Carpal tunnel syndrome: surgical treatment using the Paine retinaculatome

Pagnanelli, David M.; Barrer, Steven J.

doi:10.3171/jns.1991.75.1.0077

Cited by 30 publications

(11 citation statements)

References 31 publications

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“…Some surgical outcome studies that include NCSnegative patients failed to provide a breakdown of outcome by NCS result. 26 At least two studies have suggested that, in patients with normal NCS results, surgical treatment may lead to unfavorable outcomes, 2,12 and a recent report indicated that surgical outcome is more favorable in patients with longer preoperative median latencies. 6 In summary, we found that NCS results provide independent information not fully predictable from clinical variables alone.…”

Section: Discussionmentioning

confidence: 99%

Carpal tunnel syndrome with normal nerve conduction studies

2004

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The utility of electrodiagnostic testing in the evaluation of carpal tunnel syndrome (CTS) has been questioned. We studied patients who met the clinical criteria for CTS and compared patients who had normal nerve conduction studies (NCS) with patients who had abnormal NCS. We found that 25% of the CTS patients without confounding neurologic disorders had normal NCS with median palmar nerve stimulation. Patients with abnormal NCS were older and heavier and had more clinical features of CTS. NCS results could not be predicted accurately from clinical features by use of logistic regression models. This was especially true in clinically borderline cases. NCS did not predict the outcome of conservative management. We concluded that NCS provide independent information in the evaluation of suspected CTS, especially when fewer clinical criteria are present, but that NCS are not helpful in predicting the outcome of nonsurgical management.

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Section: Discussionmentioning

confidence: 99%

Carpal tunnel syndrome with normal nerve conduction studies

2004

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“…Phalen advocated bilateral carpal tunnel releases, performed at least 1 month apart to minimize incapacitation and improve the chance of recovery [29,31]. Other reports have described success with simultaneous bilateral procedures [2,5,25,26]. Pagnanelli and Barrer reported that simultaneous releases, using the Paine retinaculatome, relieved symptoms in 94% of 228 patients with bilateral symptoms [26].…”

Section: Introductionmentioning

confidence: 99%

?Sympathy pains? in carpal tunnel syndrome

McLaughlin

Pizzi

1996

Acta neurochir

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We reviewed the records of all patients with carpal tunnel syndrome who underwent carpal tunnel release by the same neurosurgeon between 1980 and 1990. Of the total 102 patients, 71 patients (70%) had bilateral symptoms. Twenty-six patients in this group (37%) underwent bilateral surgery first on the more severely affected hand, and 1 month later on the contralateral hand. The remaining 45 patients with bilateral symptoms had surgery only on the more severely affected hand, contralateral surgery being withheld for various reasons. These 45 patients were sent follow-up questionnaires to evaluate the symptoms on the hand not treated surgically. The minimum follow up time after surgery was 14 months with an overall mean follow up of 5 years. Of the 33 respondents to the questionnaire, 15 patients stated that symptoms had disappeared in the non-operated hand, 4 said that their symptoms had improved, and 11 reported that symptoms had stayed the same. Three patients eventually underwent surgery on this previously non-operated hand. Thus, 58% of those who responded stated that; without surgery, the symptoms on their contralateral hand either improved or disappeared after surgery on the other hand. We suggest that simultaneous bilateral carpal tunnel surgery may be unnecessary for some patients with bilateral symptoms.

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“…Although Pagnanelli and Barrer [17] reported no recurrent thenar branch injuries after CTR surgery via a blind technique using the retinaculotome, we remain concerned that the rare aberrant course of the recurrent thenar motor branch can predispose it to be injured in any blind procedure. Median and ulnar nerve transection injuries along with nerve contusion and vascular injuries with both the uniportal and two-portal ECTR techniques have been reported.…”

Section: Discussionmentioning

confidence: 97%

“…Numerous reports have documented that sectioning of the TCL by any method leads to excellent results in patients with CTS. [1,5,7,8,17,26,27] Previous reports have described endoscopic CTR (ECTR) surgery as a technically demanding procedure with a significant learning curve. [2,6,7,9,15,22,23] The immediate question that arises is: why make a simple surgery more difficult?…”

Section: Discussionmentioning

confidence: 99%

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Microsurgical carpal tunnel release

Shapiro¹

1997

FOC

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The author reports on a series of 482 patients who underwent primary carpal tunnel release (CTR) surgery beginning in 1987. Two hundred twenty-five patients underwent CTR in the right hand, 169 patients underwent CTR in the left hand, and 88 patients underwent bilateral CTR surgery, for a total of 570 hands. These surgeries were performed on an outpatient basis. After application of a local anesthetic, a microsurgical technique using a 2-cm longitudinal incision that did not cross the wrist flexion crease was accomplished. In five patients the recurrent thenar branch exited through the middle or ulnar portion of the ligament and this branch was preserved in all five. Perioperative complications included stitch abscesses in nine hands (2%), which were managed on an outpatient basis; deep wound infections occurred in three hands (0.5%) and these patients were admitted for intravenous antibiotic administration and wound care. One steroid-dependent patient suffered wound dehiscence due to a fall and the wound was primarily repaired. One patient required a second minor procedure to remove a retained suture. Two patients developed “trigger finger” 6 months postoperatively. The mean time until return to work for those patients not receiving Workers' Compensation was 3 weeks and for those receiving Workers' Compensation it was 6.5 weeks. Complete disappearance of painful dysesthesias occurred in 431 (89%) of 482 patients. Marked improvement occurred in another 33 (7%) patients, yielding an overall improvement rate of 96%. Motor improvement was noted in 438 (96%) of 454 patients with preoperative motor weakness. Bilateral symptoms resolved on the contralateral side following unilateral surgery in seven patients. Fifteen patients (12 of whom were receiving Workers' Compensation) experienced persistent dysesthesias and/or incision pain and did not return to work. An additional eight procedures were performed in patients who had previously undergone surgery at another institution; four showed no evidence of their transverse carpal ligament being sectioned. Five of the eight patients undergoing reexploration noted postoperative improvement in their symptoms. Finally, 14 (3%) patients presented 1 to 5 years postsurgery with thenar/hypothenar pain. These patients have responded to local steroid injections and are being followed by a hand surgeon. The reimbursement of the surgeon's fee is $253.00 from Medicaid, $360.00 from Medicare, and $560.00 from preferred provider insurance. The mean total time in the outpatient operating room is 35 to 40 minutes. The outcome and time to return to work are equal, if not superior, to those reported for endoscopic CTR surgery. Microsurgical CTR is thought to be safer and probably more cost-effective.

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Carpal tunnel syndrome: surgical treatment using the Paine retinaculatome

Cited by 30 publications

References 31 publications

Carpal tunnel syndrome with normal nerve conduction studies

Carpal tunnel syndrome with normal nerve conduction studies

?Sympathy pains? in carpal tunnel syndrome

Microsurgical carpal tunnel release

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