Endoscopic treatment of carpal tunnel syndrome: a critical review

Jimenez, David F.; Gibbs, Scott R.; Clapper, Adam T.

doi:10.3171/jns.1998.88.5.0817

Cited by 73 publications

(33 citation statements)

References 51 publications

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“…13,[28][29][30] Some of these studies showed that CTR provides early relief of sensory symptoms such as pain and sensory disturbance, which are the most common symptoms of median nerve compression. [13][14][15]31 In our study, 12 of the 13 patients felt sensory symptomatic relief 5.38 weeks after CTR with significant improvement in static or moving 2PD tests following surgical release of the transverse carpal ligament (Table 1). This result is similar to Yung's findings that patients receiving a limited incision of the ligament experienced improved movement in the 2PD test at 4 weeks postsurgery.…”

Section: Discussionmentioning

confidence: 99%

“…12 Using sensory measurement tools, and particularly sensory threshold measurements, previous studies imply that sensory symptoms are quickly relieved by carpal tunnel release (CTR). [13][14][15] However, few studies investigated the effect of sensory improvement upon manual capacity after therapy or surgery. Among the previous studies addressing this area, one uses a rapid pinch-and-release task to assess manual task functions of CTS patients who underwent surgery.…”

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confidence: 99%

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Functional sensibility assessment. part II: Effects of sensory improvement on precise pinch force modulation after transverse carpal tunnel release

Hsu

Kuo

Chiu

et al. 2009

Journal Orthopaedic Research

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Patients with median nerve compression at the carpal tunnel often have poor sensory afferents. Without adequate sensory modulation control, these patients frequently exhibit clumsy performance and excessive force output in the affected hand. We analyzed precision grip function after the sensory recovery of patients with carpal tunnel syndrome (CTS) who underwent carpal tunnel release (CTR). Thirteen CTS patients were evaluated using a custom-designed pinch device and conventional sensory tools before and after CTR to measure sensibility, maximum pinch strength, and anticipated pinch force adjustments to movement-induced load fluctuations in a pinch-holding-up activity. Based on these tests, five force-related parameters and sensory measurements were used to determine improvements in pinch performance after sensory recovery. The force ratio between the exerted pinch force and maximum load force of the lifting object was used to determine pinch force coordination and to prove that CTR enabled precision motor output. The magnitude of peak pinch force indicated an economic force output during manipulations following CTR. The peak pinch force, force ratio, and percentage of maximum pinch force also demonstrated a moderate correlation with the Semmes-Weinstein test. Analysis of these tests revealed that improved sensory function helped restore patients' performance in precise pinch force control evaluations. These results suggest that sensory information plays an important role in adjusting balanced force output in dexterous manipulation. ß

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Functional sensibility assessment. part II: Effects of sensory improvement on precise pinch force modulation after transverse carpal tunnel release

Hsu

Kuo

Chiu

et al. 2009

Journal Orthopaedic Research

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“…The advantages and disadvantages of the above techniques are a matter of debate, but their common goal is to release the median nerve by completely transecting the flexor retinaculum (FR) [5][6][7][8][9][10] . Whatever the technique, important structures such as the palmar cutaneous, recurrent motor and digital branches of the median nerve and the ulnar nerve, the superficial palmar arch and tendons must be protected during the operation 9 .…”

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confidence: 99%

Carpal tunnel syndrome: treatment with small transverse incision

Kaleff

Lima

Fernandes

et al. 2010

Arq. Neuro-Psiquiatr.

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Objective: To evaluate the application of a limited transverse incision technique to treat the carpal tunnel syndrome, with concern to its safety and efficacy in the opening of the flexor retinaculum (FR). Method: A prospective analysis of thirty FR release procedures performed on twenty-eight patients subjected to the proposed incision technique. Safety and total opening of the FR were evaluated through a questionnaire and an endoscopic inspection respectively. results: No major complications were observed. Two cases presented small local hematoma. One patient presented with transient neuropraxia of digital branch. In two of the first five cases, incomplete FR opening was identified during endoscopic revision with need of complementary opening. All patients reported relief of paresthesias and nocturnal pain symptoms. conclusion: The technique was safely performed on the prospection group, no major complications were detected and the opening of FR was observed in the majority of the patients. Key words: carpal tunnel syndrome, surgical procedures, minimally invasive, safety.Utilização de técnica de incisão transversal mínima no tratamento da síndrome do túnel do carpo resUMO Objetivo: Avaliação de técnica de incisão limitada no tratamento da síndrome do túnel do carpo, quanto à segurança clínica e efetividade na abertura do Retináculo Flexor (RF). Método: Estudo prospectivo de trinta procedimentos realizados em vinte e oito pacientes submetidos a técnica com incisão transversa mínima. A segurança da técnica e a abertura total do RF foram avaliadas através de questionário baseado em observações clinicas e inspeção endoscópica, respectivamente. resultados: Não foram observadas complicações maiores. Um único paciente apresentou neuropraxia de nervo interdigital. Dois pacientes apresentaram hematoma local pequeno. Em dois dos cinco primeiros casos observou-se uma abertura incompleta do RF, sendo necessária abertura complementar. Todos os pacientes apresentaram melhora do quadro clínico de dor noturna e parestesias. conclusão: A técnica foi executada com segurança no grupo analisado, sem a ocorrência de complicações graves, e com abertura do RF na quase totalidade dos casos. Palavras-chave: síndrome do túnel do carpo, cirurgia, minimamente invasiva, segurança.

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“…Other literary sources do not suggest this (3,8). A metaanalysis of randomized controlled trials (17) shows a reduction in scar tenderness and increase in grip and pinch strength at 12 week follow up in endoscopic group but also increases susceptibility to reversible nerve injury that is three times as likely to occur with endoscopic carpal tunnel release than with open carpal tunnel release.…”

Section: Tabmentioning

confidence: 99%

The Potential Benefit of Intracarpal Pressure Measurement in Endoscopic Carpal Tunnel Syndrome Surgery – An Analysis of EMG Findings and Pressure Values

Kanta

Ehler²,

Kremláček

et al. 2009

Acta Med. (Hradec Kralove, Czech Repub.)

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Several methods of carpal tunnel syndrome (CTS) surgery have been described. The open approach is regarded as the gold standard, however there are also many critics of this technique. Due to the fact that results of open surgery are often quite disappointing -about 60 % of patients have scar pain or so called pillar pain in the hypothenar and thenar eminences following surgery, we have therefore, turned our interests to less invasive techniques. In the past 12 years, we have accumulated vast experience in CTS surgery, which is a very frequent procedure in our department. Other than the classic open approach, we have obtained experience in the so called "twin incision technique" (1) "flexor carpi radialis approach" (20) and the uniportal (single portal) endoscopic approach (9). Endoscopy is our favoured technique (system Wolf). In most cases of mild or moderate EMG findings, using the endoscopic technique we were able to achieve superior patient satisfaction rates.Intracarpal pressure (ICP) measurement has a long history. The accepted normal ICP range in healthy individuals is between 3-6 mmHg in the neutral wrist position and up to 20-60 mmHg during extension (21). The positive results of certain groups, especially studies done by Japanese authors have led us to further improve our results. In our study, a Codman sensor, typically used for the measurement of intracranial pressure was used to measure intracarpal pressure. The main reason for ICP measurement was to evaluate the relationship between peroperative intracarpal pressure, the level of decompression and pre/postoperative EMG findings. In addition, the effect of different hand positions and anatomical location on ICP was assessed. Summary: Endoscopic carpal tunnel syndrome surgery is a modern minimally invasive method of carpal tunnel decompression. However, the method does also have its critics, who emphasize that there is an increased rate of complications in comparison to open procedures. To further improve and optimize results of endoscopic surgery we used an intracarpal pressure sensor to verify the effect of carpal tunnel decompression. The endoscopic single portal approach was used in all cases. Median nerve conduction studies were performed prior to and 3 months after surgery. Two groups, those with pressure studies and those without, were then compared according to several EMG parameters such as: median nerve distal motor latency, amplitude of motor response, sensory nerve conduction velocity to the index finger, and amplitude of sensory nerve action potential. In both groups, we observed similarly significant improvements in all conduction parameters, except the amplitude of motor response, which did not change in either group, i.e. no difference in postoperative EMG between the two groups was observed. Despite this fact, intracarpal pressure measurement is still useful in localising the point in which the median nerve is compressed and provides valuable functional information on the level decompression achieved. Material and Methods Surgery TH...

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Endoscopic treatment of carpal tunnel syndrome: a critical review

Abstract: Success and complication rates of endoscopic carpal tunnel release surgery are similar to those for standard open procedures.

Cited by 73 publications

References 51 publications

Functional sensibility assessment. part II: Effects of sensory improvement on precise pinch force modulation after transverse carpal tunnel release

Functional sensibility assessment. part II: Effects of sensory improvement on precise pinch force modulation after transverse carpal tunnel release

Carpal tunnel syndrome: treatment with small transverse incision

The Potential Benefit of Intracarpal Pressure Measurement in Endoscopic Carpal Tunnel Syndrome Surgery – An Analysis of EMG Findings and Pressure Values

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