scholarly journals The Effect Of Tenosynovectomy On Patient Outcome In Carpal Tunnel Syndrome Surgery

2021 ◽  
Author(s):  
Ahmet Levent Aydın ◽  
Melih Üçer
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Large Scale ◽  
Long Term Results ◽  
Vascular Elements ◽  
Tunnel Syndrome ◽  
Subsynovial Connective Tissue

INTRODUCTION: Carpal tunnel syndrome (CTS) is estimated to be the most frequently seen mononeuropathy, needing surgical intervention. Its prevalence is known to range between 1, and 3 percent. The components contained in this tunnel are the median nerve, four deep digital flexor tendons, as well as four superficial flexors and the tendon of flexor pollicis longus. Between the tendons and bursae an anatomical structure is present called subsynovial connective tissue (SSCT). SSCT absorbs and transmits stress between tendons and the median nerve and it functions as a scaffold for vascular elements. To find out the role of compression or pathologic proliferation of SSCT in the pathogenesis of CTS, we aimed to conduct a study about the surgical technique of this pathology and compared the long- term results of patients operated with or without SSCT excision in our neurosurgery clinic. METHODS: Between 2003 and 2019 we operated 1279 patients at our neurosurgery clinic. Among them 250 patients who had SSCT excision (syn+) were chosen and they were compared with other 250 patients operated without SSCT excision (Syn-). RESULTS: All patients were evaluated preoperatively and 12 months postoperatively based on the results of Boston Carpal Tunnel Syndrome Questionnaire. When pre-, and post-operative results were compared, we didn’t observe a statistically significant intergroup difference. DISCUSSION AND CONCLUSION: Although our primary goal in patients in whom we performed excision of tenosynovium is to relieve the median nerve by increasing decompression, we observed that there was no difference between the two groups in this large-scale study. We think that only liberation of the transverse carpal ligament during surgery will be sufficient.

Sono-Elastography in evaluation of the median nerve in carpal tunnel syndrome patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Maha Mohamed Abdelraouf ◽  
Amal Ibrahim Ahmed ◽  
Nouran Abdelrahman Elghitany
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Area Under Curve ◽  
University Hospitals ◽  
Electrodiagnostic Testing ◽  
Study Population ◽  
Tunnel Syndrome ◽  
Study Setting

Abstract Background Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. It is caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. The diagnosis of CTS is based on a combination of characteristic symptoms and electrophysiologic abnormalities. Electrodiagnostic testing (EDT) is uncomfortable for patients, time consuming and expensive. Objective To evaluate the role of greyscale and strain elastography ultrasound imaging in diagnosing patients with CTS and controls in comparison with nerve conductive studies. Patients and Methods Type of Study: Descriptive, prospective study. Study Setting: The study will be conducted at Ain Shams University Hospitals, Radiodiagnosis department. Study Period: 6 months. Study Population: Patients with carpal tunnel syndrome diagnosed clinically and underwent nerve conduction velocity study. Results In this study 7 wrists were diagnosed with mild CTS, 5 wrists demonstrated moderate CT, whereas only 3 wrists revealed severe CTS. The mean CSA would have increased if the number of cases with severe CTS had been higher. CSA of the median nerve has been reported to increase with the severity of entrapment. The cut off point of the average CSA to differentiate between cases and controls was found > 8 with sensitivity of 93.33%, specificity of 80% and area under curve (AUC) of 91.3% while the best cut off point for Elasto score was found > 1 with sensitivity of 86.6%, specificity of 80% and area under curve (AUC) of 93.3%. Conclusion We concluded that sonoelastography is a sensitive tool for prediction of CTS and it’s severity in correlation to NCV.

scholarly journals Role of High Resolution Ultrasound in Assessment of Abnormalities of Median Nerve in Carpal Tunnel Syndrome

2020 ◽  
Vol 10 (02) ◽  
pp. 73-88
Author(s):  
Mohamed Farouk Agag ◽  
Moutaz M. Kamal Elsharkawy ◽  
Ahmed Khedewy Ahmed
Keyword(s):  
High Resolution ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Tunnel Syndrome

Carpal tunnel syndrome—The role of the subsynovial connective tissue

2006 ◽  
Vol 39 ◽  
pp. S64
Author(s):  
P.C. Amadio ◽  
A.M. Ettema ◽  
K.-N. An ◽  
C. Zhao ◽  
L.E. Wold ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Connective Tissue ◽  
Carpal Tunnel ◽  
Tunnel Syndrome ◽  
Subsynovial Connective Tissue

scholarly journals Carpal tunnel syndrome: assessment of the need for rehabilitation and recovery treatment after endoscopic decompression of the median nerve in the late and long-term postoperative periods

2020 ◽  
Vol 9 (4) ◽  
pp. 34-43
Author(s):  
D. G. Yusupova ◽  
A. A. Zimin ◽  
D. A. Grishina ◽  
N. V. Belova ◽  
A. V. Vershinin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Controlled Study ◽  
Control Group ◽  
Clear Understanding ◽  
Significant Difference ◽  
Tunnel Syndrome

Background. Carpal tunnel syndrome is the most common tunnel neuropathy in which the median nerve is compressed at the level of the wrist in the carpal canal. Treatment of carpal tunnel syndrome can be conservative and surgical. Surgical treatment is indicated in case of ineffective conservative treatment. However, the strategy of managing patients with carpal tunnel syndrome in the postoperative period has not yet been determined; there is no clear understanding of the effectiveness and necessity of rehabilitation in the early and long-term postoperative periods.Aim. Follow-up the patients after decompression of the median nerve in the late (up to 3 weeks after surgery) and long-term (3 weeks after surgery) postoperative periods to assess the effectiveness of different methods of rehabilitation.Materials and methods. A randomized controlled study included 108 cases of idiopathic carpal tunnel syndrome (unilateral and bilateral). After surgery, the patients were divided into three groups: the restorative treatment group using magnetic therapy, the kinesiotherapy group, and the control group. Clinical, neurophysiological and ultrasound monitoring was carried out for six months.Results. Patients of all the groups showed similar improvement in the most of the analyzed parameters, without any significant difference.Conclusion. Thus, according to the results of a comprehensive study, it is evident that early diagnosis of carpal tunnel syndrome and a high-quality surgical decompression of the median nerve with a complete dissection of the flexor retinaculum of the hand guarantee improvement within six months or later after surgical treatment without additional rehabilitation measures.

Amyloidosis as a Cause of Carpal Tunnel Syndrome in Haemodialysis Patients

1988 ◽  
Vol 13 (4) ◽  
pp. 402-405
Author(s):  
J. D. SPENCER
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Small Group ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Soft Tissues ◽  
Amyloid Deposits ◽  
Tunnel Syndrome ◽  
The Relationship

Over a five-year period (1981–1985), nine patients on haemodialysis developed carpal tunnel syndrome. Five patients, following biopsy of synovium in the carpal tunnel or biopsy of thickened epineurium of the median nerve, were found to have amyloid deposits in the soft tissues. The relationship between this condition, dialysis arthropathy and long-term haemodialysis is reviewed. In addition, in this small group of patients no relationship to the side of the fistula has been demonstrated and two patients developed recurrent problems despite initial open decompression of the carpal tunnel.

scholarly journals Understanding central sensitization for advances in management of carpal tunnel syndrome

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 605
Author(s):  
César Fernández-de-las-peñas ◽  
José L Arias-Buría ◽  
Ricardo Ortega-Santiago ◽  
Ana I De-la-Llave-Rincón
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Central Sensitization ◽  
Current Data ◽  
Carpal Tunnel Surgery ◽  
The Central Nervous System ◽  
Tunnel Syndrome ◽  
Pain Symptoms

Carpal tunnel syndrome is the most common nerve compression disorder of the upper extremity, and it is traditionally considered a peripheral neuropathy associated with a localized compression of the median nerve just at the level of the carpal tunnel. Surgery and physiotherapy are treatment approaches commonly used for this condition; however, conflicting clinical outcomes suggest that carpal tunnel syndrome may be more complex. There is evidence supporting the role of peripheral nociception from the median nerve in carpal tunnel syndrome; however, emerging evidence also suggests a potential role of central sensitization. The presence of spreading pain symptoms (e.g. proximal pain), widespread sensory changes, or bilateral motor control impairments in people presenting with strictly unilateral sensory symptoms supports the presence of spinal cord changes. Interestingly, bilateral sensory and motor changes are not directly associated with electrodiagnostic findings. Other studies have also reported that patients presenting with carpal tunnel syndrome exhibit neuroplastic brainstem change supporting central sensitization. Current data would support the presence of a central sensitization process, mediated by the peripheral drive originating in the compression of the median nerve, in people with carpal tunnel syndrome. The presence of altered nociceptive gain processing should be considered in the treatment of carpal tunnel syndrome by integrating therapeutic approaches aiming to modulate long-lasting nociceptive barrage into the central nervous system (peripheral drive) and strategies aiming to activate endogenous pain networks (central drive).

scholarly journals Does Recurrence of Carpal Tunnel Syndrome (CTS) after Complete Division of the Transverse Ligament Really Exist?

2021 ◽  
Vol 10 (18) ◽  
pp. 4208
Author(s):  
Fatma Kilinc ◽  
Bedjan Behmanesh ◽  
Volker Seifert ◽  
Gerhard Marquardt
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Surgical Intervention ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Long Term Results ◽  
Transverse Ligament ◽  
Tunnel Syndrome ◽  
Clinical Signs And Symptoms

The aim of this study was to evaluate whether recurrent carpal tunnel syndrome (CTS) after complete and sufficient division of the transverse ligament really exists. Another goal was to analyze the underlying reasons for recurrent CTS operated on in our department. Over an observation period of eleven years, 156 patients underwent surgical intervention due to CTS. The records of each patient were analyzed with respect to baseline data (age, gender, affected hand), as were clinical signs and symptoms pre- and postoperatively. To assess long-term results, standardized telephone interviews were performed using a structured questionnaire in which the patients were questioned about persisting symptoms, if any. Of the 156 patients, 128 underwent first surgical intervention due to CTS in our department. In long-term follow-up, two-thirds of these patients had no symptoms at all; one-third of the patients described mild persisting numbness. None of the patients experienced a recurrence of CTS. The 28 patients who received their first operation outside of our department were operated on for recurrent CTS. The cause of recurrence was incomplete division of the distal part of the transverse carpal ligament in all cases. The results suggest that recurrent CTS after complete and sufficient division of the transverse ligament is very unlikely.

scholarly journals The Role of Multifactorial Contribution in Carpal Tunnel Syndrome Occurrence

2021 ◽  
Vol 6 (2) ◽  
pp. 266-272
Author(s):  
Putu Feryawan Meregawa ◽  
John Nolan
Keyword(s):  
Risk Factor ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Strength Loss ◽  
Peripheral Neuropathies ◽  
Functional Disturbance ◽  
Tunnel Syndrome ◽  
The Common

As one of the common peripheral neuropathies, carpal tunnel syndrome (CTS) is accountable for the majority of typical hand pain and functional disturbance in median nerve innervation. The median nerve compression may cause some uncomfortable sensations including pain, numbness, tingling, and strength loss which also depends on the severity of the condition. Many factors could contribute to CTS occurrence. Several risk factors are thought to be in charge in CTS progressions, such as body mass index (BMI), gender, pregnancy, and biomechanical exposures combination is significantly explained as the major component in suffering CTS. Clinicians need to know the contributing risk factor to benefit the information within the implication for the treatment and reducing symptoms severity. Keywords: carpal tunnel syndrome, risk factor, multifactor.

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