scholarly journals Median nerve decompression in carpal tunnel syndrome: short- and long-term results

2018 ◽  
Vol 10 (3) ◽  
pp. 79-85 ◽  
Author(s):  
A. S. Gilveg ◽  
V. A. Parfenov ◽  
G. Yu. Evzikov
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Long Term Results ◽  
Functional Improvement ◽  
Nerve Decompression ◽  
Group 2 ◽  
Median Nerve Decompression ◽  
Group 1

Objective: to investigate the short- and long-term results of surgical median nerve decompression via classical and minimally invasive approaches in patients with carpal tunnel syndrome (CTS), as well as factors that influence surgical outcomes. Patients and methods. The investigation enrolled 70 patients (13 men and 57 women) aged 36 to 84 years (mean age, 62±10.8 years) who had undergone median nerve decompression. Surgery was performed in the classical way in 35 patients (Group 1) and via a minimally invasive access in the remaining 35 patients (Group 2). The efficiency of treatment was evaluated using the Boston Carpal Tunnel Questionnaire (BCTQ) and a visual analog scale for pain before and 1, 3, 6, and 12 months after surgery, as well as from patient satisfaction with surgical outcomes. Results. No complications of surgical treatment were detected. There was a marked reduction in pain and other neuropathic disorders just 1 month after surgery and a substantial hand functional improvement following 6 months. After 12 months, in Group 1, the mean BCTQ Symptom Severity Scale and Functional Deficit Scale scores decreased from 2.76 to 1.15 (p≤0.01) and from 2.72 to 1.24 (p≤0.01), respectively; in Group 2, these dropped from 2.86 to 1.14 (p≤0.01) and from 2.95 to 1.24 (p≤0.01), respectively. Complete recovery from sensory problems occurred in 24 (69%) patients in Group 1 and in 25 (71%) patients in Group 2; their partial recovery was observed in 11 (31%) and 10 (29%) patients in these groups, respectively. One 1 month following decompression, the patients in Group 1 had more severe pain syndrome than those in Group 2; these differences became statistically insignificant after 6 months. The patients were found to be highly satisfied with surgical treatment. Permanent numbness, subjective weakness, thenar muscle atrophy, stage III CTS, and diabetes mellitus (DM) were predictors for less pronounced improvement in BCTQ scores after surgical treatment (p<0.05). The paper describes a clinical case that achieved full postoperative occupational and home rehabilitation. Conclusion. The patients with CTS were observed to have a marked reduction in pain and other neuropathic disorders just one month after surgical decompression and a substantial hand functional improvement following 6 months. The benefit from a minimally invasive access is less severe pain syndrome at 1 month after surgery. The predictors of less successful results of surgery are age (the older the patient is, the greater likelihood of having a worse result), permanent numbness, subjective hand weakness, thenar muscle atrophy, DM, and stage III CTS.

scholarly journals Efficacy of Hyalase Hydrodissection in the Treatment of Carpal Tunnel Syndrome: A Randomized, Double-Blind, Controlled, Clinical Trial

2020 ◽  
Vol 2;23 (4;2) ◽  
pp. E175-E183
Author(s):  
Emad Zarief Kamel
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Saline Solution ◽  
Controlled Clinical Trial ◽  
Tunnel Syndrome ◽  
Group 2 ◽  
Group 1

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, which results from median nerve compression. A lot of nonsurgical modalities are available for the management of mild to moderate situations. Local Hyalase hydrodissection (HD) of the entrapped median nerve could offer a desirable sustained symptom alleviation. Objectives: To evaluate the clinical efficacy of Hyalase/saline solution carpal tunnel HD on pain, functional status, and nerve conduction in patients with CTS. Study Design: A randomized, double-blinded trial. Setting: Anesthesia, pain, and rheumatology clinics in a university hospital. Methods: Patients: 60 patients with CTS (> 6 months’ duration). Intervention: patients were allocated equally into either group 1 (HD with Hyalase + 10 mL saline solution injection), or group 2 (HD with 10 mL saline solution only). Measurements: assessment of pain using Visual Analog Scale (VAS), functional disability (FD) score, and nerve conduction studies before injection, and over 6 months after injection. Nerve conduction parameters before injection and postinjection by the end of 3 and 6 months were evaluated as well. Results: Statistically significant lower postinjection values of VAS (1 ± 1.8, 2 ± 1.1, 2 ± 1.2, 2 ± 1.1) in group 1 versus (2 ± 1.2, 3 ± 1.7, 4 ± 1.5, 5 ± 2.6) in group 2 by the end of the first week, and the first, third, and sixth months, and significantly lower FD scores (15.3 ± 1.2, 13 ± 1.3, 10.2 ± 1.3, 10.2 ± 1.3) in group 1 versus (17.5 ± 1.8, 16.6 ± 2.8, 19.4 ± 3.2, 21.2 ± 2.5) in group 2 during the same time intervals. Nerve conduction study parameters have shown significantly higher velocity and lower latency in the Hyalase group than in the saline solution group by the 3 and 6 month follow-up. Limitation: We suggest a longer period could be reasonable. Conclusions: Carpal tunnel HD with Hyalase with saline solution is considered as an efficient technique offering a rapid onset of pain relief and functional improvements, and better median nerve conduction in patients with CTS over 6 months follow-up duration. Key words: Carpal tunnel syndrome, Hyalase, median nerve hydrodissection

scholarly journals Long-term results of surgical treatment of thyroid adenomas

2019 ◽  
Vol 100 (6) ◽  
pp. 892-897
Author(s):  
Stanislav Olegovich Artyukhin ◽  
Vladimir Georgievich Aristarhov ◽  
Denis Anatolyevich Puzin
Keyword(s):  
Surgical Treatment ◽  
Needle Aspiration ◽  
Long Term Results ◽  
Fine Needle ◽  
Thyroid Adenomas ◽  
Follicular Tumor ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aim. To study the long-term results of surgical treatment of patients with thyroid adenomas. Methods. From 2004 to 2006, 667 patients with follicular adenomas of the thyroid gland, including 134 (20.1%) men and 533 (79.9%) women, were operated on in the surgical department №2 of city clinical hospital №11 of Ryazan. 3 groups of patients were defined: group 1 operated on for solitary adenomas of the thyroid gland, 103 patients, hemithyreoidectomy performed; group 2 operated on for multiple adenomas of the thyroid in both lobes, 101 patients, thyroidectomy performed; group 3 32 patients operated on for multiple adenomas of the thyroid in the same lobe, hemithyreoidectomy performed. Patients were examined 14 years after the surgery. Results. Hypothyroidism was diagnosed in: group 1 18 (17.5%) patients, group 2 101 (100%), group 3 0. All patients with hypothyroidism were compensated with hormone replacement therapy. Permanent hypoparathyroidism was diagnosed only in group 2 8 (4.8%) patients. Unilateral laryngeal paralysis was found in group 1 in 1 (0.9%) patient, group 2 in 2 (1.9%) patients, group 3 contained no such patients. Recurrence (node more than 1 cm according to ultrasound) was observed in group 1 in 12 (11.7%) patients; fine-needle aspiration found colloidal nodes in 8 (7.8%) patients (Bethesda II), in 4 (3.9%) follicular tumor (IV). Group 2 had no recurrences. In group 3 11 (34.3%) patients had recurrence; fine-needle aspiration found colloidal nodes in 1 (3.1%) patient (Bethesda II), in 10 (31.3%) follicular tumor (Bethesda IV). Conclusion. In solitary adenomas it is possible to perform organ-saving operations, which reduces the percentage of postoperative complications; in multiple adenomas, the optimal volume of surgery is thyroidectomy; when multiple adenomas are localized in one lobe, the chance of recurrence of the disease (31.3%) is high leading to re-surgery.

Evolving Concepts of Median Nerve Decompression in the Carpal Tunnel

Hand Clinics ◽  
1986 ◽  
Vol 2 (4) ◽  
pp. 723-736
Author(s):  
Frederick R. Heckler ◽  
Michael E. Jabaley
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Decompression ◽  
Median Nerve Decompression

Prospective evaluation of preoperative and postoperative sleep quality in carpal tunnel release

2018 ◽  
Vol 44 (3) ◽  
pp. 278-282 ◽  
Author(s):  
Cüneyt Emre Okkesim ◽  
Sancar Serbest ◽  
Uğur Tiftikçi ◽  
Meriç Çirpar
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Sleep Quality ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Level Of Evidence ◽  
Nerve Decompression ◽  
Tunnel Syndrome ◽  
Median Nerve Decompression

Sleep disturbance is a frequent symptom of carpal tunnel syndrome. The aim of this study was to investigate the effect of median nerve decompression on sleep quality of patients with this condition. The study sample consisted of 41 patients with severe carpal tunnel syndrome who were admitted to our clinic and treated with open median nerve decompression. Sensation and functional recovery of the patients were followed using the Boston Function Questionnaire, the Semmes–Weinstein monofilament test and the two-point discrimination test. Symptomatic recovery of the patients was followed by the Boston Symptom Questionnaire. The tests were used before surgery and at three and six months afterwards. Sensory, functional and symptomatic recovery from the third month to the sixth month following surgery also affected sleep parameters and improved the sleep quality of patients with carpal tunnel syndrome. Level of evidence: IV

scholarly journals Results of surgical treatment of patients with carpal tunnel syndrome depending on the severity of the disease

2021 ◽  
Vol 27 (1) ◽  
pp. 24-31
Author(s):  
O.M. Semenkin ◽  
◽  
S.N. Izmalkov ◽  
A.N. Bratiichuk ◽  
E.B. Solopikhina ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Functional Improvement ◽  
Group Iii ◽  
Group I ◽  
Tunnel Syndrome ◽  
Wrist Function

Introduction Although surgical treatment of carpal tunnel syndrome (CTS) is known to be highly effective outcomes may not be equally satisfactory for the patients due to severity of clinical presentation and objectifying assessment of the condition. Purpose Provide clinical evaluation of outcomes of surgical treatment of CTS using questionnaires and electroneuromyography (ENMG) findings depending on baseline severity of the condition. Material and methods The review included 161 patients who underwent 189 operations of open decompression of the median nerve using mini-access. The patients were assigned to three groups with mild (Group I), moderate (Group II) and severe (Group III) CTS. Evaluations were produced at 6 weeks, 3, 6 and 12 months following the surgery. Results The majority of patients showed positive dynamics, and delayed recovery of the wrist function was noted in Group III at a 12-month follow-up. Patients of Group III exhibited spasmodic improvement of the wrist function at 6-week-to-3-month follow-up. Conclusion Open decompression of the median nerve performed for patients with CTS using mini-approach facilitated substantial clinical and functional improvement in most cases. However, the most favorable results could be provided for mild and moderate CTS.

scholarly journals Limited mid palmar versus extended incision in surgical treatment of carpal tunnel syndrome: Clinical analysis

2020 ◽  
Vol 24 (3) ◽  
pp. 360-366
Author(s):  
Jagar Doski ◽  
Reber Sindy ◽  
Farhad Hamzani ◽  
Hishyar Omar
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Return To Work ◽  
Carpal Tunnel ◽  
Operative Time ◽  
Daily Life ◽  
Daily Life Activities ◽  
Tunnel Syndrome ◽  
Group 2 ◽  
Group 1

Background and objective: There are different methods and incisions to release the transverse carpal ligament in carpal tunnel syndrome. This study aimed to compare the surgical outcome of the conventional extended incision with the limited mid palmar one. Methods: The study was a prospective comparative one. Patients with carpal tunnel syndrome were divided into two groups: Group 1 was patients operated on by the conventional extended incision, Group 2 with a limited mid palmar incision. Results: The patients included were 79 with 89 hands. The age mean was 41 years. Group 1 included 47, and Group 2 included 42 hands. The differences between both groups were statistically significant regarding the operative data (the incision length and the operative time) and the post-operative data (the duration of analgesia needed, the date of starting to use the hand in daily life activities, and return to work). However, the date of improvement of the sensory symptoms from the fingers showed no significant differences. The sum of the overall complications that occurred for the cases of Group 2 was about a third of that occurred for Group 1. The highly significant difference was in the scar tenderness in the third month of the post-operative period. Conclusion: The limited mid palmar incision to release the entrapment of median nerve in carpal tunnel syndrome offers a shorter operative time, less analgesia needed post-operatively, less complication rate, less scar tenderness, earlier use of the hand in daily life activities, and return to work in a shorter period. Keywords: Carpal tunnel syndrome; Surgical treatment; Incision.

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