Ulnar tunnel syndrome: pathoanatomy, clinical features and management

2020 ◽  
Vol 81 (9) ◽  
pp. 1-9
Author(s):  
Alexander Scarborough ◽  
Robert J MacFarlane ◽  
Nisarg Mehta ◽  
Gillian D Smith
Keyword(s):  
Gold Standard ◽  
Standard Treatment ◽  
Ganglion Cyst ◽  
Nerve Conduction Studies ◽  
Vascular Anomalies ◽  
X Rays ◽  
Inflammatory Conditions ◽  
Ganglion Cysts ◽  
Tunnel Syndrome ◽  
Ulnar Tunnel

Ulnar tunnel syndrome is compression of the ulnar nerve at the level of the wrist within Guyon's canal. It is most commonly caused by a ganglion cyst but may also be secondary to fractures, inflammatory conditions, neoplasm, vascular anomalies, aberrant musculature or a combination of these. Assessment should include a detailed history focusing on duration, site and progression of symptoms. The level of compression can be estimated clinically on examination by assessing motor and sensory changes in the hand. Investigations are used to confirm diagnosis or to clarify the underlying cause. X-rays and computed tomography can be used to exclude fractures. Ultrasound is used to diagnose ganglion cysts and vascular anomalies, and can localise the level of compression. Nerve conduction studies can be used to support the diagnosis and look for proximal compression. Mild symptoms can be managed non-operatively. Surgical exploration and decompression is the gold standard treatment for neuro-compressive causes with largely good outcomes.

A Clinical Questionnaire for the Diagnosis of Carpal Tunnel Syndrome

2003 ◽  
Vol 28 (5) ◽  
pp. 455-459 ◽  
Author(s):  
V. KAMATH ◽  
J. STOTHARD
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Gold Standard ◽  
Symptom Relief ◽  
Nerve Conduction Studies ◽  
Initial Assessment ◽  
Hand Surgeon ◽  
Tunnel Syndrome ◽  
Electrophysiological Examination

This prospective study compared the sensitivities of a scored questionnaire and electrophysiological examination in the diagnosis of carpal tunnel syndrome. Patients were assessed by a hand surgeon using a scored questionnaire, and then underwent an electrophysiological assessment by an experienced neurophysiologist (blinded to the questionnaire results). Patients diagnosed as having carpal tunnel syndrome by either the questionnaire, the electrophysiological examination or both underwent decompression. Symptom relief was taken as the “gold standard” for true carpal tunnel syndrome. The results showed a sensitivity of 85% for the scored questionnaire and 92% for nerve conduction studies with a positive predictive value of 90% for the scored questionnaire and 92% for nerve conduction studies. The authors recommend that a scored questionnaire can replace nerve conduction studies in the initial assessment of whether patients presenting with dysaesthesiae in the fingers should undergo surgery. This will give major time, personnel and cost benefits.

Review of Symptoms and Signs for Working Adults with Median Nerve Entrapment

2019 ◽  
Vol 24 (2) ◽  
pp. 3-5, 16
Author(s):  
J. Mark Melhorn ◽  
Kurt T. Hegmann
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Gold Standard ◽  
Nerve Conduction Studies ◽  
Accurate Diagnosis ◽  
Electrodiagnostic Testing ◽  
Working Adults ◽  
Tunnel Syndrome ◽  
Symptoms And Signs ◽  
Palmar Aspect

Abstract Physicians often must evaluate patients who present with symptoms in a median nerve distribution and typically diagnose carpal tunnel syndrome (CTS), but an accurate diagnosis is critical to determine causation and to define possible impairment. CTS is a constellation of symptoms and signs that result from mononeuropathy of the median nerve in the carpal tunnel; symptoms typically include tingling and/or numbness, dysesthesias, and/or pain in the radial palm and palmar aspect of the thumb, index, middle, and perhaps ring fingers. The American Academy of Orthopaedic Surgeons suggests use of the CTS-6 scoring aid (shown in a table) as a clinical aid for diagnosing CTS. Electrodiagnostic testing, nerve conduction studies in particular, are considered the gold standard for diagnosis of CTS, but research suggests that the definitions of relevant sensory and assignment of CTS are sensitive to threshold changes from a latency of, eg, >4.4 msec vs >4.5 msec. Other factors to consider include whether there are effects from the known association between wrist ratio and CTS and assessing the benefits of neuromuscular ultrasound to diagnose CTS. Nocturnal paresthesias and paresthesias while holding onto an object were sensitive indicators of the presence of CTS but use of the Phalen and Hoffmann-Tinel signs has significant potential to be unreliable.

Ultrasound: A Screening Tool for Carpal Tunnel Syndrome

2015 ◽  
Vol 26 (4) ◽  
pp. 102-108
Author(s):  
Bobeena Rachel Chandy ◽  
M. Betty ◽  
Henry Prakash Magimairaj ◽  
Binu P. Thomas ◽  
George Tharion
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Gold Standard ◽  
Screening Tool ◽  
Nerve Conduction Studies ◽  
Cross Sectional ◽  
Non Invasive ◽  
Tunnel Syndrome

Abstract Background Electrodiagnostic test is considered as the gold standard for diagnosis of carpal tunnel syndrome (CTS). Ultrasonography provides a simple non-invasive means of visualising peripheral nerve pathology. Objective The objective of the study was to assess the role of ultrasonography in CTS and its correlation with the present day gold standard of nerve conduction studies (NCS). Materials and Methods A prospective cohort size of 100 subjects was calculated based on a hypothesized sensitivity of 90% and a confidence interval of 85-95%. All 100 subjects, 64 controls and 36 patients underwent nerve conduction studies and USG. Transverse images of the median nerve were obtained at three levels: proximal to the carpal tunnel inlet, at the carpal tunnel inlet and at the carpal tunnel outlet. The flattening ratio was also assessed at the tunnel inlet and outlet. Statistical analysis was done to corelate the ultrasound findings at each level with nerve conduction studies and calculation of the positive and negative predictive values. The cut offs of the cross-sectional areas of the median nerve at the three anatomical levels on ultrasonography were taken at the best sensitivity and specificity according to the ROC curve. Results We found that at any one anatomical level, the sensitivity of ultrasound to detect carpal tunnel syndrome by increase in the cross-sectional area of median nerve as compared to the nerve conduction studies is 90%. Conclusions At 45% specificity, ultrasonography could be used as a non-invasive and easily available screening tool in carpal tunnel syndrome. Also, the best level to look for nerve compression is at the level of the carpal tunnel inlet.

scholarly journals Carpal tunnel release by mini palmar incision

2011 ◽  
Vol 5 (1) ◽  
pp. 139-142 ◽  
Author(s):  
Kawee Pataradool ◽  
Pravit Kitidumrongsook ◽  
Adisorn Patradul
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Gold Standard ◽  
Standard Treatment ◽  
Carpal Tunnel Release ◽  
Small Series ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release ◽  
Mini Incision

Abstract Background: Open carpal tunnel release is the gold standard treatment for carpal tunnel syndrome. However, there are complications related to the long incision. Method: We report the results from a mini-incision open carpal tunnel release with simple instruments. Results: There were no complications in our small series, improvement of scores was shown at four-week follow-up, and cosmetic results were satisfactory. Conclusions: Mini-incision carpal tunnel release is one option to treat carpal tunnel syndrome.

Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice

2021 ◽  
pp. 004947552110100
Author(s):  
Shamir O Cawich ◽  
Avidesh H Mahabir ◽  
Sahle Griffith ◽  
Patrick FaSiOen ◽  
Vijay Naraynsingh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gold Standard ◽  
Standard Treatment ◽  
Gallstone Disease ◽  
Acute Attack ◽  
Early Laparoscopic Cholecystectomy ◽  
Delayed Surgery ◽  
Delayed Cholecystectomy ◽  
Delayed Laparoscopic Cholecystectomy

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.

scholarly journals Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient

2021 ◽  
Vol 14 (5) ◽  
pp. e241540
Author(s):  
Jaekyoung Lee ◽  
Dong Cheol Lee
Keyword(s):  
Elderly Patient ◽  
Cerebrospinal Fluid ◽  
Gold Standard ◽  
Standard Treatment ◽  
Nasolacrimal Duct ◽  
Intravenous Antibiotic ◽  
Duct Obstruction ◽  
Orbital Wall ◽  
Silicone Intubation ◽  
Endoscopic Dcr

Dacryocystorhinostomy (DCR) is the ‘gold standard’ treatment for nasolacrimal duct obstruction (NLDO). However, despite its recent technical advancements, complications are possible. Herein, to the best of our knowledge, we present the first reported case of delayed unilateral pneumocephalus after bilateral endoscopic DCR. An 85-year-old man with bilateral NLDO underwent endoscopic DCR with silicone intubation. After 1 month, he became lethargic and was admitted to emergency room. Brain CT demonstrated left pneumocephalus and a suspected microfistula in left orbital wall. Intravenous antibiotic therapy was started, and cerebrospinal fluid studies showed no evidence of meningitis. After 13 days of antibiotic treatment, his mental state recovered with no signs of pneumocephalus. Although DCR has high success rate and is relatively safe, surgeons should be aware of the risk, although low, of pneumocephalus, especially in elderly patients who are vulnerable to fractures and who exhibit headache or mental status changes after endoscopic DCR.

scholarly journals Local Chemotherapy as an Adjuvant Treatment in Unresectable Squamous Cell Carcinoma: What Do We Know So Far?

2021 ◽  
Vol 28 (4) ◽  
pp. 2317-2325
Author(s):  
Luigi Bennardo ◽  
Francesco Bennardo ◽  
Amerigo Giudice ◽  
Maria Passante ◽  
Stefano Dastoli ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Gold Standard ◽  
Systemic Chemotherapy ◽  
Standard Treatment ◽  
Case Reports ◽  
Case Series ◽  
Surgical Removal ◽  
Local Chemotherapy

Background: Squamous cell carcinoma (SCC) is one of the most common cancers involving skin and oral mucosa. Although this condition’s gold-standard treatment is the surgical removal of the lesions, the physician must propose alternative treatments in some cases due to the patient’s ineligibility for surgery. Among the available alternative therapies, local chemotherapy may represent an initial treatment in combination with radiotherapy or systemic chemotherapy due to the low frequency of side-effects and the lack of necessity for expensive devices. Methods: In this paper, we review all available literature in various databases (PubMed, Scopus-Embase, Web of Science), proposing local chemotherapy as a treatment for cutaneous and oral SCC. Exclusion criteria included ocular lesions (where topical treatments are common), non-English language, and non-human studies. Results: We included 14 studies in this review. The majority were case reports and case series describing the treatment of non-resectable localized SCC with either imiquimod or 5-fluorouracil. We also analyzed small studies proposing combination treatments. Almost all studies reported an excellent clinical outcome, with a low risk of relapses in time. Conclusions: Resection of the lesion remains the gold-standard treatment for SCC. When this approach is not feasible, local chemotherapy may represent a treatment alternative, and it may also be associated with radiotherapy or systemic chemotherapy.

Factors Impacting Recurrence Rate After Open Ganglion Cyst Excision

Hand ◽  
2020 ◽  
pp. 155894472092147
Author(s):  
Landon M. Cluts ◽  
John R. Fowler
Keyword(s):  
Recurrence Rate ◽  
Ganglion Cyst ◽  
Significant Risk ◽  
Recurrence Rates ◽  
Cyst Excision ◽  
Small Series ◽  
Ganglion Cysts ◽  
Surgeon Experience ◽  
Cyst Recurrence ◽  
Open Excision

Background: The recurrence rate after open excision of ganglion cysts is approximately 20%. However, this literature is based on a small series of subjects. This study aims to determine the rate and risk of recurrence after open excision of ganglion cysts in a large patient series. Methods: This study included 628 patients who had ganglion cyst excision from 2010 to 2018. A retrospective chart review recorded the following: age, sex, laterality, volar/dorsal location, and recurrence. An overall recurrence rate was calculated. In addition, a 1-way analysis of variance test was used to compare recurrence rates among the individual surgeons, and unpaired t tests were used to compare age of recurrence, dorsal cyst recurrence, laterality of cyst, and recurrence based on sex. Finally, a comparison of recurrence rate over time was conducted for surgeon 3. Results: The overall recurrence rate was 3.8% (24 of 628). The recurrence rates for each surgeon were 3% (9 of 353), 2% (3 of 167), and 11% (12 of 107), P = .02. The age of those with and without a recurrence did not differ (32 years vs 38 years), P = .06. The recurrence rate of dorsal ganglion cysts was 4.1% (14 of 341) compared with 3.5% (10 of 286) for volar ganglion cysts, P = .69. Male patients had a recurrence in 6.4% (13 of 204) of cases compared with 2.6% (11 of 424) of female patients, P = 0.01. There was a decrease in the rate of recurrence from 42.9% to 5.3% over 5 years for surgeon 3. Conclusion: In our sample, male sex and surgeon experience were significant risk factors in ganglion cyst recurrence.

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