Getting Patients Back to Work after Carpal Tunnel Surgery

2008 ◽  
Vol 18 (2) ◽  
pp. 60-63 ◽  
Author(s):  
Martyn Newey ◽  
Malcolm Clarke
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Patient Needs ◽  
Carpal Tunnel Surgery ◽  
Tunnel Syndrome ◽  
Back To Work

This article describes the condition known as carpal tunnel syndrome and reviews a carpal tunnel service that was started in Leicester in 1999. We look at how the service has developed to meet patient needs, and how we now aim to return patients back to function and employment as quickly as possible after surgery.

The Relationship of the Double Crush to Carpal Tunnel Syndrome (An Analysis of 1,000 Cases of Carpal Tunnel Syndrome)

1985 ◽  
Vol 10 (2) ◽  
pp. 202-204
Author(s):  
LAWRENCE C. HURST ◽  
DAVID WEISSBERG ◽  
ROBERT E. CARROLL
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Surgery ◽  
Significant Incidence ◽  
Tunnel Syndrome ◽  
Relationship Of ◽  
The Relationship ◽  
Double Crush ◽  
Double Crush Syndrome ◽  
Bilateral Carpal Tunnel Syndrome

In this series of 1,000 cases of carpal tunnel syndrome (888 patients) there is a statistically significant incidence of bilaterality in patients with cervical arthritis. There is also a statistically significant increase in the incidence of diabetes mellitus over the general population. These findings lend further support to Upton’s Double Crush hypothesis. Further, the double crush syndrome predisposes to bilateral carpal tunnel syndrome and may be an important prognostic factor. It may also be an explanation for some of the failures following carpal tunnel surgery and lead surgeons to look for other associated systemic diseases or mechanical blocks, when attempting to alleviate recalcitrant symptoms.

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.

AN UNCOMMON CAUSE FOR A COMMON COMPLAINT

Hand Surgery ◽  
2009 ◽  
Vol 14 (02n03) ◽  
pp. 131-134 ◽  
Author(s):  
P. A. Rust ◽  
T. Bennett
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Extensive Review ◽  
Common Condition ◽  
Mycobacterium Kansasii ◽  
Review Of The Literature ◽  
Common Complaint ◽  
Carpal Tunnel Surgery ◽  
Tunnel Syndrome ◽  
High Level

Infective tenosynovitis is an uncommon cause of a common condition namely carpal tunnel syndrome. Following an extensive review of the literature, we report what we understand to be the first published case of Mycobacterium kansasii (M. kansasii) causing tenosynovitis of flexor tendons resulting in carpal tunnel syndrome in Australia. Our case highlights the need for a high level of suspension, histology and appropriate culture with specific microbiological tests for atypical mycobacteria where tenosynovitis is present at carpal tunnel surgery, even in patients who do not appear to have risk factors.

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).

scholarly journals Comparison of open and endoscopic carpal tunnel surgery regarding clinical outcomes, complication and return to daily life: A prospective comparative study

2019 ◽  
Vol 35 (6) ◽  
Author(s):  
Tahsin Gürpınar ◽  
Barış Polat ◽  
Ayşe Esin Polat ◽  
Engin Carkçı ◽  
Ahmet Sinan Kalyenci ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Return To Work ◽  
Carpal Tunnel ◽  
Daily Life ◽  
Carpal Tunnel Release ◽  
Incision Length ◽  
Early Return ◽  
Carpal Tunnel Surgery ◽  
Prospective Comparative Study ◽  
Tunnel Syndrome

Objective: This study aimed to compare the clinical results and complications as well as patient satisfaction in patients with carpal tunnel syndrome operated with open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR) techniques. Methods: This study conducted in Istanbul Training and Research Hospital between August 2016 and January 2018. A total of 54 patients were operated with the ECTR technique and 50 patients were operated with the OCTR technique after failing nonsurgical treatment. Patients functional scores are assessed with the carpal tunnel syndrome-functional status score (CTS-FSS) and carpal tunnel syndrome-symptom severity score (CTS-SSS). Operation time, incision length and complications of the two techniques were noted and compared. Results: The age, sex distribution, distribution of sides, and complaint period were not significant (p > 0.05) between the groups. The preoperative or postoperative CTS-SSS and CTS-FSS values did not differ significantly (p > 0.05). Incision length, time to return to work and return to daily life in the OCTR group was significantly higher than the ECTR group (p < 0.05). Conclusion: ECTR has similar results in terms of symptom relief, severity, functional status, pillar pain and complication rates compared to OCTR. However, it has the advantages of early return to daily life, early return to work and less incision length. doi: https://doi.org/10.12669/pjms.35.6.967 How to cite this:Gurpinar T, Polat B, Polat AE, Carkci E, Kalyenci AS, Ozturkmen Y. Comparison of open and endoscopic carpal tunnel surgery regarding clinical outcomes, complication and return to daily life: A prospective comparative study. Pak J Med Sci. 2019;35(6):1532-1537. doi: https://doi.org/10.12669/pjms.35.6.967 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Neurophysiology not Required Before Surgery for Typical Carpal Tunnel Syndrome

2001 ◽  
Vol 26 (1) ◽  
pp. 61-64 ◽  
Author(s):  
V. FINSEN ◽  
H. RUSSWURM
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Diagnosis ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Neurophysiological Tests ◽  
Carpal Tunnel Surgery ◽  
Neurophysiological Studies ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release

Sixty-eight patients with typical carpal tunnel syndrome underwent neurophysiological investigations preoperatively, but these were not assessed until the end of the study. Open carpal tunnel release was performed and the clinical diagnosis of carpal tunnel syndrome was considered as confirmed when there was a prompt resolution of the preoperative symptoms. Sixty-three of the 68 patients responded well to surgery, three had equivocal outcomes and two did not improve, and thus were considered not to have carpal tunnel syndrome. The neurophysiological tests were normal in these two patients, but were also normal in 14 of the 63 patients who improved with carpal tunnel surgery. Preoperative neurophysiology might therefore have led to up to 14 of the 63 cases of carpal tunnel syndrome being turned down for surgery. We conclude that neurophysiological studies contribute little to the diagnosis in typical cases of carpal tunnel syndrome, and are more often confounding than of assistance.

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 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.

SKIN CLOSURE IN CARPAL TUNNEL SURGERY: A PROSPECTIVE COMPARATIVE STUDY BETWEEN NYLON, POLYGLACTIN 910 AND STAINLESS STEEL SUTURES

Hand Surgery ◽  
2004 ◽  
Vol 09 (01) ◽  
pp. 35-38 ◽  
Author(s):  
Tomas Menovsky ◽  
Ronald H. M. A. Bartels ◽  
Erik L. van Lindert ◽  
J. André Grotenhuis
Keyword(s):  
Stainless Steel ◽  
Carpal Tunnel Syndrome ◽  
Pain Score ◽  
Carpal Tunnel ◽  
Statistical Tests ◽  
Randomised Clinical Trial ◽  
Skin Closure ◽  
Polyglactin 910 ◽  
Carpal Tunnel Surgery ◽  
Tunnel Syndrome

Objective: To compare the cosmetic outcome, pain and tenderness around the operation scar of carpal tunnel syndrome surgery using either nylon, polyglactin 910 or stainless steel sutures for skin closure. Methods: A randomised clinical trial comparing nylon, polyglactin 910 or stainless steel sutures for skin closure in 61 patients undergoing carpal tunnel syndrome surgery was performed. Pain, tenderness, scar hypertrophy, redness and the presence of granulomas were assessed in all patients at ten days and six weeks after surgery and compared by non-parametric statistical tests. Results: Adequate surgical decompression of the median nerve could be achieved in all patients. All but two patients experienced significant relief of tingling of the fingers. Nearly all patients reported some degree of discomfort around the scar. At ten days, the mean pain score was 1.7 (±2.2), 3.1 (±2.3) and 1.9 (±2.3) for the nylon, vicryl and steel groups, respectively. At six weeks, the pain score was 3.6 (±3.1), 3.4 (±2.6) and 2.7 (±2.1) for the nylon, vicryl and steel groups, respectively. The infection rate was 0%, 8% and 0% for the nylon, vicryl and steel groups, respectively. Suture granulomas were significantly more present in the vicryl group (p<0.05). There were no statistical differences in redness or hypertrophy of the wound between the three groups. Conclusions: Nylon and stainless steel sutures are both suitable for skin closure after carpal tunnel surgery. Based on this study, absorbable vicryl sutures should not be used, since the incidence of infections and the presence of suture granulomas was much higher than in the nylon and steel suture groups.

Sign in / Sign up

Export Citation Format

Share Document