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.

Ulnar and Median Nerve Abnormalities in Carpal Tunnel Syndrome

2020 ◽  
Vol 22 (5) ◽  
pp. 313-322
Author(s):  
Filip Georgiew ◽  
Andrzej Maciejczak ◽  
Jakub Florek ◽  
Ireneusz Kotela
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Control Group ◽  
Conduction Disturbances ◽  
Tunnel Syndrome ◽  
Sensory Fibers ◽  
American Academy Of Neurology

Background. Nerve compression underlying carpal tunnel syndrome (CTS) results in an increase in the threshold of superficial sensation in the area supplied by the median nerve, which is a mixed nerve dominated by sensory fibres. The distribution of sensory symptoms is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment at wrist level is still unclear. Patho­logical processes leading to median neuropathy in CTS may affect ulnar nerve motor and sensory fibers in the Guyon canal. This may explain the extra-median spread of sensory symptoms in CTS patients. Material and methods. The study involved 88 patients (104 hands), with 70 women (83 hands) and 18 men (21 hands) aged between 25 and 77 years. 50 age- and sex-matched subjects without carpal tunnel syndrome were used as a control group. The diagnosis of carpal tunnel syndrome was made according to the criteria of the American Academy of Neurology 1993 guidelines. Based on the results of an ENG trace evaluating the degree of conduction disturbances in the median nerve, the patients were classified to one of three severity subgroups. The threshold of sensory excitability to pulsed current was determined in a test with single 100 ms rectangular pulses. Conclusions. 1. The threshold of sensation in the fingers innervated by the median and ulnar nerve is significantly lon­ger in patients with CTS than in controls. 2. Surgical treatment decreases the threshold of sensation in the fingers innervated by the median nerve. 3. Surgical treatment does not decrease the threshold of sensation in the fingers innervated by the ul­nar nerve. 4. The preoperative and postoperative threshold of sensation in the fingers innervated by the median and ulnar nerve is significantly longer in patients with severe carpal tunnel than in mild and moderate cases.

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.

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.

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.

COMPARISON OF CLINICAL RESULTS BETWEEN ELDERLY AND YOUNGER PATIENTS FOLLOWING ENDOSCOPIC CARPAL TUNNEL RELEASE SURGERY FOR IDIOPATHIC CARPAL TUNNEL SYNDROME

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 59-61 ◽  
Author(s):  
Aya Yoshida ◽  
Ichiro Okutsu ◽  
Ikki Hamanaka
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Muscle Power ◽  
Carpal Tunnel Release ◽  
Clinical Results ◽  
Postoperative Recovery ◽  
Recovery Rates ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
Touch Sensation

We retrospectively analyzed clinical results of 107 hands of an elderly idiopathic carpal tunnel syndrome group (65 years old and older) and 234 hands of a younger group (under 65 years old) following endoscopic carpal canal release surgery. There were statistical differences in recovery rates for tingling, pain sensation and touch sensation (p < 0.01) and recovery periods of touch sensation (p < 0.05). There were no statistical differences in recovery rates, periods of thumb abduction muscle power, and recovery rates of electrophysiological examination results. Cervical spondylosis may affect postoperative recovery of subjective sensory disturbance, especially in the elderly group. From these results, in elderly patients we recommend primary minimally invasive endoscopic carpal canal release surgery and only apply primary opponoplasty in cases when the patient strongly wishes reconstruction faster than six months.

Sign in / Sign up

Export Citation Format

Share Document