scholarly journals Surgical correction of iatrogenic lesion of the median nerve after endoscopic decompression: Case report

2021 ◽  
Author(s):  
Erlan Pércio Lopes Rufino ◽  
Eduarda Silvestre Ribeiro da Costa Gomes ◽  
Gabriela Silvestre Ribeiro da Costa Gomes ◽  
João Guilherme Araújo Magalhães Neiva ◽  
Maria Eduarda Queiroz de Albuquerque
Keyword(s):  
Case Report ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Surgical Procedure ◽  
Surgical Techniques ◽  
Motor Branch ◽  
Left Hand ◽  
Iatrogenic Lesion ◽  
Tunnel Syndrome

Introduction: Carpal tunnel syndrome is neuropathy of compressive origin, surgical treatment can present complications that are difficult to solve, among them, painful neuromas of the peripheral nerves, affecting 2–60% of patients with nerve damage. There is no consensus on the ideal treatment for painful neuroma. Consequently, numerous modalities to treat neuroma pain are described. Case report: Female, 45 years old, presented with a left hand carpal tunnel syndrome clinic. There is a report of having undergone a surgical procedure for decompression of the carpal tunnel with endoscopy, progressing with worsening of symptoms. Another surgical procedure was performed (conventional open route) in the region of the left wrist with intra-op visualization of total nerve rupture. Neurorrhaphy of the median nerve was performed. Patient came to our service complaining of severe pain (VAS 9/10) in median nerve topography associated with paresis of the muscles innervated by the same. Neuroma resection and sural nerve grafting for the tenar motor branch, ulnar and radial median group and patient evolved with significant pain improvement (VAS of 2/10). Discussion: A wide variety of surgical techniques are described to treat painful neuroma. In this case, the success of the chosen tchnique is evidenced by the drop of 07 points in the VAS. Conclusion: It is evident that the endoscopic correction of carpal tunnel syndrome is not without complications and should be indicated with caution. It is necessary to carry out more studies that can evidence the best conduct for each case.

Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

2021 ◽  
pp. 175319342110017
Author(s):  
Saskia F. de Roo ◽  
Philippe N. Sprangers ◽  
Erik T. Walbeehm ◽  
Brigitte van der Heijden
Keyword(s):  
Systematic Review ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Open Release ◽  
Flap Coverage ◽  
Tunnel Syndrome

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

scholarly journals Carpal Tunnel Syndrome Associated with Klippel-Trénaunay Syndrome: A Case Report

2020 ◽  
Vol 6 (3) ◽  
pp. 161-164
Author(s):  
Joan Arenas-Prat ◽  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Peripheral Nerves ◽  
Distribution Area ◽  
Left Hand ◽  
Nerve Involvement ◽  
Tunnel Syndrome ◽  
Operative Findings ◽  
Klippel Trenaunay Syndrome

Background and Importance: Klippel-Trénaunay syndrome is a rare congenital condition that rarely affects peripheral nerves. Median nerve involvement at the carpal tunnel level has only been reported on four occasions of this syndrome in the medical literature. Case Presentation: A 61-year-old Caucasian female patient with Klippel-Trénaunay syndrome presented with a 10-month history of paraesthesia and numbness affecting the median nerve distribution area of her left hand. The clinical and neurophysiological examination confirmed a moderately severe carpal tunnel syndrome that required surgical decompression. Conclusion: Pre-operative findings demonstrated diffuse vascular infiltration and engorgement of the median nerve. Flexor tendons had a normal appearance. The patient had a satisfactory post-operative period with full resolution of her symptoms 4 weeks after the procedure. Although peripheral nerves are rarely affected in patients with Klippel-Trénaunay syndrome, neurological symptoms could indicate nerve involvement and magnetic resonance imaging (MRI) examination should be considered to further assess the extension of the lesion.

scholarly journals Median Nerve Variation: A Complete Spin before Terminal Branching

2020 ◽  
Vol 15 (01) ◽  
pp. e1-e4
Author(s):  
Amgad S. Hanna ◽  
Zhikui Wei ◽  
Barbara A. Hanna
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Distal Forearm ◽  
Flexor Digitorum Superficialis ◽  
Anatomical Variant ◽  
Motor Branch ◽  
Surgical Interventions ◽  
Tunnel Syndrome ◽  
Flexor Digitorum

AbstractMedian nerve anatomy is of great interest to clinicians and scientists given the importance of this nerve and its association with diseases. A rare anatomical variant of the median nerve in the distal forearm and wrist was discovered during a cadaveric dissection. The median nerve was deep to the flexor digitorum superficialis (FDS) in the carpal tunnel. It underwent a 360-degree spin before emerging at the lateral edge of FDS. The recurrent motor branch moved from medial to lateral on the deep surface of the median nerve, as it approached the distal carpal tunnel. This variant doesn't fall into any of Lanz's four groups of median nerve anomalies. We propose a fifth group that involves variations in the course of the median nerve. This report underscores the importance of recognizing variants of the median nerve anatomy in the forearm and wrist during surgical interventions, such as for carpal tunnel syndrome.

scholarly journals Incidental finding of a persistent median artery (palmar type) during a routine carpal tunnel decompression: a case report

2017 ◽  
Vol 99 (7) ◽  
pp. e204-e205
Author(s):  
J Butt ◽  
AK Ahluwalia ◽  
A Dutta
Keyword(s):  
Case Report ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Incidental Finding ◽  
Surgical Decompression ◽  
Iatrogenic Injury ◽  
Palmar Fascia ◽  
Tunnel Syndrome ◽  
Median Artery

Carpal tunnel syndrome is characterised by compression of the median nerve. The mainstay of treatment is surgical decompression. This case report highlights the occurrence of a persistent median artery, which could complicate surgery. A 55-year-old woman underwent carpal tunnel decompression. An incidental finding of a large-calibre persistent median artery, which was superficial to the flexor sheath, could have been damaged. This was carefully retracted and the procedure was completed, without any complications. Several studies have shown the prevalence of persistent median artery to range from 1.1–27.1%. It is usually found deep to the flexor retinaculum but in this case it was found to be just beneath the palmar fascia. There is increased chance of iatrogenic injury with this particular variant. Surgeons performing the procedure should be mindful of this variation, because accidental damage could result in devastating consequences to the hand.

Trigger Wrist Associated with Carpal Tunnel Syndrome Caused by Flexor Digitorum Superficialis Muscle Belly Hypertrophy: A Case Report and Literature Review

2020 ◽  
Author(s):  
Behzad Enayati ◽  
Mahmoud Farzan ◽  
Shahram Akrami ◽  
Pouya Tabatabaei Irani ◽  
Alireza Moharrami
Keyword(s):  
Case Report ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Surgical Techniques ◽  
Muscle Belly ◽  
Painful Sensation ◽  
Tunnel Syndrome ◽  
Trigger Wrist ◽  
Flexor Digitorum

Background: Trigger wrist is a rare disease with few reported cases in the literature. This condition presents with painful sensation and a clicking sound during finger or wrist movements. Case Report: In this report, we present a 32-year-old man suffering from trigger wrist along with carpal tunnel syndrome caused by muscle belly hypertrophy and extension to the carpal tunnel. The diagnostic approach and surgical techniques are explained. Conclusion: In cases of trigger wrist associated with carpal tunnel syndrome (CTS), there may be an underlying cause covering both the trigger wrist and CTS at the volar side of the wrist. Therefore, a precise clinical examination is recommended to avoid unnecessary surgery, releasing of A1 pulley, or steroid injection.  

Carpal tunnel syndrome: matching minimally invasive surgical techniques

2008 ◽  
Vol 108 (5) ◽  
pp. 1033-1036 ◽  
Author(s):  
Vittoria Nazzi ◽  
Angelo Franzini ◽  
Giuseppe Messina ◽  
Giovanni Broggi
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Minimally Invasive ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Surgical Techniques ◽  
The Past ◽  
Minimally Invasive Surgical ◽  
Group A ◽  
Tunnel Syndrome ◽  
Group B

✓In the past few years, several different minimally invasive surgical techniques have been proposed to decompress the median nerve at the wrist. Use of these techniques has become widespread due to fewer local complications, faster functional recovery, and reduced surgical time. In this paper the authors compare 3 different minimally invasive surgical techniques used at their institution in the past 13 years. Between January 1994 and January 2007, 891 patients underwent 1272 surgeries at the authors' institution for carpal tunnel syndrome (CTS), for which a minimally invasive technique was used. In 473 cases (Group A), the transillumination technique with a single wrist incision and a “carpalotome” (a modified Paine retinaculotome) was used; in 216 cases (Group B), transillumination was abandoned and a single linear wrist incision for access with the carpalotome was performed; and in 583 cases (Group C), the techniques were further modified by making a second incision in the palm using the carpalotome. All 3 groups of patients were homogeneous for age, sex, and duration of the symptomatology. In 90% of the patients in Group A, in 88% of those in Group B, and 99.8% of patients in Group C, complete remission of symptoms was obtained. Due to persistence of symptoms, 44 patients in Group A, 24 in Group B, and only 1 in Group C underwent a repeated operation with the open technique. The only surgical complication requiring repeated operation of the 1272 operations was a lesion of the primitive median artery (1 patient in Group C). The technique of median nerve decompression at the wrist that was used for patients in Group C represents a valid alternative for treatment of CTS.

EXTRASKELETAL CHONDROMA AS A CAUSE OF CARPAL TUNNEL SYNDROME: A CASE REPORT

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 327-330 ◽  
Author(s):  
D. Cumming ◽  
A. Massraf ◽  
J. W. M. Jones
Keyword(s):  
Case Report ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Clinical Examination ◽  
Carpal Tunnel ◽  
Common Causes ◽  
Tunnel Syndrome ◽  
Uncommon Condition ◽  
The Common ◽  
Space Occupying Lesion

We report a case of carpal tunnel syndrome as a result of an extraosseous chondroma in a 47-year-old gentleman. This case demonstrates the importance of clinical examination and occasional radiographs in this not uncommon condition. We also highlight that this well known entrapment syndrome is not only caused by the common causes that we all know, but also any space-occupying lesion in the carpal tunnel compressing the median nerve.

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