scholarly journals Biological and Preclinical Evaluations of Designed Optically Guided Medical Devices with Light Scattering Modules for Carpal Tunnel Syndrome Treatment and Surgical Procedure

2020 ◽  
Author(s):  
Ching-Cheng Huang ◽  
Ming-Che Chiang
Keyword(s):  
Light Scattering ◽  
Carpal Tunnel Syndrome ◽  
Medical Devices ◽  
Carpal Tunnel ◽  
Surgical Procedure ◽  
Tunnel Syndrome

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.

scholarly journals Preoperative use of gabapentin for pain reduction in open surgeries under local anesthesia for idiopathic bilateral carpal tunnel syndrome

2021 ◽  
Vol 10 (4) ◽  
pp. e54410414506
Author(s):  
Sergio Murilo Georgeto ◽  
Rodrigo Antônio Carvalho Andraus ◽  
Ovídia Ignês Pires ◽  
Eros de Oliveira Junior ◽  
Karen Barros Parron Fernandes
Keyword(s):  
Postoperative Pain ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Surgical Procedure ◽  
Placebo Control ◽  
Double Blind Study ◽  
Double Blind ◽  
Degree Of Satisfaction ◽  
Tunnel Syndrome ◽  
Bilateral Carpal Tunnel Syndrome

This article aims to evaluate the preoperative use of gabapentin in the control of intra- and postoperative pain in patients with idiopathic bilateral carpal tunnel syndrome (CTS). A prospective, randomised, double-blind study involving 45 subjects with severe CTS, 23 receiving treatment (gabapentin 600 mg) and 22 receiving placebo (control), who underwent an open surgical approach in one hand under local anaesthesia. Information related to the patients’ profile, safety of the surgical procedure, history of pain, adverse effects, numbness, and medications used were collected during the 14 days of the procedure and evaluated by Generalised Estimated Equations and Generalised Linear Mixed Models. The treatment and control groups were homogeneous regarding the patients’ profile and surgical procedure data. The patients who used gabapentin 600 mg had a better evaluation during surgery (d = 0.655), anaesthesia (d = 0.854), and on the first night of sleep (d = 1.323), and they reported a higher degree of satisfaction with the surgery after 14 days (d = 1.091). The treatment group reported decreased pain in the operated hand in a 24-hour period (r = 0.34, 95% CI: 0.223–0.457) and in the 14-day follow-up period (r = 0.412, 95% CI: 0.217–0.608). These results were not impacted by the medications used and remained consistent over time. The use of a single dose of gabapentin 600 mg in the preoperative period proved to be safe and effective in reducing postoperative pain, and the improvement was noticed by the patient.

Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

2003 ◽  
Vol 8 (4) ◽  
pp. 4-5
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Proper Time ◽  
Carpal Tunnel Release ◽  
Hand Function ◽  
Factors Affecting ◽  
Early Results ◽  
Medical Evaluation ◽  
Nerve Recovery ◽  
Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

Clinical Update: Understanding Causation: An Example Using Carpal Tunnel Syndrome

2007 ◽  
Vol 12 (6) ◽  
pp. 5-8 ◽  
Author(s):  
J. Mark Melhorn
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Legal Responsibility ◽  
Medical Evidence ◽  
Anatomic Structure ◽  
Legal Professionals ◽  
Compensation Systems ◽  
Tunnel Syndrome ◽  
Four Levels

Abstract Medical evidence is drawn from observation, is multifactorial, and relies on the laws of probability rather than a single cause, but, in law, finding causation between a wrongful act and harm is essential to the attribution of legal responsibility. These different perspectives often result in dissatisfaction for litigants, uncertainty for judges, and friction between health care and legal professionals. Carpal tunnel syndrome (CTS) provides an example: Popular notions suggest that CTS results from occupational arm or hand use, but medical factors range from congenital or acquired anatomic structure, age, sex, and body mass index, and perhaps also involving hormonal disorders, diabetes, pregnancy, and others. The law separately considers two separate components of causation: cause in fact (a cause-and-effect relationship exists) and proximate or legal cause (two events are so closely related that liability can be attached to the first event). Workers’ compensation systems are a genuine, no-fault form of insurance, and evaluators should be aware of the relevant thresholds and legal definitions for the jurisdiction in which they provide an opinion. The AMA Guides to the Evaluation of Permanent Impairment contains a large number of specific references and outlines the methodology to evaluate CTS, including both occupational and nonoccupational risk factors and assigning one of four levels of evidence that supports the conclusion.

Sign in / Sign up

Export Citation Format

Share Document