Carpal tunnel syndrome: Morphologic changes after release of the transverse carpal ligament

Richman, Jonathan; Gelberman, Richard H.; Rydevik, Björn; Hájek, P.; Braun, Richard M.; Gylys-Morin, Victoria M.; Berthoty, Dean

doi:10.1016/s0363-5023(89)80089-9

Cited by 181 publications

(89 citation statements)

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“…A large proportion of patients fail to respond to conservative treatment and, in this population, carpal tunnel decompression with division of the transverse carpal ligament has been a highly successful pro c e d u re 1 2 . While the patient satisfaction is usually high with the surg e ry, potential complications do exist and includes pain and scar disc o n f o rt, wound dehiscence, bowstringing of the flexor tendons and inclusion of the median nerve within the postoperative scar [13][14][15] .…”

Section: Discussionmentioning

confidence: 99%

Wrist immobilization after carpal tunnel release: a prospective study

Martins

Siqueira

Simplício

2006

Arq. Neuro-Psiquiatr.

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-This prospective study evaluates the possible advantages of wrist imobilization after open carpal tunnel release comparing the results of two weeks immobilization and no immobilization. Fifty two patients with idiopathic carpal tunnel syndrome were randomly selected in two groups after open carpal tunnel release. In one group (A, n=26) the patients wore a neutral-position wrist splint continuosly for two weeks. In the other group (B, n=26) no wrist immobilization was used. Clinical assessment was done preoperatively and at 2 weeks follow-up and included the two-point discrimination test at the second finger and two questionnaires as an outcome measurement of symptoms severity and intensity. All the patients p resented improvement in the postoperative evaluations in the three analyzed parameters. There was no significant difference between the two groups for any of the outcome measurements at the final followup. We conclude that wrist immobilization in the immediate post-operative period have no advantages when compared with no immobilization in the end result of carpal tunnel release.KEY WORDS: carpal tunnel syndrome, surgical decompression, wrist imobilization.Avaliação prospectiva da imobilização do pulso após descompressão cirúrgica do nervo mediano no túnel do carpo RESUMO -Neste estudo prospectivo avaliamos se há vantagens na imobilização pós-operatória do pulso após a ciru rgia para o tratamento da síndrome do túnel do carpo comparando este tratamento com a ausência de imobilização. Cinqüenta e dois pacientes portadores de síndrome do túnel do carpo idiopáti-ca foram randomizados em dois grupos após a ciru rgia. Em um grupo (grupo A, n=26) os pacientes utilizaram uma tala em posição neutra para imobilização do pulso por duas semanas. No outro grupo (B, n=26), nenhum tipo de imobilização foi adotada. A avaliação foi realizada antes da ciru rgia e re p e t i d a após duas semanas e incluiu a mensuração da sensibilidade discriminatória no segundo dedo e dois questionários que avaliaram a gravidade e intensidade dos sintomas. Em todos os pacientes houve melhora nos p a r â m e t ros avaliados. Não houve diferença estatisticamente significativa entre os dois grupos considerando os parâmetros avaliados. Concluímos que a imobilização do pulso no período pós-operatório imediato não apresenta vantagens quando comparada com a ausência de imobilização após a descompressão cirúr-gica do nervo mediano no punho. PALAVRAS-CHAVE: síndrome do túnel do carpo, descompressão cirúrgica, imobilização, pulso.Carpal tunnel syndrome (CTS) is the most comm o n peripheral entrapment mononeuropathy and is manifested by characteristic signs and symptoms re s u l ting from median nerve compression at the wrist and/ or palm 1 . Diagnosis is essentially clinical and often p atient history alone is indicative of CTS. The electrop h ysiologic studies confirm the diagnosis. The tre a t m e n t can be conservative, with cort i c o s t e roid infiltration, use of symptomatic drugs and/or wrist splinting 2 .The surgical treatment is ...

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Section: Discussionmentioning

confidence: 99%

Wrist immobilization after carpal tunnel release: a prospective study

Martins

Siqueira

Simplício

2006

Arq. Neuro-Psiquiatr.

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“…There are a number of reasons that may account for these strength decreases, including altered morphology of the carpal tunnel, 9,73 decreased thenar muscle and digital flexor muscle strengths, inhibition of muscle by pain, and scar or pillar pain. After the TCL is cut, the stable point of anchor for the thenar muscles' origin changes.…”

Section: Consequences Of Ctr: What To Expect Following Surgerymentioning

confidence: 99%

Conservative Interventions for Carpal Tunnel Syndrome

Michlovitz¹

2004

J Orthop Sports Phys Ther

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The assessment and conservative interventions in patients with carpal tunnel syndrome (CTS) are described in this paper. Information about surgical procedures and postoperative care has also been included. It is difficult to make definitive conclusions about the literature regarding success of treatment for CTS due to variations in outcome measures, severity of CTS, and inconsistencies in duration, dosage, and follow-up time for interventions. Based on what is known to date, this author recommends that patients with mild or moderate CTS be provided with a conservative program of splinting the wrist in neutral for nocturnal wear. In addition, intermittent exercise (nerve-gliding exercises) and activity modification, including avoidance of protracted periods of sustained gripping activities and awkward wrist positions, can be useful. This conservative program may be complemented by pain-relieving modalities during times of activity and supplemental participation in other exercise such as yoga. If symptoms are not relieved to the satisfaction of the patient, or they recur, then it is incumbent upon the therapist to refer the patient to a hand surgeon for injection or possible surgical decompression.

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“…Although carpal tunnel release is a common procedure, controversy persists as to the need for postoperative immobilization. Richman et al (1989) reported an average anterior dislocation of the contents of the carpal canal of 3.5 mm after sectioning the carpal ligament. Some authors recommend immobilization to reduce the risk of bowstringing of the flexor tendons or subluxation and tethering of the median nerve in the scar (MacDonald et al 1978, Inglis 1980, Gelberman et al 1987, Omer 1992, Weirich and Gelberman 1993.…”

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confidence: 99%