Release with or without reconstruction of the transverse carpal ligament for severe carpal tunnel syndrome: a randomized clinical trial

2017 ◽  
Vol 43 (3) ◽  
pp. 303-309 ◽  
Author(s):  
Rodrigo G. Gutiérrez-Monclus ◽  
Hector J. Gutiérrez-Espinoza ◽  
Alvaro R. Flores-Astudillo ◽  
Alberto L. Lluch-Homedes ◽  
Marcela Aguirre-Jerez
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Grip Strength ◽  
Carpal Tunnel ◽  
Surgical Techniques ◽  
Secondary Outcome ◽  
Control Group ◽  
Transverse Carpal Ligament ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
Experimental Group

The objective of this study is to compare the clinical effectiveness of two surgical techniques in patients with severe unilateral idiopathic carpal tunnel syndrome. A total of 117 patients were randomized in two groups. In the experimental group ( n = 59) reconstruction of the transverse carpal ligament was performed after open retinaculum release (TCL reconstruction group). In the control group ( n = 58) only retinaculum release was performed (TCL release group). The primary outcome measure was grip strength; secondary outcome measures were pain and response to the Boston questionnaire. Significance was analysed using the t-test or Mann–Whitney test. At 6 months, the experimental group showed clinical and statistically significant improvement in grip strength and decrease in symptom severity. Retinaculum release with reconstruction of the transverse carpal ligament results in improvement of grip strength in the medium term when compared with open retinaculotomy in patients with severe unilateral idiopathic carpal tunnel syndrome. Level of evidence: II

scholarly journals The double tunnels technique: an alternative minimally invasive approach for carpal tunnel syndrome

2015 ◽  
Vol 123 (5) ◽  
pp. 1230-1237 ◽  
Author(s):  
Daniele Vanni ◽  
Francesco Saverio Sirabella ◽  
Renato Galzio ◽  
Vincenzo Salini ◽  
Vincenzo Magliani
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Minimally Invasive ◽  
Carpal Tunnel ◽  
Secondary Outcome ◽  
Invasive Technique ◽  
Control Group ◽  
P Value ◽  
Invasive Approach ◽  
Group A ◽  
Tunnel Syndrome

OBJECT The purpose of this study was to assess the effectiveness and safety of an alternative minimally invasive technique for the treatment of carpal tunnel syndrome (CTS). METHODS This was designed as a prospective, randomized, open-label, blinded end point evaluation (PROBE) study. The active comparison was double tunnels technique (DTT) (Group A, 110 patients) versus standard open decompression of the median nerve (control [Group B], 110 patients). Patient recruitment started in January 2011. The primary outcomes were the functional Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) scores and visual analog scale (VAS) scores for pain (pVAS) at Weeks 2 and 4, and at Months 3, 6, and 12. The secondary outcome was the aesthetics (aVAS) score at Weeks 2 and 4, and at Months 3, 6, and 12. RESULTS The Student t-test and ANOVA were used, and the results were considered statistically significant if the p value was ≤ 0.05 for continuous variables. The DTT is a tissue-sparing approach that allows the surgeon to limit the length of the incision (0.6 ± 0.05 cm) and to respect the palmar fascia and the subcutaneous tissue. Recovery from wrist pain, night pain, numbness, stiffness, and weakness was achieved more effectively and quickly compared with the standard approach. Better BCTSQ, pVAS, and aVAS scores were observed in Group A. CONCLUSIONS The DTT is a safe and effective approach for the treatment of CTS. This technique entails faster recovery times, better aesthetic outcomes, and lower risks of complications.

Upper extremity disability is associated with pain intensity and grip strength in women with bilateral idiopathic carpal tunnel syndrome

2019 ◽  
Vol 44 (2) ◽  
pp. 199-205 ◽  
Author(s):  
Akihito Yoshida ◽  
Shigeru Kurimoto ◽  
Katsuyuki Iwatsuki ◽  
Masaomi Saeki ◽  
Takanobu Nishizuka ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Pain Intensity ◽  
Grip Strength ◽  
Upper Extremity ◽  
Carpal Tunnel ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome

The History of Carpal Tunnel Syndrome

1988 ◽  
Vol 13 (1) ◽  
pp. 28-34
Author(s):  
G. B. PFEFFER ◽  
R. H. GELBERMAN ◽  
J. H. BOYES ◽  
B. RYDEVIK
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Transverse Carpal Ligament ◽  
Motor Branch ◽  
Compressive Neuropathy ◽  
Anatomical Localization ◽  
History Of ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome

Carpal tunnel syndrome is the most frequently diagnosed, best understood and most easily treated entrapment neuropathy. During the first half of the 20th century, however, most patients with carpal tunnel syndrome were diagnosed as having compression of either the brachial plexus or thenar nerve motor branch of the median nerve. As late as 1950, only twelve patients with operative release of the transverse carpal ligament for idiopathic carpal tunnel syndrome had been reported. The delay in accurate anatomical localization of this compressive neuropathy can be attributed both to the confusion caused by the diverse manifestations of median nerve compression in the carpal tunnel, and to some interesting developments that altered early investigations in this area.

scholarly journals Is manual therapy based on neurodynamic techniques effective in the treatment of carpal tunnel syndrome? A randomized controlled trial

2018 ◽  
Vol 33 (3) ◽  
pp. 408-417 ◽  
Author(s):  
Tomasz Wolny ◽  
Pawel Linek
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Nerve Conduction ◽  
Controlled Trial ◽  
Group Differences ◽  
Control Group ◽  
Randomized Controlled ◽  
Tunnel Syndrome ◽  
Experimental Group

Objective: The aim of this study was to evaluate the efficacy of manual therapy based on neurodynamic techniques in conservative treatment of carpal tunnel syndrome. Design: Randomized controlled trial. Setting: Several medical outpatient clinics in the south of Poland. Participants: The study included 103 patients with mild and moderate carpal tunnel syndrome (mean age = 53.95, SD = 9.5) years, who were randomly assigned to a neurodynamic techniques group (experimental group, n = 58) or a group without treatment (control group, n = 45). Intervention: Neurodynamic techniques were used in the experimental group. Treatment was conducted twice weekly (20 sessions). Control group did not receive treatment. Main measures: Nerve conduction study, pain, symptom severity and functional status of Boston Carpal Tunnel Questionnaire, and strength of cylindrical and pincer grips were assessed at baseline and immediately after treatment (nerve conduction study one month after treatment). Results: Baseline assessment revealed no group differences in any assessed parameters ( P > 0.05). There were significant differences between groups after treatment, including nerve conduction (e.g. sensory conduction velocity: experimental group: 38.3 m/s, SD = 11.1 vs control group: 25.9 m/s, SD = 7.72, P  < 0.01). Significant changes also occurred in pain (experimental group: 1.38, SD = 1.01 vs control group: 5.46, SD = 1.05, P < 0.01), symptom severity (experimental group: 1.08, SD = 0.46 vs control group: 2.87, SD = 0.68, P < 0.01), and functional status (experimental group: 1.96, SD = 0.64 vs control group: 2.87, SD = 1.12, P < 0.01). There were no group differences in strength ( P > 0.05). Conclusion: The use of neurodynamic techniques in conservative treatment for mild to moderate forms of carpal tunnel syndrome has significant therapeutic benefits.

The Role of Wrist Anthropometric Measurement in Idiopathic Carpal Tunnel Syndrome

2008 ◽  
Vol 33 (5) ◽  
pp. 645-647 ◽  
Author(s):  
P. G. LIM ◽  
S. TAN ◽  
T. SARA AHMAD
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Healthy Volunteers ◽  
Carpal Tunnel ◽  
Matched Control ◽  
Anthropometric Measurement ◽  
Control Group ◽  
Matched Control Group ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome

Anthropometric wrist measurement ratios were examined for an association with idiopathic carpal tunnel syndrome (CTS). Wrist measurements were recorded in 67 patients with CTS and in a matched control group of 67 healthy volunteers. The Wrist Ratio (WR) (wrist anterior to posterior dimension/wrist medial–lateral dimension) and the Wrist Palm Ratio (wrist anterior to posterior dimension/palm length) were calculated for each case. We found that a WR of ≥0.70 and a Wrist Palm Ratio of >0.342 were significantly associated with idiopathic CTS.

Palmar Musculature: Does It Affect the Development of Carpal Tunnel Syndrome? A Pilot Study

2021 ◽  
Author(s):  
Trevor Simcox ◽  
Lauren Seo ◽  
Kevin Dunham ◽  
Shengnan Huang ◽  
Catherine Petchprapa ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Correlation Coefficient ◽  
Carpal Tunnel ◽  
Case Control Study ◽  
Anatomical Variation ◽  
Case Control ◽  
Transverse Carpal Ligament ◽  
Large Variability ◽  
Tunnel Syndrome ◽  
Control Study

Abstract Background The etiology of carpal tunnel syndrome (CTS) is multifactorial. Static mechanical characteristics of CTS have been described, but dynamic (muscular) parameters remain obscure. We believe that musculature overlying the transverse carpal ligament may have an effect on carpal tunnel pressure and may explain the prevalence of CTS in manual workers. Questions/Purposes To utilize magnetic resonance imaging (MRI) imaging to estimate the amount of muscle crossing the area of the carpal tunnel and to compare these MRI measurements in patients with and without documented CTS. Methods A case–control study of wrist MRI scans between January 1, 2018, and December 1, 2019, was performed. Patients with a diagnosis of CTS were matched by age and gender with controls without a diagnosis of CTS. Axial MRI cuts at the level of the hook of the hamate were used to measure the thenar and hypothenar muscle depth overlying the carpal tunnel. Muscle depth was quantified in millimeters at three points: midcapitate, capitate–hamate border, capitate–trapezoid border. Average depth was calculated by dividing the cross-sectional area (CSA) by the transverse carpal ligament width. Statistical analysis included Student's t-test, chi-square test, and Pearson's correlation coefficient calculation. Results A total of 21 cases and 21 controls met the inclusion criteria for the study. There were no significant differences in demographics between case and control groups. The location and depth of the musculature crossing the carpal tunnel were highly variable in all areas evaluated. A significantly positive correlation was found between proximal median nerve CSA and muscle depth in the capitate–hamate area (correlation coefficient = 0.375; p = 0.014). CSA was not significantly associated with chart documented CTS. Conclusions We found large variability in our measurements. This likely reflects true anatomical variation. The significance of our findings depends on the location of the muscles and the line of pull and their effect on the mechanics of the transverse carpal ligament. Future research will focus on refining measurement methodology and understanding the mechanical effect of the muscular structure and insertions on carpal tunnel pressure. Level of Evidence This is a Level 3, case–control study.

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