scholarly journals Surgery of True Recurring Median Carpal Tunnel Syndrome with Synovial Flap by Wulle Plus Integument Enlargement Leads to a High Patient’s Satisfaction and Improved Functionality

2019 ◽  
Vol 8 (12) ◽  
pp. 2094
Author(s):  
Stephan Payr ◽  
Thomas M. Tiefenboeck ◽  
Veith Moser ◽  
Edvin Turkof
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction Velocity ◽  
Compound Muscle Action Potential ◽  
Sensory Nerve ◽  
Muscle Action ◽  
Patient’S Satisfaction ◽  
Muscle Action Potential ◽  
Tunnel Syndrome ◽  
Tissue Flap

This prospective study was conducted to investigate electrophysiological qualities and patient’s satisfaction of a synovial gliding tissue flap in treating true recurring carpal tunnel syndrome. In 14 patients (11 women, three men), 15 median nerves were included in this retrospective study. For all 15 nerves, motor and sensory nerve conduction velocity, compound muscle action potential, a Visual Analogue Scale-score (VAS-score) questionnaire and an adapted Levine-Test were evaluated pre- and postoperatively. All participants underwent operative neurolysis of the median nerve, which was then enwrapped by a synovial gliding tissue flap. Eleven procedures were completed by integument enlargement. Follow-up period was 12 months. Postoperatively, distal latency decreased significantly by 15.6%. Compound muscle action potential and sensory nerve conduction velocity did not improve significantly. VAS score regarding pain reduced highly significantly with 74.1%. The adapted Levine-Test function score improved highly significantly with 39.2%. The synovial gliding tissue flap lead to an excellent patient’s satisfaction for treating true recurring carpal tunnel syndrome. Primary wound closure should be completed with integument enlargement if needed.

scholarly journals Clinical predictors of surgical outcomes of severe carpal tunnel syndrome patients: utility of palmar stimulation in a nerve conduction study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuichi Sasaki ◽  
Tohru Terao ◽  
Emiko Saito ◽  
Keiichiro Ohara ◽  
Shotaro Michishita ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Action Potential ◽  
Carpal Tunnel ◽  
Compound Muscle Action Potential ◽  
Sensory Nerve ◽  
Sensory Nerve Action Potential ◽  
Muscle Action ◽  
Muscle Action Potential ◽  
Sensory Nerve Action ◽  
Tunnel Syndrome

Abstract Background Carpal tunnel syndrome is a common peripheral nerve compression disorder. However, there is no established opinion regarding the predictors of symptom improvement after surgery. This study aimed to identify the predictors of surgical outcomes of severe carpal tunnel syndrome patients. Methods In the patients who underwent a carpal tunnel syndrome surgery, we selected the patients who had a preoperative Bland’s classification of grade 5 or 6, and assessed for the changes in Bland’s classification grade before and after surgery. Those who showed improvement from preoperative grades 5–6 to postoperative grades 1–4 comprised the improvement group. In contrast, those who did not show improvement and had postoperative grades 5 or 6 comprised the non-improvement group. In a nerve conduction study, amplitudes of the compound muscle action potential and sensory nerve action potential of the palms were assessed between the improvement and non-improvement groups. Results Among the 60 hands of 46 patients who had a preoperative Bland’s classification of grade 5 or 6, 49 hands of 37 patients comprised the improvement group, and 11 hands of 9 patients comprised the non-improvement group. The amplitudes of the compound muscle action potential and sensory nerve action potential of the palms before surgery were significantly higher in the improvement group. The degree of improvement in Bland’s classification grade was correlated with the degree of clinical symptom improvement. Conclusions Amplitudes of compound muscle action potential and sensory nerve action potential before surgery induced by palmar stimulation can predict improvements in nerve conduction study scores and clinical findings after surgical treatment.

ADDITIONAL METHOD FOR DIAGNOSIS OF CARPAL TUNNEL SYNDROME: VALUE OF THE SECOND LUMBRICAL-INTEROSSEI TEST (2L-INT)

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 49-52 ◽  
Author(s):  
Tomoo Inukai ◽  
Kenzo Uchida ◽  
Chikara Kubota ◽  
Takaharu Takamura ◽  
Hideaki Nakajima ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction Velocity ◽  
Compound Muscle Action Potential ◽  
Sensory Nerve ◽  
Standard Test ◽  
Additional Method ◽  
Abductor Pollicis Brevis ◽  
Muscle Action Potential ◽  
Tunnel Syndrome

We examined 57 hands referred with suspected carpal tunnel syndrome (CTS) using the second lumbrical-interossei nerve test (2L-INT) as well as standard test. Sensory nerve conduction velocity (SCV) was detectible in 67% of patients (38/57), the abductor pollicis brevis-compound muscle action potential (APB-CMAP) in 84% (48/57), 2L-CMAP in 96% (55/57) and the first interossei palmares muscle (INT-CMAP) in 100% (57/57). ABP-CMAP was not recorded in patients in whom severe atrophy of the abductor pollicis brevis muscle was evident. As 2L-CMAP is maintained even in the most severe cases of CTS, the 2L-INT method is a valuable test for improving the accuracy of preoperative diagnosis in the electrophysiological diagnosis of CTS.

A novel approach to the diagnostic assessment of carpal tunnel syndrome based on the frequency domain of the compound muscle action potential

2020 ◽  
Vol 65 (1) ◽  
pp. 61-71
Author(s):  
Veysel Alcan ◽  
Hilal Kaya ◽  
Murat Zinnuroğlu ◽  
Gülçin Kaymak Karataş ◽  
Mehmet Rahmi Canal
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Action Potential ◽  
Carpal Tunnel ◽  
Compound Muscle Action Potential ◽  
Confusion Matrix ◽  
Maximum Power ◽  
Muscle Action ◽  
Muscle Action Potential ◽  
Tunnel Syndrome ◽  
The Mean

AbstractConventional electrophysiological (EP) tests may yield ambiguous or false-negative results in some patients with signs and symptoms of carpal tunnel syndrome (CTS). Therefore, researchers tend to investigate new parameters to improve the sensitivity and specificity of EP tests. We aimed to investigate the mean and maximum power of the compound muscle action potential (CMAP) as a novel diagnostic parameter, by evaluating diagnosis and classification performance using the supervised Kohonen self-organizing map (SOM) network models. The CMAPs were analyzed using the fast Fourier transform (FFT). The mean and maximum power parameters were calculated from the power spectrum. A counter-propagation artificial neural network (CPANN), supervised Kohonen network (SKN) and XY-fused network (XYF) were compared to evaluate the classification and diagnostic performance of the parameters using the confusion matrix. The mean and maximum power of the CMAP were significantly lower in patients with CTS than in the normal group (p < 0.05), and the XYF network had the best total performance of classification with 91.4%. This study suggests that the mean and maximum power of the CMAP can be considered as less time-consuming parameters for the diagnosis of CTS without using additional EP tests which can be uncomfortable for the patient due to poor tolerance to electrical stimulation.

scholarly journals Long-term outcomes of symptomatic electrodiagnosed carpal tunnel syndrome

2003 ◽  
Vol 61 (2A) ◽  
pp. 194-198 ◽  
Author(s):  
Joao Aris Kouyoumdjian ◽  
Maria P.A. Morita ◽  
Amalia F.P. Molina ◽  
Dirce M.T. Zanetta ◽  
Adriana K. Sato ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Compound Muscle Action Potential ◽  
P Value ◽  
Long Term Outcomes ◽  
Patient’S Satisfaction ◽  
Muscle Action Potential ◽  
Tunnel Syndrome

This study was done to evaluate the long-term patient's satisfaction after carpal tunnel syndrome (CTS) electrodiagnostic done between 1989 and 1994 (5 to 10 years follow-up). Mail contact was made to 528 consecutive cases with a questionnaire to be filled; 165 patients responded after 19 exclusions. CTS severity was graded from 0 (incipient) to 4 (severe) after a combination of median sensory distal latency, sensory median-radial latency difference and amplitude of the median compound muscle action potential. Current symptoms ("cure", improved, unchanged or worsed) and the therapy utilized, either surgical or conservative, were analyzed to the initial CTS severity, age and duration of symptomatology. Surgical release was done in 114 cases (69%). Patient's satisfaction after surgical and non-surgical were respectively, 77.6% and 16% ("cure"), 13.6% and 52% (much improved), 5.4% and 9.3% (little improved), 2.7% and 16% (unchanged), 0.7% and 6.7% (worsed). The frequency of "cure" versus unchanged/worsed or "cure"/much improved versus unchanged/worsed was highly significative (Fisher, P-value < 0.001) and was not influenced by the CTS electrophysiological severity. There was no relationship between the outcome after surgery and duration of symptomatology, age or CTS severity. Conservative benefice was more prevalent in those with shorter symptomatology and older age; the majority of conservative failure cases had mild initial CTS. We concluded the excellent surgical benefice described by patients and the absence of any predictive factors based on CTS severity, age or duration of symptomatology for outcome.

Prognosis of severe carpal tunnel syndrome with absent compound muscle action potential

2016 ◽  
Vol 54 (3) ◽  
pp. 427-431 ◽  
Author(s):  
Hisao Kamiya ◽  
Michio Kimura ◽  
Satoshi Hoshino ◽  
Masahito Kobayashi ◽  
Masahiro Sonoo
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Action Potential ◽  
Carpal Tunnel ◽  
Compound Muscle Action Potential ◽  
Muscle Action ◽  
Muscle Action Potential ◽  
Tunnel Syndrome

scholarly journals Power Spectrum Analysis of Compound Muscle Action Potential in Carpal Tunnel Syndrome Patients

2002 ◽  
Vol 10 (1) ◽  
pp. 67-71 ◽  
Author(s):  
Taku Ogura ◽  
Toshikazu Kubo ◽  
Yoshiki Okuda ◽  
Kookho Lee ◽  
Yasuhiko Kira ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Power Spectrum ◽  
Action Potential ◽  
Carpal Tunnel ◽  
Spectrum Analysis ◽  
Compound Muscle Action Potential ◽  
Power Spectrum Analysis ◽  
Muscle Action ◽  
Muscle Action Potential ◽  
Tunnel Syndrome

The objective of using wave-form analysis to assess compound muscle action potential (CMAP) in entrapment neuropathy had not been fully developed. We applied the power spectrum analysis to patients with carpal tunnel syndrome (CTS) for this purpose. 24 patients with CTS were divided into three stages according to Mackinnon's classification, and 50 normal volunteers were examined. CMAP was obtained from the abductor pollicis brevis with supramaximal stimulation to median nerve. Mean and peak frequencies were measured by power spectrum analysis. The distal latencies of CMAP and the sensory nerve conduction velocities showed some prolongation in CTS patients. Integral values of CMAP were also decreased in CTS patients. Mean and peak frequencies of power spectrum of CMAP in volunteers were 134Hz and 98 Hz, respectively. These values shifted into lower frequencies in CTS patients, namely 102Hz and 61Hz. Regardless of clinical stage, distal latency of CTS patients correlated with mean frequency.

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