Surgery of the carpal tunnel

1978 ◽  
Vol 49 (2) ◽  
pp. 316-318 ◽  
Author(s):  
Noel Eboh ◽  
Donald H. Wilson
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Modified Technique ◽  
Content Type ◽  
Electrical Studies ◽  
Entrapment Neuropathies ◽  
Palmaris Longus ◽  
Tunnel Syndrome ◽  
Fine Print

✓ The authors describe a modified technique for surgery of the carpal tunnel. The primary cause of the carpal tunnel syndrome is the same as other entrapment neuropathies: an enlarged nerve within a tight tunnel. Electrical studies have shown that the area of compression is in the middle of the tunnel. Treatment is surgical: a palmar incision, which begins at the wrist medial to the palmaris longus, to avoid damage to the sensory branch of the median nerve; and section of the retinaculum from the exit of the tunnel toward the entrance.

Magnetic resonance neurography studies of the median nerve before and after carpal tunnel decompression

2002 ◽  
Vol 96 (6) ◽  
pp. 1046-1051 ◽  
Author(s):  
Simon A. Cudlip ◽  
Franklyn A. Howe ◽  
Andrew Clifton ◽  
Martin S. Schwartz ◽  
B. Anthony Bell
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Surgical Decompression ◽  
Mr Neurography ◽  
Magnetic Resonance Neurography ◽  
Content Type ◽  
Before And After ◽  
Tunnel Syndrome ◽  
Fine Print

Object. Recently developed novel MR protocols called MR neurography, which feature conspicuity for nerve, have been shown to demonstrate signal change and altered median nerve configuration in patients with median nerve compression. The postoperative course following median nerve decompression can be problematic, with persistent symptoms and abnormal results on electrophysiological studies for some months, despite successful surgical decompression. The authors undertook a prospective study in patients with carpal tunnel syndrome, correlating the clinical, electrophysiological, and MR neurography findings before and 3 months after surgery. Methods. Thirty patients and eight control volunteers were recruited to the study. The MR neurography consisted of axial and sagittal images (TR = 2000 msec, TE = 60 msec) obtained using a temporomandibular surface coil, fat saturation, and flow suppression. Maximum intensity projection images were used to follow the median nerve through the carpal tunnel in the sagittal plane. Magnetic resonance neurography in patients with carpal tunnel syndrome demonstrated proximal swelling (p < 0.001) and high signal change in the nerve, together with increased flattening ratios (p < 0.001) and loss of nerve signal in the distal carpal tunnel (p < 0.05). Sagittal images were very effective in precisely demonstrating the site and severity of nerve compression. After surgery, division of the flexor retinaculum could be demonstrated in all cases. Changes in nerve configuration, including increased cross-sectional area, and reduced flattening ratios (p < 0.001) were seen in all patients. In many cases restoration of the T2 signal intensity toward that of controls was seen in the median nerve in the distal carpal tunnel. Sagittal images were excellent in demonstrating expansion of the nerve at the site of surgical decompression. Conclusions. In this study the authors suggest that MR neurography is an effective means of both confirming compression of the median nerve and its successful surgical decompression in patients with carpal tunnel syndrome. This modality may prove useful in the assessment of unconfirmed or complex cases of carpal tunnel syndrome both before and after surgery.

Atypical carpal tunnel syndrome with compression of the ulnar and median nerves

1981 ◽  
Vol 54 (5) ◽  
pp. 668-669 ◽  
Author(s):  
Vagn Eskesen ◽  
Jarl Rosenørn ◽  
Ole Osgaard
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Clinical Signs ◽  
Content Type ◽  
Nerve Involvement ◽  
Tunnel Syndrome ◽  
Fine Print

✓ Clinical signs of ulnar nerve involvement at the wrist level were found in a 51-year-old man. The electrophysiological changes were indicative of a median nerve involvement in the carpal tunnel. At operation, the compressed ulnar nerve was found in the carpal tunnel, together with the median nerve. This localization of the ulnar nerve has not been described previously.

Carpal tunnel syndrome in pediatric mucopolysaccharidoses

1975 ◽  
Vol 43 (1) ◽  
pp. 102-103 ◽  
Author(s):  
Michael E. Miner ◽  
R. Neil Schimke
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Clinical Examination ◽  
Carpal Tunnel ◽  
Pediatric Patients ◽  
Surgical Decompression ◽  
Content Type ◽  
Careful Clinical Examination ◽  
Tunnel Syndrome ◽  
Fine Print

✓ Four pediatric patients with mucopolysaccharidoses and an associated carpal tunnel syndrome are presented. Findings in these cases were typical of the adult form of median nerve compression at the wrist, but the patients had minimal symptoms in view of these findings. The importance of careful clinical examination and early surgical decompression is emphasized.

Anomalous course of the recurrent motor branch of the median nerve in a patient with carpal tunnel syndrome

1977 ◽  
Vol 47 (1) ◽  
pp. 113-114 ◽  
Author(s):  
J. Douglas Werschkul
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Motor Branch ◽  
Content Type ◽  
Tunnel Syndrome ◽  
Fine Print

✓ A case is discussed in which carpal tunnel syndrome with an unusual course of the motor recurrent branch was discovered at operation. The importance of a careful dissection of the median nerve in this condition is emphasized.

Carpal tunnel syndrome caused by thrombosis of the median artery: importance of high-resolution ultrasonography for diagnosis

2002 ◽  
Vol 97 (2) ◽  
pp. 471-473 ◽  
Author(s):  
Henrich Kele ◽  
Raphaela Verheggen ◽  
Carl Detlev Reimers
Keyword(s):  
High Resolution ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Rare Case ◽  
Content Type ◽  
The Third ◽  
Tunnel Syndrome ◽  
Median Artery ◽  
High Resolution Ultrasonography ◽  
Fine Print

✓ The rare case of a patient with carpal tunnel syndrome caused by thrombosis of a persistent median artery is presented. Progressive pain in the wrist and dysesthesias in the third and fourth fingers were the atypical complaints. High-resolution ultrasonography revealed a bifid median nerve that was compressed by an occluded median artery. The intraoperative findings are described, and emphasis is placed on the importance of using high-resolution ultrasonography for presurgical diagnosis.

Endoscopic treatment of carpal tunnel syndrome: a critical review

1998 ◽  
Vol 88 (5) ◽  
pp. 817-826 ◽  
Author(s):  
David F. Jimenez ◽  
Scott R. Gibbs ◽  
Adam T. Clapper
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Critical Review ◽  
Carpal Tunnel Release ◽  
Content Type ◽  
Endoscopic Techniques ◽  
Endoscopic Carpal Tunnel Release ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery ◽  
Fine Print

Object. The goal of this paper is to present a critical review of the endoscopic procedures currently in use for the treatment of carpal tunnel syndrome. Endoscopic techniques and outcomes are discussed. Methods. An extensive review of published articles on the subject of endoscopic carpal tunnel release surgery is presented, encompassing six endoscopic techniques used to treat carpal tunnel syndrome. Since the first report in 1987, 7091 patients have undergone 8068 operations. The overall success rate has been 96.52%, with a complication rate of 2.67% and a failure rate of 2.61%. The mean time to return to work in patients not receiving Workers' Compensation was 17.8 days, ranging between 10.8 and 22.3 days. The most common complications were transient paresthesias of the ulnar and median nerves. Other complications included superficial palmar arch injuries, reflex sympathetic dystrophy, flexor tendon lacerations, and incomplete transverse carpal ligament division. In many studies in which open and endoscopic techniques were compared, it was reported that patients in the the latter group experienced significantly less pain and returned to work and activities of daily living earlier. Conclusions. Success and complication rates of endoscopic carpal tunnel release surgery are similar to those for standard open procedures.

scholarly journals Revision of Carpal Tunnel Release due to Palmaris Longus Profundus

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Lyrtzis Christos ◽  
Natsis Konstantinos ◽  
Pantazis Evagelos
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Postoperative Course ◽  
Palmaris Longus ◽  
Tunnel Syndrome

Purpose. The palmaris longus profundus has been documented throughout the literature as a cause of carpal tunnel syndrome. We present a case of palmaris profundus tendon removal during the revision of carpal tunnel release.Method. During a carpal tunnel release in a 66-year-old woman, palmaris profundus tendon was found inside the tunnel under the transverse carpal ligament, just above the median nerve, but it was left intact. The patient complained of pain in the hand at night and weakness of her hand one month after surgery. We decided on a revision of the carpal tunnel release. The palmaris profundus tendon was found and was removed.Results. The patient had a normal postoperative course. Two months later she returned to her normal activities and was asymptomatic.Conclusions. When a palmaris profundus muscle is located in carpal tunnel, we recommend its excision during carpal tunnel release. This excision will eliminate the possibility of recurrent compression over the median nerve.

Carpal tunnel syndrome

1983 ◽  
Vol 59 (6) ◽  
pp. 1031-1036 ◽  
Author(s):  
Kenneth W. E. Paine ◽  
Konstantinos S. Polyzoidis
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Clinical Findings ◽  
Transverse Carpal Ligament ◽  
Content Type ◽  
Detailed Procedure ◽  
Flexor Retinaculum ◽  
Tunnel Syndrome ◽  
Fine Print

✓ The presenting symptomatology and clinical findings of 464 patients with the carpal tunnel syndrome are reviewed. The results of decompression by section of the transverse carpal ligament are presented, with particular reference to the use of the Paine retinaculotome. Approximately 90% of patients achieved very satisfactory results and complications were minimal. The commonest reason for failure is incomplete division of the flexor retinaculum. The detailed procedure is presented.

Transillumination in minimally invasive surgery for carpal tunnel release

1996 ◽  
Vol 85 (6) ◽  
pp. 1184-1186 ◽  
Author(s):  
Angelo Franzini ◽  
Giovanni Broggi ◽  
Domenico Servello ◽  
Ivano Dones ◽  
Maria Grazia Pluchino
Keyword(s):  
Minimally Invasive Surgery ◽  
Carpal Tunnel Syndrome ◽  
Minimally Invasive ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Alternative Technique ◽  
Content Type ◽  
Operative Results ◽  
Tunnel Syndrome ◽  
Fine Print

✓ An alternative technique for performing minimally invasive release of carpal tunnel syndrome is described. The suggested methodology is based on transillumination of the carpal tunnel during surgery. The advantages of the technique are discussed and compared with other available surgical procedures including endoscopy. The authors also describe preliminary operative results in 50 consecutive patients.

scholarly journals Hypertrophied reverse palmaris longus muscle: a rare cause of carpal tunnel syndrome

2020 ◽  
Vol 7 (2) ◽  
pp. 576
Author(s):  
Narayanamurthy Sundaramurthy ◽  
Surya Rao Rao Venkata Mahipathy ◽  
Alagar Raja Durairaj
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Palmaris Longus ◽  
Longus Muscle ◽  
Palmaris Longus Muscle ◽  
Palmar Aponeurosis ◽  
Tunnel Syndrome ◽  
Phalen's Test ◽  
Flexor Digitorum

Carpal tunnel syndrome (CTS) is usually secondary to compression or irritation of the median nerve in the fibro-osseous canal formed by the flexor retinaculum (transverse carpal ligament) and the carpal bones. The prevalence of CTS in the general population is about 7 to 19%. Several causes both local and systemic have been described, but CTS due to aberrant musculature are rare. Here we report a case of a middle-aged female with paresthesia of the hand and a positive Phalen’s test with nerve conduction study of the median nerve showing sensorimotor neuropathy. The patient underwent surgery for open CTS release where we found a hypertrophied reverse palmaris longus muscle attached to the palmar aponeurosis which was excised along with its proximal tendon. On post-operative follow up all the symptoms of CTS were completely resolved. Muscle abnormalities concern three muscles: the palmaris longus, the flexor digitorum superficialis of index, and the lumbricals. These muscles can be hypertrophied, bifid, duplicated, digastric, inverted or have an abnormal insertion, thus creating a mechanical restriction of the carpal tunnel. Surgical resection of abnormal muscle provides excellent functional recovery. 

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