Pre- and post-operative comorbidities in idiopathic carpal tunnel syndrome: cervical arthritis, basal joint arthritis of the thumb, and trigger digit

2012 ◽  
Vol 38 (1) ◽  
pp. 50-56 ◽  
Author(s):  
J.H. Kim ◽  
H.S. Gong ◽  
H.J. Lee ◽  
Y. H. Lee ◽  
S.H. Rhee ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
De Quervain’S Disease ◽  
Basal Joint ◽  
Before And After ◽  
Electrophysiological Studies ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
Joint Arthritis

We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain’s disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain’s disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome.

INVESTIGATION OF SEGMENTAL CARPAL TUNNEL PRESSURE IN PATIENTS WITH IDIOPATHIC CARPAL TUNNEL SYNDROME — IS IT NECESSARY TO RELEASE THE DISTAL APONEUROTIC PORTION OF THE FLEXOR RETINACULUM IN ENDOSCOPIC CARPAL TUNNEL RELEASE SURGERY?

Hand Surgery ◽  
2007 ◽  
Vol 12 (03) ◽  
pp. 205-209 ◽  
Author(s):  
Keiichi Murata ◽  
Hiroshi Yajima ◽  
Naoki Maegawa ◽  
Koji Hattori ◽  
Yoshinori Takakura
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Guide Wire ◽  
Carpal Tunnel Release ◽  
Endoscopic Carpal Tunnel Release ◽  
Flexor Retinaculum ◽  
Before And After ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery

Segmental carpal tunnel pressure was measured in 12 hands of 11 idiopathic carpal tunnel syndrome patients before and after two-portal endoscopic carpal tunnel release. We aimed to determine at which part of the carpal tunnel the median nerve could be compressed, and to evaluate whether carpal tunnel pressure could be reduced sufficiently at all segments of the carpal tunnel after the surgery. Pressure measurements were performed using a pressure guide wire. The site with the highest pressure corresponded to the area around the hamate hook; the pressure in the area distal to the flexor retinaculum could be pathogenically high (more than 30 mmHg) before the surgery. The two-portal endoscopic carpal tunnel release achieved sufficient pressure reduction in all segments of the carpal tunnel when the flexor retinaculum and the fibrous structure between the flexor retinaculum and the palmar aponeurosis were completely released.

Use of Nerve Conduction Studies and the Pressure-Specified Sensory Device in the Diagnosis of Carpal Tunnel Syndrome

2009 ◽  
Vol 34 (1) ◽  
pp. 60-65 ◽  
Author(s):  
D. J. SLUTSKY
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Diagnostic Yield ◽  
Carpal Tunnel Release ◽  
Nerve Conduction Studies ◽  
Control Group ◽  
Asymptomatic Volunteers ◽  
Before And After ◽  
Tunnel Syndrome

Sixty-nine patients with signs of carpal tunnel syndrome (CTS) underwent nerve conduction studies (NCS) and testing with the Pressure-Specified Sensory Device (PSSD). A total of 102 tests were performed (28 bilateral). Twenty patients underwent a carpal tunnel release and were retested after 4 to 6 months. The Symptom Severity Score (SSS) was calculated before and after surgery. A control group of 20 hands in 10 asymptomatic volunteers underwent identical testing. The NCS sensitivity was 87% with a specificity of 90% whereas the PSSD sensitivity was 81% with a specificity of 65%. The combined sensitivity of the two tests was 93%. In the operative group the SSS improved from a mean of 3.34 pre-operatively to 1.95 postoperatively. The NCS improved in 19/21 hands whereas the PSSD improved in 16/19 hands. The non-invasive SSS and PSSD can increase the diagnostic yield in CTS, especially when the NCS are normal.

The Anatomical Site of Constriction of the Median Nerve in Patients with Severe Idiopathic Carpal Tunnel Syndrome

2006 ◽  
Vol 31 (6) ◽  
pp. 608-610 ◽  
Author(s):  
M. M AL-QATTAN
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Anatomical Site ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
A Prospective Study ◽  
Open Carpal Tunnel Release ◽  
Radiological Studies

During open carpal tunnel release in patients with severe idiopathic carpal tunnel syndrome, an area of constriction in the substance of the median nerve is frequently noted. In a prospective study of 30 patients, the central point of the constricted part of the nerve was determined intraoperatively and found to be, on average, 2.5 (range 2.2–2.8) cm from the distal wrist crease. This point always corresponded to the location of the hook of the hamate bone. These intraoperative findings were compared with the “narrowest” point of the carpal canal as determined by anatomical and radiological studies in the literature.

scholarly journals Ozone Therapy in Idiopathic Carpal Tunnel Syndrome. Biochemical, Neurophysiological and Clinical Aspects [abstract]

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Marco Rascaroli ◽  
Barbara Borghi
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Reperfusion Injury ◽  
Carpal Tunnel ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Ozone Therapy ◽  
Before And After ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
Physiological Tests

PURPOSE: Idiopathic Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy. The aim of the paper was to design a prospective study to evaluate clinical and neurophysiological outcome following Ozone Therapy . We also focusing the attention on the evidences concerning the role of Subsynovial Connective Tissue (SSCT )in the pathogenesis of CTS and the ozone pre-conditioning effects linked to pain pathways and to fibrosis induced by Ischemia-Reperfusion Injury. MATERIALS and METHODS: Thirty-one patients, aged between 36 and 86 23 women and 8 men), were stratified clinically by Boston Carpal Tunnel Questionnaire (B.C.T.Q.) and Neurophysiologically by Padua’s Gravity Scale classifying patients into five Electro-myographic categories (Minimal, Slight, Moderate, Severe and Extreme) . The mean symptom duration was also recorded. The patients included in the B.C.T.Q. underwent diagnostic neurophysiological tests, strictly standardized in stimulation parameters, electrodes distances and skin temperature, before and after treatment. The Ozone Therapy was performed by injecting 4 ml of O3-O2 mixture at 10 mcrg/mL concentration under the transverse carpal ligament twice a week for eight sessions. RESULTS: We compared the B.C.T.Q. scores and the neurophysiological parameters obtained before and after O2-O3 treatment: the improvement of symptoms was significantly greater than the improvement of motor and sensory nerve conduction. The highest clinical improvement degree was found in patients classified in Slight and Moderate Groups. DISCUSSION: Chemical mediators, neo-angiogenesis and Ischemia-Reperfusion Injury lead to oxidative stress and non-inflammatory fibrosis that play a central role at various stages in CTS pathogenesis that can be recognized by clinical and neuro-physiological tests. Further studies have to be carried out to better understand these relationships and optimize timing of Ozone Therapy.

EVIDENCE OF IMPROVEMENT IN DISTAL CONDUCTION OF ULNAR NERVE SENSORY FIBERS AFTER CARPAL TUNNEL RELEASE

Neurosurgery ◽  
2009 ◽  
Vol 65 (4) ◽  
pp. 696-701 ◽  
Author(s):  
Mauro Mondelli ◽  
Federica Ginanneschi ◽  
Alessandro Rossi
Keyword(s):  
High Pressure ◽  
Carpal Tunnel Syndrome ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Patients Âgés ◽  
Sensory Action ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
Sensory Fibers

Abstract OBJECTIVE The aim of this study was to verify any effect of carpal tunnel release (CTR) on distal ulnar nerve conduction findings, using the database of a previous study performed to establish a protocol for CTR outcome. METHODS The motor and sensory ulnar distal conduction findings of 251 consecutive hands belonging to 217 patients (175 women and 42 men; mean age, 55.6 years) with idiopathic carpal tunnel syndrome (CTS) were reanalyzed before and 1 and 6 months after CTR. RESULTS Before surgery, 115 hands (45.8%) showed reduction of ulnar nerve sensory action potential (SAP) amplitude; this number was reduced significantly to 85 (33.9%) after CTR. The SAP amplitude and sensory conduction velocity values of the ulnar nerve showed significant improvement 1 month after CTR; SAP amplitude values showed further significant improvement 6 months after CTR. Patients' ages and occupations were independent predictors of reduced baseline SAP amplitudes of the ulnar nerve in CTS. CONCLUSION These results demonstrate an improvement in conduction values in sensory ulnar fibers in a percentage of patients with CTS after CTR, providing further support for the conclusion that in CTS ulnar fibers may be subject to compressive forces in the Guyon canal as a consequence of high pressure in the carpal tunnel.

A comparison of outcomes of carpal tunnel release for carpal tunnel syndrome in patients diagnosed with and without electrophysiological studies

2017 ◽  
Vol 49 (05) ◽  
pp. 304-308
Author(s):  
Piotr Puchalski ◽  
Andrzej Zyluk ◽  
Zbigniew Szlosser
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Clinical Findings ◽  
Pinch Strength ◽  
Electrophysiological Studies ◽  
Tunnel Syndrome

AbstractRecords were analysed from the institutional database, including 943 patients (1089 hands) with CTS who were operated on in the authors’ department over a period of four years (2012 to 2015). The diagnosis of CTS was made solely on the basis of clinical findings in 551 patients (58 %); 392 patients (42 %) also had electrodiagnostic tests performed, for various reasons. Patients were followed-up at 1 and 6 months with assessments that included the Levine scores, filament tests, grip and pinch strength. No significant differences in Levine scores were found at the 1 and 6 month assessments. Statistically significant differences were noted in 3-point pinch strength and sensation: however, these were not clinically meaningful. The results of the study show that the results of carpal tunnel release in patients with typical symptoms are no better after electrodiagnostic tests.

TRIGGER DIGITS-ASSOCIATED CARPAL TUNNEL SYNDROME: RELATIONSHIP BETWEEN CARPAL TUNNEL RELEASE AND TRIGGER DIGITS

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 205-208 ◽  
Author(s):  
K. Harada ◽  
H. Nakashima ◽  
K. Teramoto ◽  
T. Nagai ◽  
S. Hoshino ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Flexor Tendon ◽  
Carpal Tunnel Release ◽  
Tendon Sheath ◽  
Flexor Tendon Sheath ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
The Difference ◽  
Performance Rate

Of 875 idiopathic carpal tunnel syndrome (CTS) cases, 101 (11.5%) required trigger digit release operations within three years before and/or after carpal tunnel release (CTR); these 101 cases were investigated, retrospectively. Trigger digit release (TDR) was performed most often after the CTR, especially within three months. Next most common was at the same time as the CTR. The TDR performance rate after CTR was 5.9%. The nerve conduction study (NCS) comparison between trigger digits-associated CTS and isolated CTS showed that pre-operative distal motor latency was significantly more delayed in trigger digits-associated CTS, while there was no evidence of any difference due to age or gender. The difference of operative method (open or endoscopic procedure) did not influence the incidence rate of trigger digits after the CTR. This study suggested that trigger digits-associated CTS has a previously developed wide-ranging narrowing of the flexor tendon sheath.

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