’S Canal ◽  
Unique Case ◽  
Sensory Deficits ◽  
Compressive Neuropathy ◽  
Guyon's Canal

Ganglions of the wrist and hand causing compressive neuropathies are rare clinical entities. Compression of the ulnar and median nerves in their respective fibro-osseous tunnels lead to characteristic patterns of motor and/or sensory deficits, which are directly related to the location of the lesion. We present a unique case of a "dumbbell" shaped ganglion invading both Guyon's canal and the carpal tunnel causing a dual compressive neuropathy of the ulnar and median nerve. We discuss the patho-anatomy, clinical assessment, investigation and surgical treatment of this condition.

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.

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.

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