Simultaneous Surgical Release of Ipsilateral Pronator Teres and Carpal Tunnel Syndromes

Mujadzic, Mirsad; Papanicolaou, George; Young, H. B.; Tsai, Tsu Min

doi:10.1097/01.prs.0000260703.56453.06

Cited by 31 publications

(14 citation statements)

References 21 publications

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“…Our previous study reported 55 patients in whom both lesions were suspected and they underwent simultaneous release of the ipsilateral pronator and carpal tunnel. Benefits of this protocol were limited exposure for two operations, shortened morbidity time and provided satisfactory outcome (86% improved symptom and 65% complete recovery) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Role of pronator release in revision carpal tunnel surgery

Luangjarmekorn

Tsai

Honsawek

et al. 2016

SICOT-J

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Introduction: The purpose of this study was to compare the result of treatment of patients with failed primary carpal tunnel surgery who suspected pronator teres syndrome (PTS) by performing revision carpal tunnel release (CTR) with pronator teres release (PTR) and revision CTR alone. Methods: Retrospective chart review in patients who required revision CTR and suspected PTS. Group 1, treated by redo CTR with PTR and group 2, treated by redo CTR alone. Intraoperative findings, pre and postoperative numbness (2-PD), pain (VAS score), and grip strength were studied. Results: There were 17 patients (20 wrists) in group 1 and 5 patients (5 wrists) in group 2. Patients in group 1 showed more chance of fully recovery of numbness and pain than group 2 (60% vs. 0%, p < 0.05 and 55.0% vs. 0%, p < 0.05, respectively). Mean grip strength was increased 16.0% in group 1 and increase 11.7% in group 2. Most common pathology at the elbow were deep head of pronator teres 90% (18/20 elbows) and lacertus fibrosus 50% (10/20 elbows). The most common finding at carpal tunnel was the reformed transverse carpal ligaments (80%, 20/25 wrists) and scar adhesion around the median nerve (40%, 10/25 wrists). Discussion: Intraoperative findings from our study confirmed that there were pathology in both carpal tunnel and pronator area in failed primary CTR with suspected PTS. Our study showed that combined PTR with revision CTR provided higher chance of completely recovery from numbness and pain more than redo CTR alone.

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Section: Introductionmentioning

confidence: 99%

Role of pronator release in revision carpal tunnel surgery

Luangjarmekorn

Tsai

Honsawek

et al. 2016

SICOT-J

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“…Symptoms were resolved in 8 forearms: reduced (n = 20), persistent (n = 5), and unchanged (n = 3). 3 Mujadzic et al 25 evaluated 61 patients following release of the lacertus fibrosus, PT, and the FDS arch and reported complete relief in 39 patients. In a previous anatomical study, the FDS arch was found to be tendinous in most cases with direct fibrous attachments to the underlying median nerve and increased compression seen with forearm extension.…”

Section: Discussionmentioning

confidence: 99%

Median Nerve Compression in the Forearm: A Clinical Diagnosis

El-Haj

Ding

Sharma

et al. 2019

Hand (New York, N,Y.)

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Background: Median nerve entrapment in the forearm (MNEF) without motor paralysis is a challenging diagnosis. This retrospective study evaluated the clinical presentation, diagnostic studies, and outcomes following surgical decompression of MNEF. Methods: The study reviewed 147 patient medical charts following MNEF surgical decompression. With exclusion of patients with combined nerve entrapments (radial and ulnar), polyneuropathy, neurotmetic nerve injury, or median nerve motor palsy, the study sample included 27 patients. Data collected include: clinical presentation and pain, strength, provocative testing, functional outcomes, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: The study included 27 patients (mean follow-up = 7 months), and 13 patients had previous carpal tunnel release (CTR). Clinical presentation included pain (n = 27) (forearm, n = 22; median nerve innervated digits, n = 21; and palm, n = 21) and positive clinical tests (forearm scratch collapse test, n = 27; pain with compression over the flexor digitorum superficialis arch/pronator, n = 24; Tinel sign, n = 11). Positive electrodiagnostic studies were found for MNEF (n = 2) and carpal tunnel syndrome (n = 11). Primary CTR was performed in 10 patients and revision CTR in 7 patients. Postoperatively, there were significant ( P < .05) improvements in strength, pain, quality of life, and DASH scores. Conclusions: The MNEF without motor paralysis is a clinical diagnosis supported by pain drawings, pain quality, and provocative tests. Patients with persistent forearm pain and median nerve symptoms (especially after CTR) should be evaluated for MNEF. Surgical decompression provides satisfactory outcomes.

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“…46) If there is tenderness at the proximal forearm and sensory changes are found in the palm and the first three fingers, pronator teres syndrome should be also considered. 47) Concomitant ulnar or cubital tunnel syndrome should be considered if signs include first dorsal interosseous weakness or tingling in the fourth and fifth digits. 1,2) Raynaud’s phenomenon—vibration white finger—should be considered if the patient has a history of exposure to cold temperatures or vibration.…”

Section: Differential Diagnosis Of Ctsmentioning

confidence: 99%

Importance of Recognizing Carpal Tunnel Syndrome for Neurosurgeons: A Review

Yunoki

Kanda

Suzuki

et al. 2017

Neurol. Med. Chir.(Tokyo)

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Idiopathic carpal tunnel syndrome (CTS) is a common complaint, reflecting entrapment neuropathy of the upper extremity. CTS produces symptoms similar to those of other conditions, such as cervical spondylosis or ischemic or neoplastic intracranial disease. Because of these overlaps, patients with CTS are often referred to a neurosurgeon. Surgical treatment of CTS was started recently in our department. Through this experience, we realized that neurosurgeons should have an increased awareness of this condition so they can knowledgeably assess patients with a differential diagnosis that includes CTS and cervical spinal and cerebral disease. We conducted a literature review to gain the information needed to summarize current knowledge on the clinical, pathogenetic, and therapeutic aspects of CTS. Because the optimal diagnostic criteria for this disease are still undetermined, its diagnosis is based on the patient’s history and physical examination, which should be confirmed by nerve conduction studies and imaging modalities such as magnetic resonance imaging and ultrasonography. Treatment methods include observation, medication, splinting, steroid injections, and surgical intervention. Understanding the clinical features and pathogenesis of CTS, as well as the therapeutic options available to treat it, is important for neurosurgeons if they are to provide the correct management of patients with this disease.

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Simultaneous Surgical Release of Ipsilateral Pronator Teres and Carpal Tunnel Syndromes

Abstract: The main benefit of using this protocol in this selected group of patients is to shorten total morbidity time and to avoid exposure of the patient to two operations instead of one.

Cited by 31 publications

References 21 publications

Role of pronator release in revision carpal tunnel surgery

Role of pronator release in revision carpal tunnel surgery

Median Nerve Compression in the Forearm: A Clinical Diagnosis

Importance of Recognizing Carpal Tunnel Syndrome for Neurosurgeons: A Review

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