Carpal tunnel syndrome-median nerve enlargement restricted to the distal carpal tunnel

2012 ◽  
Vol 46 (3) ◽  
pp. 455-457 ◽  
Author(s):  
Aravindakannan Therimadasamy ◽  
Yeoung Pin Peng ◽  
Einar P. Wilder-Smith
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Enlargement ◽  
Tunnel Syndrome

scholarly journals POS0584 ULTRASONOGRAPHY OF THE MEDIAN NERVE IN PATIENTS WITH RHEUMATOID ARTHRITIS UNDER SUSPICION OF CARPAL TUNNEL SYNDROME

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 525.1-525
Author(s):  
S. Tsiami ◽  
E. Ntasiou ◽  
C. Krogias ◽  
R. Gold ◽  
J. Braun ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction Velocity ◽  
Sectional Area ◽  
Cross Sectional ◽  
Spearman's Rho ◽  
Spearman’S Rho ◽  
Tunnel Syndrome

Background:Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome and a common extra-articular manifestation of rheumatoid arthritis (RA). Different causes of CTS are known, among them inflammatory and non-inflammatory pathologies. Electroneurography (ENG) of the median nerve, the method of choice to diagnose CTS, measures impairment of nerve conduction velocity without explaining its underlying cause. However, because the electrical stimulation is often not well tolerated, ENG results may come out inconclusive. Using greyscale ultrasonography (GS-US) provides anatomic information including a structural representation of the carpal tunnel.Objectives:To investigate the performance of nerve GS-US in the diagnosis of CTS in patients with RA.Methods:Consecutive patients with active RA under suspicion of CTS presenting to a large rheumatologic center were included. Both hands were examined by an experienced neurologist including ENG and a GS-US (ML linear probe with 6-15 Hz) of the median nerve. An established grading system for ENG (1), and an established system for GS-US based on cut-offs for the nerve cross sectional area (CSA) [mild: 0,11-0,13cm2, moderate: 0,14-0,15 cm2, severe: > 0,15 cm2 CTS (2)] were used. In addition, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) was used to assess CTS symptoms (3).Results:Both hands of 58 patients with active RA (n=116) and clinical suspicion of CTS (in 38 cases bilaterally) were included. After clinical examination, CTS was suspicious in 96 hands (82.8%), and 59 of all hands had a final diagnosis of CTS (50.9%). Of the latter, 43 hands (72.9%) had a positive ENG and 16 (27.1%) a positive GS-US finding only, while 30 hands (50.8%) were positive in both examinations.There was a good correlation of the cross-sectional area (CSA) as well as the CSA-ratio to the ENG findings: the larger the CSA, the more severe was the CTS as assessed by ENG (Spearman’s rho=0.554; p<0.001). The more severe the GS-US findings of CTS were, the more definite were the distal motor latency (Spearman’s rho=0.554; p<0.001) and sensible nerve conduction velocity of the median nerve (Spearman’s rho=-0.5411; p<0.001).In the 46 hands positive in GS-US, tenosynovial hypertrophy of the flexor tendons was detected in 19 hands (41.3%), 7 of which (36.8%) also showed an additional cystic mass. In these 19 patients, clinical complains were more severely present than in patients with non-inflammatory CTS, as assessed by the BCTSQ with a total score of 68.8±13.4 vs. 59.3±13.7, respectively (p=0.007).Conclusion:In patients with active RA and clinical complains of CTS, ultrasound examinations provide additional information about inflammation which is helpful for a diagnosis of CTS. Thus, ENG and nerve GS-US should be used complementary for a diagnostic workup of CTS in RA patients with a suspicion of CTS. Power-Doppler may further improve the diagnostic performance of GS-US.References:[1]Padua L et al. Acta Neurol Scand 1997; 96:211–217[2]El Miedany et al., Rheumatology (Oxford). 2004 Jul; 43(7):887-895[3]Levine DW et al. J Bone Joint Surg Am 1993; 75: 1585-1592Figure 1.BCTSQ scores in patients with diagnosis of CTS and absence or presence of RA-related tenosynovial hypertrophyDisclosure of Interests:None declared

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.

scholarly journals First Lumbrical Muscle Flap for Recurrence of Carpal Tunnel Syndrome: Anatomical Study and Surgical Technique

2021 ◽  
Vol 49 (01) ◽  
pp. 079-087
Author(s):  
Esther Fernández Tormos ◽  
Fernando Corella Montoya ◽  
Blanca Del Campo Cereceda ◽  
Montserrat Ocampos Hernández ◽  
Teresa Vázquez Osorio ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Revision Surgery ◽  
Muscle Flap ◽  
Anatomical Study ◽  
Physical Barrier ◽  
Adjacent Structures ◽  
Tunnel Syndrome ◽  
Lumbrical Muscle

AbstractRecurrence of carpal tunnel syndrome implies the reappearance of symptoms after release surgery. If the cause of recurrence is not an incomplete release, but a traction neuritis, the tendency is to add to the revision surgery of the carpal tunnel the use of flaps to cover the median nerve. These flaps establish a physical barrier between the nerve and the rest of the adjacent structures, preventing adhesions, and providing neovascularization and better nerve sliding.In the present work, we detail a revision surgery in which the first lumbrical muscle is used as a covering flap. This flap has two benefits. Firstly, it acts as a vascularized coverage for the median nerve (avoiding the formation of fibrosis and favoring its sliding); secondly, a structure that takes up space is removed from the carpal tunnel, thus reducing the pressure within it.Along with the explanation of the technique, the present article provides a detailed description of the anatomical variability of the first lumbrical muscle and its vascularization, as well as the results of a cadaveric study on the location of the vascular pedicle of the first lumbrical muscle.

Bilateral clinical neurophysiological assessment of median nerve in carpal tunnel syndrome patients

1998 ◽  
Vol 21 (2) ◽  
pp. 264-265 ◽  
Author(s):  
Luca Padua ◽  
Mauro LoMonaco ◽  
Bruno Gregori ◽  
Vincenzo Di Lazzaro ◽  
Roberto Padua ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Tunnel Syndrome ◽  
Neurophysiological Assessment
Sign in / Sign up

Export Citation Format

Share Document