Carpal tunnel syndrome and treatment of recurrent symptoms

Dahlin, Lars B.; Salö, Martin; Thomsen, Niels; Stutz, Nathalie

doi:10.3109/02844310903528697

Cited by 28 publications

(23 citation statements)

References 50 publications

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“…Treatment of recurrent CTS is challenging, and several procedures have been reported to prevent re‐recurrence of the disease. Hypothenar fat pad is the most commonly used local flap to cover the median nerve for recurrent CTS . However, its coverage of the median nerve is sometimes not sufficient and re‐recurrence rate of CTS is high; the procedure is often ineffective for the treatment of cases with severe pain, such as CRPS type II.…”

Section: Discussionmentioning

confidence: 99%

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Free anterolateral thigh flap with vascularized lateral femoral cutaneous nerve for the treatment of neuroma‐in‐continuity and recurrent carpal tunnel syndrome after carpal tunnel release

et al. 2013

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Treatment of recurrent carpal tunnel syndrome (CTS) is challenging, especially in a case with recurrent CTS and a neuroma formation. Resection of the neuroma causing the syndrome, reconstruction of the nerve gap of the median nerve, and covering up the reconstructed median nerve with well-vascularized soft tissue for prevention of CTS re-recurrence are the essential procedures. We report a case of recurrent CTS with severe pain due to a neuroma-in-continuity successfully treated using a free anterolateral thigh (ALT) flap with a vascularized lateral femoral cutaneous nerve (LFCN). A 2 cm neuroma existed in the median nerve and was resected. The nerve gap was repaired using a vascularized LFCN included in the ALT flap. The ALT flap was transferred to the wrist to cover the median nerve. The severe pain disappeared completely and the sensory and motor impairment of the median nerve improved 5 months after the free flap surgery, as the Tinel's sign moved distally away from the wrist and disappeared. The result of the Semmes-Weinstein test improved from 5.08 to 4.31 and she was able to flex and extend the right wrist and fingers without pain. CTS did not recur 15 months after the surgery. A free ALT flap with vascularized LFCN allows nerve reconstruction for the median nerve gap created after neuroma resection and coverage of the median nerve with well-vascularized soft tissue to prevent adhesion and CTS recurrence.

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Section: Discussionmentioning

confidence: 99%

“…Simple re‐CTR and dissection of adhesion surrounding the median nerve is rarely effective in recurrent CTS . Local or free flaps are used to prevent the adhesion of the surrounding tissue to the median nerve . Treatment of recurrent CTS with severe pain, especially one with a neuroma‐in‐continuity, is challenging .…”

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confidence: 99%

Free anterolateral thigh flap with vascularized lateral femoral cutaneous nerve for the treatment of neuroma‐in‐continuity and recurrent carpal tunnel syndrome after carpal tunnel release

et al. 2013

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“…There are at least 16 possible interventions for CTS with varying levels of evidence to support their use [13]. Surgical treatment is considered the most effective treatment for severe CTS [14] but is a less-than-optimal initial approach for people with mild-to-moderate CTS because of the potential for adverse events [15], recurrence [16], and high medical costs [17,18]. A recent international multidisciplinary treatment guideline [12] has suggested that treatment should be based on the duration and severity of the CTS and advocated for combinations of education, splinting, and steroids, with surgery provided for those with severe CTS or who did not respond well to conservative treatment.…”

Section: Introductionmentioning

confidence: 99%

What Types of Treatment Are Provided for Patients With Carpal Tunnel Syndrome? A Retrospective Analysis of Commercial Insurance

Baker

Stevans

Terhorst

et al. 2018

PM&R

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Background Treatment of carpal tunnel syndrome (CTS) in commercially insured patients across the spectrum of provider types has rarely been described. Objective The purpose of this study was to describe patterns of types of treatment for patients with CTS using a large commercial insurance database. Design Retrospective cohort descriptive study Setting Administrative health data from the Clinformatics® Datamart (OptumInsight, Eden Prairie, MN). Patients Adults with a primary diagnosis of CTS seen from between January, 2010 to December, 2012 who had a total of 48 months of continuous data (12 months prior to diagnosis and 36 months after diagnosis) (n = 24,931). Outcomes Frequency of types of treatment (heat, manual therapy, positioning, steroid, stretching, surgery) by number of treatments, number of visits, provider type, and characteristics. Results Fifty-three percent of patients received no reported treatment and 50.4% had no additional visits. Surgery (42.5%) and positioning (39.8%) were the most frequent single treatments. Patients who were seen by orthopedist for their first visit more frequently received some treatment (75.1%) and at least one additional visit (74.1%) compared to those seen by general practitioners (59.5%, 57.5% respectively) or other providers (65.4%, 68.4 respectively). Orthopedists more frequently prescribed positioning devices (26.8%) and surgery (36.8%) than general practitioners (18.8%, 14.1%, respectively) or other providers (15.7%, 19.7%, respectively). Older adults more frequently had CTS surgery as did people who lived in the Midwest. Overall, only 24% of CTS patients had surgery. Conclusions For more than half of patients with CTS no treatment was provided after an initial visit. Surgery rates were much lower than what has previously been reported in the literature. Generally, patients with CTS receive treatments that are supported by current treatment guidelines.

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“…Neural adhesion of superficial radial nerve sometimes occurs when scar tissue adheres to the damaged nerve. This condition is characterized by dysesthesia and pain radiating to the nerve‐innervated area during wrist and thumb motion . Definitive diagnostic criteria for neural adhesion have not yet been established and thus diagnosis might be difficult clinically.…”

mentioning

confidence: 99%

“…This condition is characterized by dysesthesia and pain radiating to the nerve-innervated area during wrist and thumb motion. [8][9][10][11] Definitive diagnostic criteria for neural adhesion have not yet been established and thus diagnosis might be difficult clinically. Some surgeons have reported that recurrent adhesion after neurolysis is not uncommon, but great care should be taken in operations for neurolysis because of the unreliable outcomes.…”

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confidence: 99%

Application of free temporoparietal fascial flap for recurrent neural adhesion of superficial radial nerve—A case report

et al. 2015

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Because of its anatomical location, the superficial radial nerve is vulnerable to trauma as well as injury during various surgical procedures. Once the nerve adheres to surrounding scar tissue, radiating pain often occurs due to nerve traction caused by loss of smooth gliding. Since it has been reported that the success rate with neurolysis only is lower, additional preventive procedures for recurrent neural readhesion are recommended. In the current report, we describe our experience performing neurolysis followed by nerve coverage using a free temporoparietal fascial flap for recurrent neural adhesion of the superficial radial nerve. A 45-year-old male complained of motion pain of the left wrist and thumb joints caused by recurrent neural adhesion of the superficial radial nerve after a chain saw trauma and following multiple reconstructive procedures. The radiating pain completely disappeared after neurolysis performed by a previous surgeon; however, it recurred 4 weeks later. Four months after the previous neurolysis the patient underwent external neurolysis and covering of the nerve with a free temporoparietal fascial flap to prevent neural readhesion because local soft tissue could not be used due to the massive scar tissues on the forearm. One year after the secondary neurolysis, the symptoms of radiating pain during wrist and thumb motion were drastically improved. A free adipofascial flap such as a temporoparietal flap may be an option for prevention of neural readhesion after neurolysis of the superficial radial nerve in cases where a local flap cannot be used on the forearm.

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Carpal tunnel syndrome and treatment of recurrent symptoms

Cited by 28 publications

References 50 publications

Free anterolateral thigh flap with vascularized lateral femoral cutaneous nerve for the treatment of neuroma‐in‐continuity and recurrent carpal tunnel syndrome after carpal tunnel release

Free anterolateral thigh flap with vascularized lateral femoral cutaneous nerve for the treatment of neuroma‐in‐continuity and recurrent carpal tunnel syndrome after carpal tunnel release

What Types of Treatment Are Provided for Patients With Carpal Tunnel Syndrome? A Retrospective Analysis of Commercial Insurance

Application of free temporoparietal fascial flap for recurrent neural adhesion of superficial radial nerve—A case report

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