scholarly journals VARIATIONS IN DISTRIBUTION OF MEDIAN NERVE IN THE HAND AND ITS RELATIONS IN FLEXOR RETINACULUM

2017 ◽  
Vol 4 (26) ◽  
pp. 1535-1541
Author(s):  
Vijayamma Kunnath Narayanan ◽  
Ushavathy Padmanabhan ◽  
Jude Jose Thomson ◽  
Anjana Jayakumaran Nair
Keyword(s):  
Median Nerve ◽  
Flexor Retinaculum

scholarly journals Supraretinacular endoscopic carpal tunnel release: A safe alternative method for treatment of carpal tunnel syndrome

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199340
Author(s):  
Kotaro Sato ◽  
Kenya Murakami ◽  
Yoshikuni Mimata ◽  
Gaku Takahashi ◽  
Minoru Doita
Keyword(s):  
Learning Curve ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Open Surgery ◽  
Carpal Tunnel Release ◽  
Safe Alternative ◽  
Endoscopic Carpal Tunnel Release ◽  
Flexor Retinaculum ◽  
Carpal Tunnel Surgery ◽  
Conversion Rates

Purpose: Supraretinacular endoscopic carpal tunnel release (SRECTR) is a technique in which an endoscope is inserted superficial to the flexor retinaculum through a subcutaneous tunnel. The benefits of this method include a clear view for the surgeon and absence of median nerve compression. Surgeons can operate with a familiar view of the flexor retinaculum and median nerve downward, similar to open surgery. This study aimed to investigate the learning curve for SRECTR, an alternate method for carpal tunnel release, and evaluate its complications and the functional outcomes using a disposable commercial kit. Methods: We examined the open conversion rates and complications associated with SRECTR in 200 consecutive patients performed by two surgeons. We compared the operative time operated by a single surgeon. We evaluated outcomes in 191 patients according to Kelly’s grading system. Patients’ mean follow-up period was 12.7 months. Results: Nine patients required conversion to open surgery. There were no injuries to the nerves and tendons and no hematoma or incomplete dissection of the flexor retinaculum. The operative times varied between 11 and 34 minutes. We obtained the following results based on Kelly’s grading of outcomes: excellent in 116, good in 59, fair in 13, and poor in 3 patients. Conclusions: We found no patients with neurapraxia, major nerve injury, flexor tendon injury, superficial palmar arch injury, and hematoma. Although there was a learning curve associated with SRECTR, we performed 200 consecutive cases without neurovascular complications. This method may be a safe alternative to minimally invasive carpal tunnel surgery.

scholarly journals Aberrant Positioning of the Ulnar Nerve Found During Carpal Tunnel Release: A Case Report

2019 ◽  
Author(s):  
David R. Veltre ◽  
Kelvin Naito ◽  
Xinning Li ◽  
Andrew B. Stein
Keyword(s):  
Case Report ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Distal Forearm ◽  
Anatomic Variations ◽  
Transverse Carpal Ligament ◽  
Iatrogenic Injuries ◽  
Flexor Retinaculum

Introduction: Aberrant positioning of the ulnar nerve volar to the transverse carpal ligament is a rare anatomic variation.Case Presentation: We present the case of a 55-year-old female with unique ulnar nerve anatomy that was discovered introperatively during carpal tunnel release.  The ulnar nerve was running directly adjacent to the median nerve in the distal forearm and as the median nerve traversed dorsal to the transverse carpal ligament (flexor retinaculum) to enter the carpal tunnel the ulnar nerve continued directly volar to this structure before angling towards Guyon’s Canal.  The unique ulnar nerve anatomy was successfully identified, carefully dissected and managed with a successful patient outcome.Conclusion: Variations of the anatomy at the level of the carpal tunnel are rare but do exist.  Awareness of these anatomic variations and adequate visualization of the ulnar nerve along with the surrounding structures is crucial to avoid iatrogenic injuries during carpal tunnel release. 

A New Technique for Endoscopic Carpal Tunnel Decompression

1995 ◽  
Vol 20 (4) ◽  
pp. 465-469 ◽  
Author(s):  
T. M. TSAI ◽  
T. TSURUTA ◽  
S. A. SYED ◽  
H. KIMURA
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Glass Tube ◽  
New Technique ◽  
Motor Branch ◽  
Flexor Retinaculum ◽  
Fresh Cadaver ◽  
Custom Made ◽  
Portal Technique

A new one-portal technique for endoscopic carpal tunnel release (ECTR) is introduced with its clinical results. The incision is made at the palmar aspect of file hand. A custom-made glass tube with a groove is inserted, and under endoscope observation, a meniscus knife is pushed forward along the groove to release the flexor retinaculum. This new technique has been studied in ten fresh cadaver hands and used in 123 patients' hands. Results of the cadaver study showed that the flexor retinaculum was released completely in all ten hands. No injuries to tendons, nerves, or arteries were noted. In one case the cotton tip was lost from the stick. All clinical releases were performed uneventfully except for three cases of neuropraxia of the digital nerve of the radial side of the ring finger, one laceration of the motor branch of the median nerve, one mild infection, one loss of cotton tip from the cotton swab stick, and one case of chipping of the glass tube. The case with the laceration of the motor branch of the median nerve occurred early in the series and required the conventional open incision to repair the nerve. The cases with loss of cotton from the stick and chipping of the tube also required a conventional incision to remove the cotton and glass chip. Advantages of this one-portal technique with the glass tube include less scar tenderness than with two-portal techniques, decreased risk of injury to the superficial palmar arch and ulnar nerve because of the distal approach, a view of pathology in the carpal tunnel through the glass tube, and confirmation of release of the flexor retinaculum.

Transverse Sliding of the Median Nerve Beneath the Flexor Retinaculum

1992 ◽  
Vol 17 (2) ◽  
pp. 213-216 ◽  
Author(s):  
K. NAKAMICHI ◽  
S. TACHIBANA
Keyword(s):  
Median Nerve ◽  
Flexor Tendons ◽  
Flexor Retinaculum ◽  
Physiological Phenomenon

Transverse sliding of the median nerve beneath the flexor retinaculum during active-resistant flexion of the fingers was sonographically demonstrated. Although it is a physiological phenomenon, it may cause mechanical nerve deformation in addition to longitudinal sliding when the nerve is subject to compression against the flexor retinaculum by tensed overlying flexor tendons.

scholarly journals Ultrasound as a diagnostic tool in the investigation of patients with carpal tunnel syndrome

2018 ◽  
Vol 28 (2) ◽  
Author(s):  
Leila Kanafi Vahed ◽  
Afshin Arianpur ◽  
Mohammad Gharedaghi ◽  
Hosein Rezaei
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Clinical Symptoms ◽  
Cost Effective ◽  
Time Saving ◽  
Cross Sectional ◽  
Clinical Criteria ◽  
Flexor Retinaculum ◽  
Tunnel Syndrome

Carpal tunnel syndrome (CTS) is reveled to be the most common peripheral nerve entrapment syndrome, estimating for 90% of all compressive. The diagnosis of CTS is based on the use of clinical criteria and imaging technique tests such as ultrasonography (US) and magnetic resonance imaging (MRI). US is a time-saving method in the diagnosis of CTS, which induces less discomfort to the patient and may be a more cost-effective approach to confirm clinical suspicion of this syndrome .The current study was aimed to evaluate the value of US and physical examinations in the diagnosis of CTS. This cross-sectional and cross-sectional prospective case study was conducted to evaluate the usefulness of wrist ultrasonography in diagnosing CTS. Twenty one patients (21 wrists) were invited to participate in the study along with an age- and sex-matched group of participant controls. Physical examination included Phalen, Tinel, Durkan, Tourniquet test. Anteroposterior and mediolateral dimension of carpal tunnel, and the median nerve area at the tunnel were also measured. All the patients underwent the open surgical release of the flexor retinaculum. There was a significant statistical relationship (p=0.05) between anteroposterior diameter of the carpal tunnel and clinical and electro physiologic nerve involvement. Furthermore, some qualitative findings was achieved such as median nerve splitting, hypo echogenicity of the involved nerve, thickening of flexor retinaculum and disappearance of median nerve areas (especially mediolateral direction). In conclusion, ultrasonographic examination of the wrists in the patients with suspected clinical symptoms can improve the diagnostic ability of CTS, especially by improving technology and experience. US can be applied for the median nerve area (MNA) measurement as a first line technique in patients with CTS.

Triggering of the Finger at the Flexor Retinaculum

HAND ◽  
1982 ◽  
Vol os-14 (1) ◽  
pp. 53-55 ◽  
Author(s):  
Q. M. Iqbal
Keyword(s):  
Median Nerve ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Unusual Case ◽  
Trigger Finger ◽  
Flexor Retinaculum

An unusual case of trigger finger associated with paraesthesia of the hand is described. The site of triggering was at the flexor retinaculum consequent upon a tumour of the profundus tendon. Nerve conduction study of the median nerve revealed a co-existing incipient median neuritis.

Is Complete Release of all Volar Carpal Canal Structures Necessary for Complete Decompression in Endoscopic Carpal Tunnel Release?

2007 ◽  
Vol 32 (5) ◽  
pp. 537-542 ◽  
Author(s):  
A. YOSHIDA ◽  
I. OKUTSU ◽  
I. HAMANAKA
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Active Power ◽  
Full Length ◽  
Hand Position ◽  
Pressure Measurements ◽  
Proximal Margin ◽  
Endoscopic Carpal Tunnel Release ◽  
Flexor Retinaculum

This study investigated the need to completely divide the flexor retinaculum to achieve full decompression of the median nerve in the carpal canal, using carpal canal pressure measurements at the mid-point and/or the proximal one-third of the flexor retinaculum to analyse the degree of decompression after release of successive lengths of the flexor retinaculum from the distal holdfast fibres to its proximal margin. Pressure measurements were taken at each operative step in the resting hand position and during active power gripping. The pressure measurements indicated that decompression of the carpal canal was achieved both at rest and on active gripping after complete division of the flexor retinaculum. However, pressure measurements indicated that complete decompression had not been achieved during active power gripping with the proximal one-third of the flexor retinaculum intact. These results demonstrate the need for complete release of the full length of the flexor retinaculum, including the distal holdfast fibres.

TWO CASES OF ENDOSCOPIC MANAGEMENT OF CARPAL TUNNEL SYNDROME IN MACRODACTYLY PATIENTS

Hand Surgery ◽  
2007 ◽  
Vol 12 (01) ◽  
pp. 41-46 ◽  
Author(s):  
A. Yoshida ◽  
I. Okutsu ◽  
I. Hamanaka ◽  
S. Morimoto
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Muscle Power ◽  
Nerve Compression ◽  
Endoscopic Management ◽  
Decompression Surgery ◽  
Median Nerve Compression ◽  
Flexor Retinaculum ◽  
Tunnel Syndrome

Some cases of carpal tunnel syndrome in macrodactyly patients have been reported. We performed endoscopic carpal canal release on two unilateral macrodactyly patients suffering from bilateral carpal tunnel syndrome. We measured carpal canal pressure before performing endoscopic surgery using the Universal Subcutaneous Endoscope system to confirm median nerve compression. We diagnosed median nerve compression in each patient due to the high preoperative carpal canal pressure. Carpal canal pressure immediately decreased to within normal range following release of both the flexor retinaculum and the distal holdfast fibres of the flexor retinaculum. One patient recovered to within normal in terms of sensory disturbances and abductor pollicis brevis muscle strength. The other patient showed improvement in terms of sensory disturbance, however, muscle power did not recover because this patient had suffered from carpal tunnel syndrome for ten years. Endoscopic carpal canal release and decompression surgery was effective for carpal tunnel syndrome in both macrodactyly patients.

scholarly journals Role of High-Resolution Ultrasonography in Evaluation of Median Nerve and Thickness of Flexor Retinaculum in Patients with Hypothyroidism

2020 ◽  
Vol 2 ◽  
pp. 36-43
Author(s):  
Kunwar Pal Singh ◽  
Kamlesh Gupta ◽  
Iqbaljit Kaur ◽  
Vijinder Arora
Keyword(s):  
High Resolution ◽  
Healthy Volunteers ◽  
Median Nerve ◽  
Cross Sectional Area ◽  
Width Ratio ◽  
Sectional Area ◽  
Cross Sectional ◽  
Flexor Retinaculum ◽  
Nerve Fascicle ◽  
High Resolution Ultrasonography

Objectives: To determine the role of high resolution ultrasonography in evaluation of cross sectional area, maximum nerve fascicle thickness and thickness/width ratio of the median nerve and flexor retinaculum thickness in patients with hypothyroidism and to correlate it with the healthy volunteers. Material and Methods: A prospective study was conducted from February 2018 to October 2019 on 62 patients which included 32 clinically proven cases of hypothyroidism and 30 healthy volunteers. High resolution ultrasonography was performed using high frequency linear probes. Results: The most affected parameter was cross sectional area of median nerve at three levels, inlet/outlet ratio of CSA of the median nerve and thickness of flexor retinaculum in hypothyroidism patients in correlation with healthy volunteers. These parameters showed statistically significant p values. Maximum nerve fascicle thickness and thickness/width ratio of the median nerve showed no statistical significance in hypothyroid patients in correlation with healthy volunteers. Conclusion: High-resolution ultrasonography plays an important role in evaluating the changes occuring in cross sectional area of the median nerve, its inlet/outlet CSA ratio and flexor retinaculum thickness in hypothyroidism patients as correlated with the healthy volunteers.

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