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

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

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/e175 ◽

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

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Single versus repetitive injection of lignocaine in the management of carpal tunnel syndrome – a randomized controlled trial

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413517326 ◽

2014 ◽

Vol 40 (2) ◽

pp. 179-183 ◽

Cited By ~ 2

Author(s):

S. Akarsu ◽

Ö. Karadaş ◽

F. Tok ◽

H. Levent Gül ◽

E. Eroğlu

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Controlled Trial ◽

Post Treatment ◽

Randomized Controlled ◽

Electrophysiological Findings ◽

Tunnel Syndrome ◽

Group 2 ◽

Single Versus ◽

Group 1

The aim of this study was to determine the efficacy of single versus repetitive injection of lignocaine into the carpal tunnel for the management of carpal tunnel syndrome. The 42 patients included were randomly assigned to two Groups: group 1 was injected with 4 mL of 1% lignocaine once and Group 2 was injected with 4 mL of 1% lignocaine twice a week for 2 weeks. Clinical and electrophysiological evaluations were performed at the study onset, and at 6 and 12 weeks following the final injection. Initially, the groups were similar with respect to clinical and electrophysiological findings. All parameters in Group 2 improved 6 weeks post treatment ( p < 0.05), and these improvements persisted at 12 weeks post treatment ( p < 0.05). Repetitive local lignocaine injection was effective in reducing the symptoms of carpal tunnel syndrome and improving electrophysiological findings.

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An Aggressive Return-to-Work Program in Surgical Treatment of Carpal Tunnel Syndrome

Plastic & Reconstructive Surgery ◽

10.1097/00006534-199204000-00022 ◽

1992 ◽

Vol 89 (4) ◽

pp. 715-717 ◽

Cited By ~ 15

Author(s):

R. Cole Goodman

Keyword(s):

Surgical Treatment ◽

Carpal Tunnel Syndrome ◽

Return To Work ◽

Carpal Tunnel ◽

Work Program ◽

Tunnel Syndrome

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Comparison of open and endoscopic carpal tunnel surgery regarding clinical outcomes, complication and return to daily life: A prospective comparative study

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.6.967 ◽

2019 ◽

Vol 35 (6) ◽

Author(s):

Tahsin Gürpınar ◽

Barış Polat ◽

Ayşe Esin Polat ◽

Engin Carkçı ◽

Ahmet Sinan Kalyenci ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Return To Work ◽

Carpal Tunnel ◽

Daily Life ◽

Carpal Tunnel Release ◽

Incision Length ◽

Early Return ◽

Carpal Tunnel Surgery ◽

Prospective Comparative Study ◽

Tunnel Syndrome

Objective: This study aimed to compare the clinical results and complications as well as patient satisfaction in patients with carpal tunnel syndrome operated with open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR) techniques. Methods: This study conducted in Istanbul Training and Research Hospital between August 2016 and January 2018. A total of 54 patients were operated with the ECTR technique and 50 patients were operated with the OCTR technique after failing nonsurgical treatment. Patients functional scores are assessed with the carpal tunnel syndrome-functional status score (CTS-FSS) and carpal tunnel syndrome-symptom severity score (CTS-SSS). Operation time, incision length and complications of the two techniques were noted and compared. Results: The age, sex distribution, distribution of sides, and complaint period were not significant (p > 0.05) between the groups. The preoperative or postoperative CTS-SSS and CTS-FSS values did not differ significantly (p > 0.05). Incision length, time to return to work and return to daily life in the OCTR group was significantly higher than the ECTR group (p < 0.05). Conclusion: ECTR has similar results in terms of symptom relief, severity, functional status, pillar pain and complication rates compared to OCTR. However, it has the advantages of early return to daily life, early return to work and less incision length. doi: https://doi.org/10.12669/pjms.35.6.967 How to cite this:Gurpinar T, Polat B, Polat AE, Carkci E, Kalyenci AS, Ozturkmen Y. Comparison of open and endoscopic carpal tunnel surgery regarding clinical outcomes, complication and return to daily life: A prospective comparative study. Pak J Med Sci. 2019;35(6):1532-1537. doi: https://doi.org/10.12669/pjms.35.6.967 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Effectiveness of neural mobilization and ultrasound therapy on pain severity in carpal tunnel syndrome

Biomedical Research and Therapy ◽

10.15419/bmrat.v5i4.432 ◽

2018 ◽

Vol 5 (4) ◽

pp. 2187-2193

Author(s):

Mehboob Alam ◽

Muhammad Khan ◽

Syed Imran Ahmed ◽

Syed Shahzad Ali

Keyword(s):

Carpal Tunnel Syndrome ◽

Successful Treatment ◽

Carpal Tunnel ◽

Severe Pain ◽

Pain Severity ◽

Ultrasound Therapy ◽

Mild Pain ◽

Tunnel Syndrome ◽

Group 2 ◽

Group 1

Objective: To compare the effectiveness of neural mobilization and ultrasound therapy on pain severity in carpal tunnel syndrome (CTS). Methods: This randomized controlled trial was conducted on 48 CTS patients at the Physiotherapy Department IPM&R, DUHS between 23rd January 2017 and 22nd July 2017. The CTS patients were randomly allocated into 2 equal groups by simple randomization method. Group 1 received neural mobilisation; Group 2 received ultrasound therapy with a predetermined intensity. A total of 12 sessions were given over a period of 4 weeks. Pre and post intervention data were collected from both groups on Visual Analogue Scale (VAS) to measure pain. SPSS version 20 was used for data analysis. Comparisons between post test results of both groups were done by using paired sample t-test with a p-value < 0.05 considered as significant. Results: It was found that the 79% (19 cases) and 21% (5 cases) in Group 1 (Neural Mobilization), who prior to the treatment had faced moderate and severe pain, respectively, all experienced successful treatment. Indeed, after treatment 100% (24) of the cases only experienced mild pain, indicating successful treatment. For Group 2 (Ultrasound Therapy), 54% (13) and 46% (11) of cases were with moderate and severe pain before treatment; after administering the treatment 20% (5 cases) had mild pain and 80% (19 cases) had moderate pain. Conclusion: Neural mobilization for median nerve is more beneficial than ultrasound therapy in reducing pain intensity and functional limitations due to CTS.

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The Use of Ultrasonography in Detection of Synovitis in Carpal Tunnel Syndrome

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(93)90100-t ◽

1993 ◽

Vol 18 (2) ◽

pp. 176-179 ◽

Cited By ~ 27

Author(s):

K. NAKAMICHI ◽

S. TACHIBANA

Keyword(s):

Rheumatoid Arthritis ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Lymphocytic Infiltration ◽

Idiopathic Carpal Tunnel Syndrome ◽

Tunnel Syndrome ◽

Group 3 ◽

Group 2 ◽

Inflammation Group ◽

Group 1

The findings of pre-operative ultrasonography of the carpal tunnel were compared with synovial histology in 50 surgically treated wrists with carpal tunnel syndrome. Eight wrists with a massive hypoechoic area (group 3) had synovitis. 28 with a minimal hypoechoic area (group 1) had no evidence of inflammation. 14 with a moderately increased hypoechoic area (group 2) consisted of three with synovitis, four with lymphocytic infiltration and seven without inflammation. Group 3 strongly indicates synovitis, in which case one should consider aetiology other than the idiopathic cause. Bilateral synovial thickening suggests carpal tunnel syndrome as the initial clinical picture of rheumatoid arthritis, and group 1 indicates idiopathic carpal tunnel syndrome provided that there are no primary causes.

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Minimally invasive modified Camitz opponensplasty for severe carpal tunnel syndrome

Journal of Orthopaedic Surgery ◽

10.1177/2309499018770914 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901877091

Author(s):

Mitsuhiko Nanno ◽

Norie Kodera ◽

Yuji Tomori ◽

Shinro Takai

Keyword(s):

Carpal Tunnel Syndrome ◽

Minimally Invasive ◽

Carpal Tunnel ◽

Modified Technique ◽

Abductor Pollicis Brevis ◽

Thenar Muscle ◽

Painful Wrist ◽

Tunnel Syndrome ◽

Group 2 ◽

Group 1

Purpose: We aimed to compare the clinical results and the complications between the minimally invasive modified Camitz opponensplasty and the conventional Camitz opponensplasty for severe carpal tunnel syndrome (CTS), and to evaluate the efficacy of the modified technique for CTS. Methods: Twenty-eight hands in 24 patients with severe CTS who had disorder of the thumb opposition with thenar muscle atrophy (group 1) were treated by minimally invasive modified Camitz opponensplasty, passing the transferred palmaris longus (PL) tendon under the abductor pollicis brevis (APB) fascia using only palm and thumb incision, and no incision to either wrist crease or forearm. Ten hands in 10 patients (group 2) were treated by the conventional Camitz opponensplasty. Clinical evaluation was made by comparing the results before and after surgery for the angle of the thumb palmar abduction, pinch power, and grip strength. Results: All clinical findings significantly improved after surgery compared with before surgery in all patients. In group 1, there were no complications including transferred tendon bowstring, painful wrist scar, or injury to the palmar cutaneous branch of the median nerve in all hands. Conversely, patients in group 2 had four painful wrist scars and nine bowstrings of the transferred tendon. Conclusions: Several complications have been considered to attribute to the long incision and an extensive dissection crossing the wrist crease from the palm to the wrist in the conventional Camitz procedure. The current modified Camitz opponensplasty by minimally invasive incision without straddling the wrist crease is a simple and effective procedure that can decrease the risk of painful scar around the wrist crease in severe CTS patients with disorder of thumb opposition. Additionally, this technique, by passing the transferred PL tendon under the APB fascia, is useful in restoring the thumb opposition immediately, and in preventing the bowstringing of the transferred tendon.

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