Comparison Efficacy of Ultrasound-Guided Needle Release Plus Corticosteroid Injection and Mini-Open Surgery in Patients with Carpal Tunnel Syndrome

This retrospective study was to compare clinical outcomes of ultrasound-guided needle release with corticosteroid injection versus mini-open surgery in patients with carpal tunnel syndrome (CTS). From January 2020 to December 2020, 40 patients (40 wrists) with CTS were analyzed in this study. Diagnosis was based on clinical symptoms, electro-physiological and ultrasound imaging. 20 wrists were treated with ultrasound-guided needle release plus corticosteroid injection (Group A) and other 20 wrists went mini-open surgery (Group B). We evaluated Boston carpal tunnel questionnaire, electrophysiological parameters (distal motor latency, sensory conduction velocity and sensory nerve action potential of median nerve) and ultrasound parameters (cross-sectional area, flattening ratio and the thicknesses of transverse carpal ligament) both before and 3 months after treatment. Total treatment cost, duration of treatment, healing time and complications were also recorded for two groups. Boston carpal tunnel questionnaire, electrophysiologic and ultrasound outcomes at preoperatively and 3 months postoperatively had significant difference for each group (each P༜0.05). There were no complications such as infection, haemorrhage, vascular, nerve or tendon injuries in both groups. Ultrasound-guided needle release and mini-open surgery are both effective measures in treating CTS patients. Ultrasound-guided needle release plus corticosteroid injection provides smaller incision, less cost, less time of treatment and faster recovery compared with mini-open surgery. Ultrasound-guided needle release plus corticosteroid injection is better for clinical application.

The experience of using anti-adhesion gel in the surgery for carpal tunnel syndrome

The study objective is to evaluate the effectiveness of anti‑adhesion gel by using in carpal tunnel syndrome surgery.Materials and methods. A prospective study was carried out among 55 patients with carpal tunnel syndrome. All patients were underwent open decompression of the carpal tunnel. Patients of study group (n = 25) got an carboxymethylcellu‑ lose anti‑adhesion gel, which was applied to the nerve before suturing the wound. Patients from control group (n = 30) were underwent surgery without using an anti‑adhesive gel. Before surgery, all patients underwent a clinical neurological examination with an assessment of symptoms according to the Boston Carpal Tunnel Questionnaire, which includes 2 scales: the scale and the functional status scale. The Boston Carpal Tunnel Questionnaire was reevaluated 2.5 years after surgery.Results. In study group the mean symptom severity decreased by 59.5 %, functional status improved by 55.1 %, in control group these indicators were 48.3 and 47.6 %. Clinical relapse of the disease was noted in 8 % of patients of study group and in 20 % of patients of control group.Conclusion. Intraoperative using of an anti‑adhesion gel allows to reduce the frequency of recurrence of carpal tunnel syndrome after surgical decompression.

A COMPARISON OF FUNCTIONAL ASSESSMENT OF PRE- AND POSTSURGICAL CARPAL TUNNEL SYNDROME USING BOSTON CARPAL TUNNEL QUESTIONNAIRE AND NERVE CONDUCTION STUDY: A PROSPECTIVE STUDY FROM A TERTIARY CENTER OF SOUTH INDIA

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common entrapment syndrome of median nerve causing frequent disability especially among working populations. Boston Carpal Tunnel Questionnaire and Electrophysiological study helps in detecting and aiding in the diagnosis of CTS and helps in determining level of improvement after surgical release of carpal tunnel. OBJECTIVES: To assess functional outcome of patients with Carpal Tunnel Syndrome after surgery as assessed by Boston Carpel Tunnel Questionnaire and Electrophysiological study. METHODS: A prospective observational study conducted over a period of one year (January 2017 to January 2018). The study was conducted among consecutive 31 electrophysiological conrmed carpal tunnel syndrome attending the outpatient department of Physical Medicine and Rehabilitation, Government Medical College, Thiruvananthapuram. All patients underwent open carpal tunnel release. Functional outcome was assessed using Boston Carpal Tunnel Questionnaire (BCTQ) both preoperatively and at interval of 3 weeks, 6weeks and 3 months postoperatively. Electrophysiological study assessed using nerve conduction study both preoperatively and 3 weeks post operatively. Data was entered in Microsoft excel and analyzed using SPSS statistical software. RESULTS: The study involves 31 conrmed cases of Carpal tunnel syndrome patients. Mean Boston Carpal Tunnel Questionnaire (BCTQ) score preoperatively was 58.52 ± 12.73 which was markedly improved postoperatively at 3weeks with mean score of 29.77±6.68. At 6 weeks and 3 month follow up period it was reduced respectively to mean score of 23.94±4.23 and 22.94±4.62. Preoperative NCS shows decreased conduction velocity with mean nerve sensory velocity (NSV) score 21.51±8.19 and mean nerve motor velocity (NMV) score of 20.72±8.81 which statistically improved following surgery with mean NSV score of 32.04±9.01 and mean NML score of 33.78±8.1. Correlation between pre- and post-operative BCTQ and NCS parameters shows positive correlation with latency and negative correlation with amplitude and conduction velocity. Increased latency and decreased conduction velocity associated with higher BCTQ score with signicant 'p' value (p<0.05). CONCLUSION: There is statistically signicant improvement of functional outcome following carpal tunnel release surgery assessed through Boston Carpal Tunnel Questionnaire and Electrophysiological ndings

Assessment of carpal tunnel syndrome via ultrasonography among hospital workers: a screening study

Background Carpal tunnel syndrome is a reasonably common disorder among working individuals. It may also be a cause of functional impairment. The aim of the study was to screen for the presence of carpal tunnel syndrome among hospital workers by non-invasive ultrasound. Results The prevalence of carpal tunnel syndrome diagnosed by ultrasound among hospital workers was 21.5%. Age and Boston carpal tunnel questionnaire scale were positively correlated to median nerve cross sectional area. Conclusions Ultrasound can be used as a non-invasive and convenient method for screening for carpal tunnel syndrome.

Comparison Efficacy of Ultrasound-Guided Needle Release Plus Corticosteroid Injection and Mini-Open Surgery in Patients with Carpal Tunnel Syndrome

Purpose To compare clinical outcomes of ultrasound-guided needle release with corticosteroid injection versus mini-open surgery in patients with carpal tunnel syndrome (CTS).Methods From January 2020 to December 2020, 40 patients (40 wrists) with CTS were retrospectively analyzed in this study. Diagnosis was based on clinical symptoms, electro-physiological and ultrasound imaging. 20 wrists were treated with ultrasound-guided needle release plus corticosteroid injection (Group A) and other 20 wrists went mini-open surgery (Group B). We evaluated Boston carpal tunnel questionnaire, electrophysiological parameters (distal motor latency, sensory conduction velocity and sensory nerve action potential of median nerve) and ultrasound parameters (cross-sectional area, flattening ratio and the thicknesses of transverse carpal ligament) both before and 3 months after treatment. Total treatment cost, duration of treatment, healing time and complications were also recorded for two groups.Results Boston carpal tunnel questionnaire, electrophysiologic and ultrasound outcomes at preoperatively and 3 months postoperatively had significant difference for each group (each P༜0.05). There were no complications such as infection, haemorrhage, vascular, nerve or tendon injuries in both groups.Conclusion Ultrasound-guided needle release and mini-open surgery are both effective measures in treating CTS patients. Ultrasound-guided needle release plus corticosteroid injection provides smaller incision, less cost, less time of treatment and faster recovery compared with mini-open surgery. Ultrasound-guided needle release plus corticosteroid injection is better for clinical application

IMPACTOS FUNCIONAIS EM MULHERES COM SINTOMAS DE COMPRESSÃO NERVOSA NA ALTURA DO PUNHO

Objetivo: Avaliar a funcionalidade em mulheres que apresentam sintomas de síndrome nervosa compressiva na altura do punho. Métodos: A pesquisa tem abordagem quantitativa, de caráter descritivo. Para coleta de dados, usou-se o instrumento Boston Carpal Tunnel Questionnaire para mensurar a intensidade e a frequência das parestesias, além de avaliar o grau de habilidade para desempenhar algumas atividades; avaliação de sensibilidade da mão no território do nervo mediano com os Monofilamentos de Semmes-Weinstein; e avaliação de força muscular para três tipos de pinça, através do Teste do Esfigmomanômetro Modificado. Realizou-se a análise descritiva univariada dos dados. Resultados: Participação de 11 mulheres adultas e idosas. Obteve-se a presença de parestesias, como dormência e formigamento nas mãos, com prevalência de sintomas bilaterais, e nos casos unilaterais prevaleceu a mão direita - mão dominante na maioria das mulheres. Na mensuração da força muscular, as participantes com diagnóstico prévio obtiveram média menor, indicando perda da força muscular para realização das pinças. Na avaliação da sensibilidade, detectaram-se, em ambas as mãos, comprometimentos sensoriais para o território de inervação do nervo mediano. Com o estudo, perceberam-se limitações para algumas atividades de vida diária, evidenciando que a perda da funcionalidade da mão provocada pelos sintomas da compressão nervosa, acarreta prejuízos nas diversas áreas do desempenho ocupacional. Considerações Finais: Sintomas de compressão nervosa na altura do punho podem indicar a presença de Síndrome do Túnel do Carpo que causa impactos funcionais, principalmente na realização de atividades envolvendo o uso das mãos, em vista das alterações sensório-motoras.