scholarly journals Effectiveness of Surgical Treatment in Carpal Tunnel Syndrome Mini-Incision Using MIS-CTS Kits: A Cadaveric Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Wongthawat Liawrungrueang ◽  
Sunton Wongsiri
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Minimally Invasive ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Fibrous Tissue ◽  
Surgical Techniques ◽  
New Device ◽  
Working Space ◽  
Carpal Tunnel Surgery ◽  
Tunnel Syndrome

Introduction. Carpal tunnel syndrome (CTS) is caused by the compression of the median nerves in the wrist. Patients have pain and numbness in the hands. According to the records of Songklanagarind Hospital from 2015 to 2018, of 800 patients, 196 or 24.5% were treated with surgery. The novel tool of minimally invasive surgery for carpal tunnel syndrome (MIS-CTS) was developed to improve effectiveness and safety. Purpose. This study was performed to the effectiveness of visualization during surgery and the complete release of the transverse carpal ligament (TCL) and also the safety of using the MIS-CTS kits. Methods. Twenty fresh cadaveric forearms had surgery. Surgical techniques were (1) incision 15–18 mm at palmar hand; (2) the scissors and the navigator were inserted to create working space underneath the palmar aponeurosis; (3) the visual enhancer was inserted. The visual enhancer improves the visual field by shielding the soft tissue around the operative field; (4) the TCL was cut at the distal TCL by surgery scalpel, and then a flexible freer was used to detach the fibrous tissue from the median nerve and the TCL; and (5) the TCL cutting blade was pushed straight to cut the TCL completely from distal to proximal. TCL length was observed until the complete release. The median nerve and the recurrent branch of the median nerve were observed. Results. All TCL were cut completely. All median nerves, recurrent branches of the median nerve, and superficial palmar arches could be observed during the operation, and none were injured. This technique showed effectiveness and safety for minimally invasive carpal tunnel surgery. Conclusions. The study found that the new device, MIS-CTS kits, along with this technique is effective for CTS release in terms of minimally invasive open carpal tunnel surgery.

Carpal tunnel syndrome: matching minimally invasive surgical techniques

2008 ◽  
Vol 108 (5) ◽  
pp. 1033-1036 ◽  
Author(s):  
Vittoria Nazzi ◽  
Angelo Franzini ◽  
Giuseppe Messina ◽  
Giovanni Broggi
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Minimally Invasive ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Surgical Techniques ◽  
The Past ◽  
Minimally Invasive Surgical ◽  
Group A ◽  
Tunnel Syndrome ◽  
Group B

✓In the past few years, several different minimally invasive surgical techniques have been proposed to decompress the median nerve at the wrist. Use of these techniques has become widespread due to fewer local complications, faster functional recovery, and reduced surgical time. In this paper the authors compare 3 different minimally invasive surgical techniques used at their institution in the past 13 years. Between January 1994 and January 2007, 891 patients underwent 1272 surgeries at the authors' institution for carpal tunnel syndrome (CTS), for which a minimally invasive technique was used. In 473 cases (Group A), the transillumination technique with a single wrist incision and a “carpalotome” (a modified Paine retinaculotome) was used; in 216 cases (Group B), transillumination was abandoned and a single linear wrist incision for access with the carpalotome was performed; and in 583 cases (Group C), the techniques were further modified by making a second incision in the palm using the carpalotome. All 3 groups of patients were homogeneous for age, sex, and duration of the symptomatology. In 90% of the patients in Group A, in 88% of those in Group B, and 99.8% of patients in Group C, complete remission of symptoms was obtained. Due to persistence of symptoms, 44 patients in Group A, 24 in Group B, and only 1 in Group C underwent a repeated operation with the open technique. The only surgical complication requiring repeated operation of the 1272 operations was a lesion of the primitive median artery (1 patient in Group C). The technique of median nerve decompression at the wrist that was used for patients in Group C represents a valid alternative for treatment of CTS.

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.

PEDICLED HYPOTHENAR FAT FLAP FOR MEDIAN NERVE COVERAGE IN RECALCITRANT CARPAL TUNNEL SYNDROME

Hand Surgery ◽  
2000 ◽  
Vol 05 (01) ◽  
pp. 33-40 ◽  
Author(s):  
Ch. Mathoulin ◽  
J. Bahm ◽  
S. Roukoz
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Anatomical Study ◽  
Ulnar Artery ◽  
Transverse Carpal Ligament ◽  
Carpal Tunnel Surgery ◽  
Tunnel Syndrome ◽  
Normal Nerve Conduction

We report the use of a hypothenar pedicled fat flap to cover the median nerve in recalcitrant carpal tunnel syndrome. Forty-five patients with recurrent symptoms after previous carpal tunnel surgery were included in this study. Patients with incomplete release of the transverse carpal ligament were not included. We performed an anatomical study on 30 cadavers. The original technique with the section of the deep branch of ulnar artery was modified. The flap could be transferred onto the median nerve without stretching. The median follow-up was 45 months (range, 12–80 months). Pain completely disappeared in 41 patients with normal nerve conduction. Based on clinical and electromyographic signs, the global results showed excellent results (49%), 19 good results (45%), two average results (4.5%) and two failures (2%). The use of a hypothenar pedicled fat flap to cover the median nerve in recalcitrant carpal tunnel syndrome is a simple and efficient technique which improves the trophic environment of the median nerve and relieves pain.

scholarly journals Understanding central sensitization for advances in management of carpal tunnel syndrome

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 605
Author(s):  
César Fernández-de-las-peñas ◽  
José L Arias-Buría ◽  
Ricardo Ortega-Santiago ◽  
Ana I De-la-Llave-Rincón
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Central Sensitization ◽  
Current Data ◽  
Carpal Tunnel Surgery ◽  
The Central Nervous System ◽  
Tunnel Syndrome ◽  
Pain Symptoms

Carpal tunnel syndrome is the most common nerve compression disorder of the upper extremity, and it is traditionally considered a peripheral neuropathy associated with a localized compression of the median nerve just at the level of the carpal tunnel. Surgery and physiotherapy are treatment approaches commonly used for this condition; however, conflicting clinical outcomes suggest that carpal tunnel syndrome may be more complex. There is evidence supporting the role of peripheral nociception from the median nerve in carpal tunnel syndrome; however, emerging evidence also suggests a potential role of central sensitization. The presence of spreading pain symptoms (e.g. proximal pain), widespread sensory changes, or bilateral motor control impairments in people presenting with strictly unilateral sensory symptoms supports the presence of spinal cord changes. Interestingly, bilateral sensory and motor changes are not directly associated with electrodiagnostic findings. Other studies have also reported that patients presenting with carpal tunnel syndrome exhibit neuroplastic brainstem change supporting central sensitization. Current data would support the presence of a central sensitization process, mediated by the peripheral drive originating in the compression of the median nerve, in people with carpal tunnel syndrome. The presence of altered nociceptive gain processing should be considered in the treatment of carpal tunnel syndrome by integrating therapeutic approaches aiming to modulate long-lasting nociceptive barrage into the central nervous system (peripheral drive) and strategies aiming to activate endogenous pain networks (central drive).

Canaletto implant in revision surgery for carpal tunnel syndrome: 21 case series

2011 ◽  
Vol 37 (7) ◽  
pp. 682-689 ◽  
Author(s):  
A. Bilasy ◽  
S. Facca ◽  
S. Gouzou ◽  
P. A. Liverneaux
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Case Series ◽  
Invasive Technique ◽  
Carpal Tunnel Surgery ◽  
Tunnel Syndrome ◽  
Quick Dash ◽  
Perineural Fibrosis

Revision carpal tunnel surgery varies from 0.3% to 19%. It involves a delayed neurolysis and prevention of perineural fibrosis. Despite numerous available procedures, the results remain mediocre. The aim of this study is to evaluate the results of the Canaletto implant in this indication. Our series includes 20 patients (1 bilateral affection) reoperated for carpal tunnel between October 2008 and December 2009. After the first operation, the symptom-free period was 112 weeks, on average. The average incision was 27 mm. After neurolysis, the Canaletto implant was placed in contact with the nerve. Immediate postoperative mobilization was commenced. Sensory (pain, DN4, and hypoesthesia), motor (Jamar, muscle wasting), and functional (disabilities of the arm, should, and hand; DASH) criteria were evaluated. Nerve conduction velocity (NCV) of the median nerve was measured. Average follow up was 12.1 months. All measurements were improved after insertion of the Canaletto implant: pain (6.45–3.68), DN4 (4.29–3.48), Quick DASH (55.30–34.96), Jamar (66.11–84.76), NCV (29.79–39.06 m/s), hypoesthesia (76.2–23.8%), wasting (42.9–23.8%). Nevertheless, four patients did not improve, and pain was the same or worse in six cases. Our results show that in recurrent carpal tunnel syndrome, Canaletto implant insertion gives results at least as good as other techniques, with the added advantage of a smaller access incision, a rapid, less invasive technique, and the eliminated morbidity of raising a flap to cover the median nerve.

Dual-portal Endoscopic Release of the Transverse Ligament in Carpal Tunnel Syndrome

Neurosurgery ◽  
2006 ◽  
Vol 59 (2) ◽  
pp. 333-340 ◽  
Author(s):  
Joachim Oertel ◽  
Henry W.S. Schroeder ◽  
Michael R. Gaab
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Surgical Complication ◽  
Postoperative Recovery ◽  
Endoscopic Technique ◽  
Reliable Technique ◽  
Endoscopic Release ◽  
Carpal Tunnel Surgery ◽  
Tunnel Syndrome

Abstract OBJECTIVE: Endoscopic release of carpal tunnel syndrome is still under debate. The main advantages of the technique are considered to be minor postoperative pain and a more rapid postoperative recovery. Disadvantages are thought to be the impossibility of a direct median nerve neurolysis and a higher surgical complication rate, including injury to the median nerve. METHODS: The results of 411 consecutive endoscopic carpal tunnel procedures performed between March 1995 and September 2004 are presented. All patients were prospectively followed. RESULTS: In the present series, a success rate of 98.05% was observed. There was no permanent morbidity and, in particular, there was no injury of the median nerve. In four (0.97%) patients, the preoperative symptoms did not improve. In two (0.49%) of these patients, an incomplete release of the carpal ligament occurred. In another four patients (0.97%), a switch to open surgery was required. CONCLUSION: The present data prove that the endoscopic technique is a safe and reliable technique for carpal tunnel surgery. The data do not support the current discussion of a higher risk of median nerve injury with endoscopic carpal tunnel surgery. Thus, for our group, the endoscopic technique represents the therapy of choice for the primary idiopathic carpal tunnel syndrome.

scholarly journals Surgical correction of iatrogenic lesion of the median nerve after endoscopic decompression: Case report

2021 ◽  
Author(s):  
Erlan Pércio Lopes Rufino ◽  
Eduarda Silvestre Ribeiro da Costa Gomes ◽  
Gabriela Silvestre Ribeiro da Costa Gomes ◽  
João Guilherme Araújo Magalhães Neiva ◽  
Maria Eduarda Queiroz de Albuquerque
Keyword(s):  
Case Report ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Surgical Procedure ◽  
Surgical Techniques ◽  
Motor Branch ◽  
Left Hand ◽  
Iatrogenic Lesion ◽  
Tunnel Syndrome

Introduction: Carpal tunnel syndrome is neuropathy of compressive origin, surgical treatment can present complications that are difficult to solve, among them, painful neuromas of the peripheral nerves, affecting 2–60% of patients with nerve damage. There is no consensus on the ideal treatment for painful neuroma. Consequently, numerous modalities to treat neuroma pain are described. Case report: Female, 45 years old, presented with a left hand carpal tunnel syndrome clinic. There is a report of having undergone a surgical procedure for decompression of the carpal tunnel with endoscopy, progressing with worsening of symptoms. Another surgical procedure was performed (conventional open route) in the region of the left wrist with intra-op visualization of total nerve rupture. Neurorrhaphy of the median nerve was performed. Patient came to our service complaining of severe pain (VAS 9/10) in median nerve topography associated with paresis of the muscles innervated by the same. Neuroma resection and sural nerve grafting for the tenar motor branch, ulnar and radial median group and patient evolved with significant pain improvement (VAS of 2/10). Discussion: A wide variety of surgical techniques are described to treat painful neuroma. In this case, the success of the chosen tchnique is evidenced by the drop of 07 points in the VAS. Conclusion: It is evident that the endoscopic correction of carpal tunnel syndrome is not without complications and should be indicated with caution. It is necessary to carry out more studies that can evidence the best conduct for each case.

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 Accessory Palmaris Longus Encountered during Carpal Tunnel Surgery: A Case Report

2021 ◽  
Vol 26 (3) ◽  
pp. 166-170
Author(s):  
Sang Hyun Ko ◽  
Jin Seong Park ◽  
Tong Joo Lee
Keyword(s):  
Case Report ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Iatrogenic Injury ◽  
Anatomical Variant ◽  
Palmaris Longus ◽  
Carpal Tunnel Surgery ◽  
Tunnel Syndrome

The accessory palmaris longus is a rare anatomical variant in the wrist and forearm, which has been reported as the cause of carpal tunnel syndrome. This paper reports a case of the accessory palmaris longus incidentally found during carpal tunnel surgery. The paucity of awareness on the accessory palmaris longus in carpal tunnel surgery may lead to accidental iatrogenic injury to the median nerve or insufficient decompression of the median nerve.

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