Simultaneous vascularized lymph node transfer and carpal tunnel release for treatment of advanced stage of breast cancer-related lymphedema with carpal tunnel syndrome

Microsurgery ◽  
2017 ◽  
Vol 37 (6) ◽  
pp. 745-746 ◽  
Author(s):  
Pedro Ciudad ◽  
Oscar J Manrique ◽  
Shivprasad Date ◽  
Mouchammed Agko ◽  
Wei-Ling Chang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Advanced Stage ◽  
Tunnel Syndrome ◽  
Breast Cancer Related Lymphedema ◽  
Lymph Node Transfer ◽  
Vascularized Lymph Node Transfer

scholarly journals Surgical Treatment of Carpal Tunnel Syndrome and Lymphedema in Advanced-Stage Upper Extremity Lymphedema

2021 ◽  
Author(s):  
Soo-Byn Kim ◽  
Kyung-Chul Moon
Keyword(s):  
Breast Cancer ◽  
Carpal Tunnel Syndrome ◽  
Upper Extremity ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Adjuvant Chemoradiotherapy ◽  
Axillary Lymph ◽  
Advanced Stage ◽  
Transverse Carpal Ligament ◽  
Tunnel Syndrome

Abstract Background Recent advances in supermicrosurgery have evolved to treat lymphedema surgically. For patients with carpal tunnel syndrome (CTS) and advanced-stage lymphedema, lymphovenous anastomosis (LVA) may effectively improve lymphedema after carpal tunnel release in patients with CTS and advanced stage lymphedema. However, no studies have reported simultaneous carpal tunnel release and LVA surgeries for patients with CTS and advanced-stage lymphedema.Case Presentation A 60-year-old female with carpal tunnel syndrome and International Society of Lymphology late stage 2 right upper extremity lymphedema following right mastectomy and axillary lymph node dissection and adjuvant chemoradiotherapy for treating breast cancer was admitted to our lymphedema clinic. She developed carpal tunnel syndrome four years after breast cancer surgery. She underwent release of the transverse carpal ligament, followed by four lymphovenous anastomoses at the wrist, forearm, and antecubital area. After two simultaneous surgeries, she had less neuropathic pain and volume reduction in her hand.Conclusion The authors recommend simultaneous LVA and release of the transverse carpal ligament as the first treatment option for patients with advanced-stage lymphedema and concurrent CTS.

A Systematic Review of Peripheral Neuropathies in Breast Cancer–Related Lymphedema

Hand ◽  
2020 ◽  
pp. 155894472096394
Author(s):  
Antonio J. Forte ◽  
Maria T. Huayllani ◽  
Daniel Boczar ◽  
Oscar J. Manrique ◽  
Xiaona Lu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Neuropathic Pain ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Peripheral Neuropathies ◽  
Secondary Lymphedema ◽  
Tunnel Syndrome ◽  
Breast Cancer Related Lymphedema

Controversy exists regarding the influence of breast cancer–related lymphedema (BCRL) in the development of peripheral neuropathies. Our aim was to evaluate the association of secondary lymphedema with peripheral neuropathies in patients with breast cancer. We performed a systematic review by querying PubMed, EMBASE, Ovid Medline and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Cochrane Central Register of Controlled Trials databases. The keywords “lymphedema” AND (“neuropathy” OR “carpal tunnel syndrome” OR “cubital tunnel syndrome” OR “neuropathic pain”) and synonyms in titles and abstracts were used to perform the search. Seventeen articles met the inclusion criteria. Discrepancies were found in studies that analyzed whether a cause-effect association exists between carpal tunnel syndrome (CTS) and secondary lymphedema. No evidence indicated that lymphedema predisposes to developing peripheral neuropathies such as CTS or brachial plexopathy. No studies found an association between patients with breast cancer at risk of or with lymphedema and the development or worsening of CTS. Carpal tunnel release can be safely performed in patients with BCRL. Neuropathic pain worsens with lymphedema, and treatment seems to improve the pain. Our study did not find enough evidence to conclude that BCRL is associated with the development of peripheral neuropathies. Carpal tunnel release is a safe procedure that can be performed in patients with BCRL and does not influence the development or worsening of lymphedema. Neuropathic pain seems to worsen after development of lymphedema, and treatment has been found to improve neuropathic pain.

Impact of carpal tunnel syndrome surgery on women with breast cancer-related lymphedema

2015 ◽  
Vol 152 (3) ◽  
pp. 683-686 ◽  
Author(s):  
Neetish Gunnoo ◽  
Michel Ebelin ◽  
Maria Arrault ◽  
Stéphane Vignes
Keyword(s):  
Breast Cancer ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Tunnel Syndrome ◽  
Breast Cancer Related Lymphedema

Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

2003 ◽  
Vol 8 (4) ◽  
pp. 4-5
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Proper Time ◽  
Carpal Tunnel Release ◽  
Hand Function ◽  
Factors Affecting ◽  
Early Results ◽  
Medical Evaluation ◽  
Nerve Recovery ◽  
Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

2021 ◽  
pp. 175319342110017
Author(s):  
Saskia F. de Roo ◽  
Philippe N. Sprangers ◽  
Erik T. Walbeehm ◽  
Brigitte van der Heijden
Keyword(s):  
Systematic Review ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Open Release ◽  
Flap Coverage ◽  
Tunnel Syndrome

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

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