Endoscopic management of carpal tunnel syndrome in long-term hemodialysis patients.

In long-term haemodialysis patients, carpal tunnel syndrome (CTS) frequently occurs as a result of amyloid deposition, originating from beta-2 microglobulin, to the flexor retinaculum, paratenons and tendons themselves, which leads to an increase in carpal canal pressure and compression of the median nerve. Surgical procedures can rectify the condition, but continuing maintenance haemodialysis sometimes causes recurrence. We endoscopically operated 1848 hands primarily, 104 recurrent post-endoscopic procedure hands and 130 recurrent post-open procedure hands using the Universal Subcutaneous Endoscope (USE) system, then analysed clinical symptoms and electrophysiological recovery for more than six months post-operatively. The patients were satisfied with the clinical results. Optimal electrophysiological improvements were reported. There were no statistical differences between three groups, except in recovery of touch sensation, which was better in the post-endoscopic group than in the post-open group. There were no complications in this series. Our minimally invasive endoscopic procedure, using the USE system, is safe and effective for primary and recurrent CTS in haemodialysis patients.

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Long-term outcome of carpal tunnel syndrome after conservative treatment

International Journal of Clinical Practice ◽

10.1111/j.1368-5031.2004.00028.x ◽

2004 ◽

Vol 58 (4) ◽

pp. 337-339 ◽

Cited By ~ 21

Author(s):

A.C.F. Hui ◽

S.M. Wong ◽

A. Tang ◽

V. Mok ◽

L.K. Hung ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Conservative Treatment ◽

Carpal Tunnel ◽

Term Outcome ◽

Long Term Outcome ◽

Tunnel Syndrome

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Carpal tunnel syndrome: long-term nerve conduction studies in 261 hands

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000100017 ◽

2009 ◽

Vol 67 (1) ◽

pp. 69-73 ◽

Cited By ~ 8

Author(s):

Dante Guilherme Velasco Hardoim ◽

Guilherme Bueno de Oliveira ◽

João Aris Kouyoumdjian

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Sensory Nerve ◽

Nerve Conduction Studies ◽

Sensory Nerve Action ◽

Tunnel Syndrome ◽

The Mean ◽

Compound Action

OBJECTIVE: To compare a long-term carpal tunnel syndrome (CTS) on nerve conduction studies (NCS) in hands treated non-surgically. METHOD: We retrospectively selected 261 symptomatic CTS hands (166 patients), all of them confirmed by NCS. In all cases, at least 2 NCS were performed in an interval greater than 12 months. Cases with associated polyneuropathy were excluded. NCS parameters for CTS electrodiagnosis included a sensory conduction velocity (SCV) <46.6 m/s (wrist to index finger, 14 cm) and distal motor latency (DML) >4.25 ms (wrist to APB, 8 cm). RESULTS: 92.8% were women; mean age was 49 years (20-76); the mean interval between NCS was 47 months (12-150). In the first exam, the median sensory nerve action potential (SNAP) and the compound action muscular potential were absent in 9.8% and 1.9%, respectively. In the second/last exam, SCV worsened in 54.2%, remained unchanged in 11.6% and improved in 34.2%. SNAP amplitude worsened in 57.7%, remained unchanged in 13.1% and improved in 29.2%. DML worsened in 52.9%, remained unchanged in 7.6% and improved in 39.5%. Overall, NCS parameters worsened in 54.9%, improved in 34.3% and remained unchanged in 10.8%. CONCLUSION: Long-term changing in NCS of CTS hands apparently were not related to clinical symptomatology and could lead to some difficulty in clinical correlation and prognosis. Aging, male gender and absent SNAP were more related to NCS worsening, regardless the mean interval time between the NCS.

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