A Median Nerve Anterior Transposition Procedure for Multi-Recurrent Hemodialysis-Related Carpal Tunnel Syndrome

2018 ◽  
Vol 23 (01) ◽  
pp. 90-95 ◽  
Author(s):  
Ichiro Okutsu ◽  
Ikki Hamanaka ◽  
Aya Yoshida
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Manual Muscle Testing ◽  
Maintenance Hemodialysis ◽  
Outpatient Basis ◽  
Muscle Testing ◽  
Anterior Transposition ◽  
Tunnel Syndrome ◽  
The Mean

Background: Some long-term hemodialysis patients suffer from multi-recurrent carpal tunnel syndrome because amyloid originating from β2-microglobulin continues to be deposited mainly in the flexor tendons, tendon sheaths and flexor retinaculum during maintenance hemodialysis. These amyloid deposits inside carpal canal (tunnel) tissues increase carpal canal pressure and this leads to compression of the median nerve. When multi-recurrent carpal tunnel syndrome occurs, previous operative scarring of soft tissue may prohibit further enlargement of the carpal canal even if any carpal canal decompression procedure is used. For this reason, we developed a median nerve anterior transposition procedure, as a new approach in the treatment of multi-recurrent hemodialysis-related carpal tunnel syndrome. Methods: Median nerve anterior transposition procedures were performed on seven hands in six patients with multi-recurrent carpal tunnel syndrome. The mean age of the patients was 68.3 years and the mean hemodialysis duration was 35.3 years. Mean follow-up period was 9.9 months. The median nerve is transposed from inside to outside of the carpal canal under local and infiltration anesthesia without a pneumatic tourniquet on an outpatient basis. This procedure is based on the same principles applied in ulnar nerve anterior transposition procedures for cubital tunnel syndrome. Results: Main preoperative patient complaints were intolerable tingling and/or pain in the diseased hands throughout the day. Following the surgeries, preoperative clinical symptoms began to subside and eventually improved in all hands. Postoperative abductor pollicis brevis muscle power using manual muscle testing improved except in one hand. Abnormal preoperative distal motor and sensory latency were improved except in two hands following the surgeries. Conclusions: The median nerve anterior transposition procedure is a beneficial treatment for patients suffering from hemodialysis-related multi-recurrent carpal tunnel syndrome.

scholarly journals Motor Examination in the Diagnosis of Carpal Tunnel Syndrome

2017 ◽  
Vol 09 (02) ◽  
pp. 067-073
Author(s):  
Mithun Neral ◽  
Joseph Imbriglia ◽  
Lois Carlson ◽  
Ronit Wollstein
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Manual Muscle Testing ◽  
Relative Importance ◽  
Retrospective Case ◽  
Muscle Testing ◽  
Motor Testing ◽  
Tunnel Syndrome ◽  
Measured Strength

AbstractThe relative importance and use of motor evaluation to diagnose carpal tunnel syndrome (CTS) is not clear. Because the ulnar nerve is not affected in CTS, we evaluated comparing the strength of the median-nerve innervated muscles to the ulnar innervated muscles in the same patient, through manual muscle testing (MMT) and a handheld dynamometer. Our purpose was to evaluate whether this method, which takes into account patient-dependent factors that would affect both groups of muscles equally, can provide better assessment of CTS. A retrospective case-control review of MMT and dynamometer-measured strength for CTS was performed. The study was performed retrospectively but prior to surgery or other treatment. There were 28 cases (CTS) and 14 controls (without CTS). Positive nerve conduction tests defined cases. MMT of the thenar musculature was found to be unreliable as a test for CTS. Comparisons to ulnar nerve innervated muscle strength did not improve sensitivity or specificity of the MMT examination. Use of the dynamometer improved sensitivity and specificity of motor testing in CTS over MMT. Motor evaluation is important for the diagnosis of CTS, but further study is warranted, specifically to define the method of motor evaluation and delineate the subgroup of patients (predominantly thenar motor presentation) that would benefit most from motor testing and motor-focused treatment.

Cross-sectional Area of the Median Nerve Before Revision Carpal Tunnel Release—A Cross-sectional Study

2017 ◽  
Vol 14 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Stephan Duetzmann ◽  
Suleyman Tas ◽  
Volker Seifert ◽  
Gerhard Marquardt ◽  
Thomas Dombert ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Reference Values ◽  
Carpal Tunnel ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Large Patient ◽  
Tunnel Syndrome ◽  
The Mean

Abstract BACKGROUND High-resolution ultrasound can be used for diagnosis of carpal tunnel syndrome with an equal accuracy to electrodiagnostic studies. Up to date there has been no investigation published that examined the median nerve in a large patient cohort with recurrent or persistent symptoms. Reference and cutoff values are lacking. OBJECTIVE To provide reference values for detection of ongoing or recurrent compression in patients with recurring or persisting symptoms in carpal tunnel syndrome. METHODS One hundred and sixteen patients undergoing revision decompression of the median nerve at the carpal tunnel between January 2010 and October 2015 were studied retrospectively to determine the cross-sectional area of the median nerve at the wrist by the technique of neurosonography. RESULTS In cases of insufficient primary release, the mean cross-sectional area was 20.0 mm2 preop. In cases of scar or synovitis, the mean cross-sectional area was 17.0 mm2 (significantly less than in cases of insufficient primary release, P = .008). Compared to successfully operated patients with de novo carpal tunnel syndrome (n = 74), a cutoff value of 14.5 mm2 yielded a sensitivity of 78% and a specificity of 97% to diagnose ongoing or recurrent compression in case of a typical clinical presentation of ongoing or recurrent symptoms (tested via comparison of patients who are symptom free vs patients with symptoms). CONCLUSION For the first time, we provide reference values in patients with recurring or persisting symptoms in carpal tunnel syndrome based on a large patient population. Ultrasound can aid in the evaluation of patients with entrapment neuropathy of the median nerve and recurring or persisting symptoms.

RETROSPECTIVE ANALYSIS OF FIVE-YEAR AND LONGER CLINICAL AND ELECTROPHYSIOLOGICAL RESULTS OF THE WORLD'S FIRST ENDOSCOPIC MANAGEMENT FOR CARPAL TUNNEL SYNDROME

Hand Surgery ◽  
2013 ◽  
Vol 18 (03) ◽  
pp. 317-323 ◽  
Author(s):  
Ichiro Okutsu ◽  
Ikki Hamanaka ◽  
Aya Yoshida
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Muscle Power ◽  
Manual Muscle Testing ◽  
Endoscopic Management ◽  
Recurrence Rates ◽  
Abductor Pollicis Brevis ◽  
Muscle Testing ◽  
Tunnel Syndrome

We have analyzed postoperative long-term follow-up results of five years or more from idiopathic carpal tunnel syndrome patients that underwent our complete carpal canal release and decompression procedure that uses the Universal Subcutaneous Endoscope system. In this series, 203 hands were followed up both clinically and electrophysiologically. Final follow-up times were determined by the most recent electrophysiological measurements. Mean follow-up period was nine years. Tingling, pain (using a 3 gm needle) and touch (using a 2 gm von Frey hair) at all median nerve distribution areas recovered to normal in 92.9, 98.2, 95.2%, respectively. Abductor pollicis brevis muscle power improved from preoperative manual muscle testing of 0, 1, 2 to post-operative 4 or 5 in 82.6%. Mean detectable distal sensory latency improved from 4.3 (n = 130) to 3.1 msec (n = 200). Mean detectable distal motor latency improved from 6.2 (n = 189) to 4.1 msec (n = 200). Complication and recurrence rates were 0% and 0.5% respectively.

scholarly journals Sonographic short-term follow-up after surgical decompression of the median nerve at the carpal tunnel: a single-center prospective observational study

2015 ◽  
Vol 39 (3) ◽  
pp. E6 ◽  
Author(s):  
Sueleyman Tas ◽  
Frank Staub ◽  
Thomas Dombert ◽  
Gerhard Marquardt ◽  
Christian Senft ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Surgical Decompression ◽  
High Definition ◽  
Distal Motor Latency ◽  
Motor Latency ◽  
Tunnel Syndrome ◽  
The Mean

OBJECT Carpal tunnel syndrome causes increased cross-sectional area (CSA) of the median nerve, which can be assessed by high-definition ultrasonography. It is unclear today, however, whether high-definition ultrasonography may play a role in the postoperative period. This prospective study aimed to determine the natural history of the morphology of the median nerve at the carpal tunnel after surgical decompression assessed by high-definition ultrasonography. METHODS Between October and December 2014, patients with suspected carpal tunnel syndrome who were referred to the authors’ center for peripheral neurosurgery were prospectively enrolled and underwent pre- and postoperative (3 months) high-definition ultrasonography, electrophysiology, and clinical testing. RESULTS Eighty-one patients were enrolled in the study, and 100% were clinically better at the 3-month follow-up. The mean CSA decreased from 14.7 ± 4.9 mm2 to 12.4 ± 3.4 mm2 (mean ± SD, p < 0.0001). The mean distal motor latency decreased from 6.6 ± 2.4 msec to 4.8 ± 1.0 msec (mean ± SD, p < 0.0001). Ninety-eight percent of patients who were available for electrodiagnostic follow-up showed an improvement of the distal motor latency; only 80% had a reduction in the CSA. CONCLUSIONS The authors present the second-largest series of patients with sonographic follow-up after surgical decompression of the carpal tunnel reported in the literature so far. This study, which showed a decrease in size of the median nerve after surgical decompression, suggests that the preoperative increase in median nerve CSA at the carpal tunnel may be due to compression and that enlargement of the median nerve is (partially) reversible.

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.

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