Recurrent and persistent carpal tunnel syndrome: “Triple-therapy approach”

Spielman, Amanda; Skowronski, Piotr Pawel; Lessard, Anne Sophie; Panthaki, Zubin J.

doi:10.1016/j.jor.2020.09.003

Cited by 8 publications

(9 citation statements)

References 28 publications

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“…Nerve reconstruction with ANC is an established method for the successful treatment of sensory nerves with short defects, and collagen conduits are commercially available and widely used. 15,[18][19][20][21][22] Meanwhile, satisfactory results have not been obtained in motor nerve recovery and nerve reconstruction in nerve injuries with long defects. Advances in new ANCs by adding fillers of various materials, growth factors, and cytokines have been achieved.…”

Section: Discussionmentioning

confidence: 99%

“…Nerve wrapping showed good results in animal models of crush injury and adhesion formation. [10][11][12] Furthermore, artificial nerve wraps (ANWs) yielded remarkable clinical results in recurrent/persistent carpal tunnel syndrome [13][14][15] and digital nerve injury. 16 In real-world clinical practice, we often experience partial nerve injuries with defects of several millimeters.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of collagen conduit wrapping with collagen fibers on nerve regeneration in sciatic nerve injury with partial transection: An experimental study in the rat model

Tanaka,

Kurimoto,

Hirata

2024

J Biomed Mater Res

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Peripheral nerve injuries (PNIs) include complete and partial transection, crushing, and chronic compression injuries. Hollow absorbable conduits are used to treat complete transection with short defects, while wrapping the injured part with an absorbent material promotes nerve recovery by inhibiting inflammatory cell infiltration and scar tissue formation in crush injuries. For treatment of partially transected nerve injuries (PTNIs), such as injection‐related iatrogenic PNI, whether wrapping the entire nerve, including the injury site, or bridging the transected fascicle with an artificial nerve conduit (ANC) is beneficial remains to be verified. The purpose of this study was to investigate whether wrapping the injured nerve and placing collagen fibers as scaffolds at the nerve defect site contribute to neural recovery in PTNI. A unilateral 5‐mm partial nerve defect was created at the mid‐thigh level in a rat sciatic nerve injury model. Fifty‐four Sprague–Dawley (SD) rats (150–250 g) were divided into three groups (n = 9 each): group 1, collagen fibers were placed in the nerve defect and the sciatic nerve was wrapped with collagen conduit; group 2, the sciatic nerve was wrapped by collagen conduit without collagen fibers; and group 3, nerve defect was reconstructed with collagen‐filled conduit. Nerve regeneration was evaluated by analyses of gait, electrophysiology, wet muscle weight, and axon numbers with immunohistochemistry at 12 and 24 weeks. Dorsiflexion angles among all groups improved significantly from 12 to 24 weeks postoperatively. At 24 weeks postoperatively, compound muscle action potential amplitudes (CMAPs) of tibialis anterior were 5.26 ± 4.64, 1.31 ± 1.17, and 0.14 ± 0.24 mV (p < .05), CMAPs of gastrocnemius were 21.3 ± 5.98, 15.4 ± 5.46, and 13.11 ± 3.91 mV in groups 1, 2, and 3, respectively; and the value of group 1 was significantly higher than that of group 3 (p < .05). Axon numbers were 2194 ± 629; 1106 ± 645; and 805 ± 907 in groups 1, 2, and 3, respectively (p < .05). For PTNI reconstruction, artificial nerve wrap (ANW) was superior to ANC. Providing collagen scaffold at the nerve defect site enhanced nerve recovery during reconstruction with ANW.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of collagen conduit wrapping with collagen fibers on nerve regeneration in sciatic nerve injury with partial transection: An experimental study in the rat model

Tanaka,

Kurimoto,

Hirata

2024

J Biomed Mater Res

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“…However, as one animal study by Nicolas et al demonstrated, the potential for over-tightening nerve wraps has detrimental effects ( 16 ). Spielman et al reported resolution of symptoms and improved VAS scores in 30 patients with recurrent or persistent carpal tunnel syndrome who had surgery that involved the use of a nerve wrap ( 17 ). Additionally, Thakkar et al in a systematic review reported improvements in outcomes after revision compressive nerve surgery that included the use of a nerve wrap ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Outcomes following use of VersaWrap nerve protector in treatment of patients with recurrent compressive neuropathies

et al. 2023

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Epineural scarring following previous carpal or cubital tunnel release can lead to pain and permanent dysfunction. To prevent this cascade, nerve wraps are an option. The purpose of this study was to evaluate outcomes following use of VersaWrap nerve protector during surgical decompression and neurolysis in patients with recurrent compressive neuropathies in the upper extremity. Twenty patients comprised the patient cohort, with a mean postoperative follow-up time of 139 days (range: 42–356 days). There were 13 females and 7 males, with a mean age of 43.4 years. Fourteen surgeries were performed for revision cubital tunnel, 5 for revision carpal tunnel, and 1 for revision radial tunnel syndrome. Average duration of symptoms prior to revision surgery with VersaWrap was 2 years (range 9 months to 6 years). Postoperatively, the mean DASH score was 57.7 and VAS 3.1. Mean s2PD median distribution was 7.3, s2PD ulnar distribution 8.9, m2PD median distribution 6.9 and m2PD ulnar distribution 7.3. All patients had subjective improvement of symptoms and were satisfied with their result. No patients in our cohort required further revisional surgery. In conclusion, the use of VersaWrap as a nerve protector following revision surgery for recurrent compressive neuropathies in the upper extremity was safe and effective.Level of Evidence: IV; retrospective case series

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“…Repeated surgical intervention will be needed in 5% to 10% of patients with recurrent or persistent symptoms [ 10 , 11 ]. The known causes affecting the failure rate of surgical decompression include incomplete release of the transverse carpal ligament, persistent tenosynovitis, prolonged compression, delayed diagnosis, and extensive external and internal neural scarring [ 12 , 13 ]. In this manner, the success rate of repeated surgery for recurrent and persistent carpal tunnel syndrome might be much lower than that of primary surgical decompression.…”

Section: Introductionmentioning

confidence: 99%

Investigation of Neuropathology after Nerve Release in Chronic Constriction Injury of Rat Sciatic Nerve

Chen

Lin

et al. 2021

IJMS

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Peripheral compressive neuropathy causes significant neuropathic pain, muscle weakness and prolong neuroinflammation. Surgical decompression remains the gold standard of treatment but the outcome is suboptimal with a high recurrence rate. From mechanical compression to chemical propagation of the local inflammatory signals, little is known about the distinct neuropathologic patterns and the genetic signatures after nerve decompression. In this study, controllable mechanical constriction forces over rat sciatic nerve induces irreversible sensorimotor dysfunction with sustained local neuroinflammation, even 4 weeks after nerve release. Significant gene upregulations are found in the dorsal root ganglia, regarding inflammatory, proapoptotic and neuropathic pain signals. Genetic profiling of neuroinflammation at the local injured nerve reveals persistent upregulation of multiple genes involving oxysterol metabolism, neuronal apoptosis, and proliferation after nerve release. Further validation of the independent roles of each signal pathway will contribute to molecular therapies for compressive neuropathy in the future.

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Recurrent and persistent carpal tunnel syndrome: “Triple-therapy approach”

Cited by 8 publications

References 28 publications

Efficacy of collagen conduit wrapping with collagen fibers on nerve regeneration in sciatic nerve injury with partial transection: An experimental study in the rat model

Efficacy of collagen conduit wrapping with collagen fibers on nerve regeneration in sciatic nerve injury with partial transection: An experimental study in the rat model

Outcomes following use of VersaWrap nerve protector in treatment of patients with recurrent compressive neuropathies

Investigation of Neuropathology after Nerve Release in Chronic Constriction Injury of Rat Sciatic Nerve

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