Reoperation for carpal tunnel syndrome

Although primary carpal tunnel release is usually successful, reoperation is needed in up to 3% of patients. Common indications of reoperation are previous incomplete surgery and postoperative fibrosis. Although most patients improve after reoperation, persistent systems are likely and failure is more frequent than after primary carpal tunnel surgery. Risk factors for failure following reoperation include the presence of an active Worker's Compensation claim, pain in the ulnar nerve distribution, and the absence of abnormality on preoperative EMG.     

Screening for carpal tunnel syndrome in the workplace

Diaphragmatic crus lipoma is a very rare entity. In this case report, smooth, rounded masses of diaphragmatic lipoma, incidentally observed in a 37-year-old female on routine abdominal computed tomographic scanning is presented.     

Re: Management of idiopathic carpal tunnel syndrome

A male fetus of gestation day 187 was aborted from a Holstein-Friesian cow in an epizootic of the Aino virus (AINOV) in September 1995. Neutralizing antibody titers against AINOV were 1:128, 1:16 and 1:64 in the dam serum, fetal ascites and cerebrospinal fluid, respectively. A 10% brain suspension of the aborted fetus was prepared immediately after autopsy, rinsed three times and sonicated before centrifugation. The supernatant was then inoculated into HmLu-1 cell cultures. A cytopathic effect was noted on post-inoculation day 7. The isolated virus was identified as the AINOV based on the physicochemical properties and cross neutralization test. This is the first report on the isolation of AINOV from an aborted bovine fetus.     

Manipulative treatment of carpal tunnel syndrome: biomechanical and osteopathic intervention to increase the length of the transverse carpal ligament

To quantify the amount of transverse carpal ligament (TCL) elongation in response to osteopathic manipulation or sustained load bearing (or both), a study involving seven cadaver limbs was conducted. Distances from the trapezium to the hamate (distance A) and from the scaphoid to the pisiform (distance B) were measured in five mounted cadaver limbs during and after the limbs bore the weight (2 newtons [N] to 4 N) for 2 several-hour periods. A several-hour period occurred between the weight bearing to assess recoil. Distances A and B were measured before and after the limbs were manipulated, according to previously described techniques, as well as with a new maneuver, termed the "guywire" technique. Two dissected limbs also were subjected to further weight bearing, this time increased to 8 N. Greater weight loads produced greater lengthening of the TCL, and recoil after removal of weight loads was slower than recoil after manipulation. Manipulation was more effective than weight loading for increasing distance A (distal canal), but weight loading generally was more effective than manipulation for increasing distance B (proximal canal). The guywire manipulation combined with direct transverse extension appeared to have the greatest impact on lengthening the TCL distally. These results show promise for the effective use of manipulation and load bearing for TCL elongation and nonsurgical relief of pressure on the median nerve in patients with carpal tunnel syndrome.     

Ampicillin-metronidazole treatment in idiopathic preterm labour: a randomised controlled multicentre trial

OBJECTIVE: To determine whether treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour will prolong the gestation and reduce maternal and neonatal infectious morbidity. DESIGN: Randomised controlled double-blind trial. SETTING: Six obstetric departments in the Copenhagen area. POPULATION: One hundred and twelve women with singleton pregnancies, with threatened idiopathic preterm labour and intact amniotic membranes at 26 to 34 weeks of gestation. METHODS: Random allocation to eight days intravenous and oral treatment with ampicillin and metronidazole, or placebo. MAIN OUTCOME MEASURES: Number of days from admission to delivery, gestational age at delivery, rates of preterm delivery, low birthweight, maternal infections and neonatal infections. RESULTS: Treatment with ampicillin and metronidazole was associated with a significant prolongation of pregnancy (admission to delivery 47.5 days versus 27 days, P < 0.05), higher gestational age at delivery (37 weeks versus 34 weeks, P < 0.05), decreased incidence of preterm birth (42% versus 65%, P < 0.05), and lower rate of admission to neonatal intensive care unit (40% versus 63%, P < 0.05), when compared with placebo treatment. Antibiotic treatment had no significant effects on infectious morbidity. CONCLUSIONS: Treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour significantly prolonged the gestation, but had no effects on maternal and neonatal infectious morbidity.     

The nerve lesion in the carpal tunnel syndrome

The relative roles of pressure deformation and ischaemia in the production of compression nerve lesions remain a controversial issue. This paper concerns the genesis of the structural changes which follow compression of the median nerve in the carpal tunnel. The initial lesion is an intrafunicular anoxia caused by obstruction to the venous return from the funiculi as the result of increased pressure in the tunnel. This leads to intrafunicular oedema and an increase in intrafunicular pressure which imperil and finally destroy nerve fibres by impairing their blood supply and by compression. The final outcome is the fibrous tissue replacement of the contents of the funiculi.     

Surgical treatment results in patients with severe forms of the carpal tunnel syndrome

A retrospective and prospective study was undertaken to determine efficacy of carpal tunnel decompression in patients with advanced carpal tunnel syndrome (CTS). The criteria for inclusion in this study were clinical and nerve conduction studies (NCS). Between 1985-1991, 1511 NCSs performed were positive for CTS.     

Acute carpal tunnel syndrome secondary to pseudogout: case report

Acute carpal tunnel syndrome secondary to chondrocalcinosis seems not to have been previously reported. In a 75-year-old woman, with arthropathy and calcification of the triangular fibrocartilage of the wrist, hyperparathyroidism was suspected, but not proven. Hydroxyapatite and calcium pyrophosphate crystals were found together in the pathological specimen. The patient obtained complete relief from sectioning of the transverse carpal ligament.     

Our experience with reoperations for the diagnosis of the carpal tunnel syndrome

On the basis of the analysis of the results obtained and of the surgical findings during reoperations for the diagnosis of the Carpal Tunnel Syndrome it is recommended to perform a reoperation in cases of primary failure. Underlined is the surgical approach with the use of a prolonged incision, as well as an adequate postoperative care.     

High-resolution ultrasonography in the study of carpal tunnel syndrome

The cellular activity of hemocytes from the marine mollusc Mytilus galloprovincialis was studied using computer-assisted microscopic image analysis. PDGF-AB and TGF-beta 1 caused changes in cellular shape and induced the immunocytes to migrate in a chemotactic manner. The effect of PDGF-AB was more potent than that of TGF-beta 1, and the responses were dose-correlated for PDGF-AB, while they were dose-dependent up to 5 pg/ml for TGF-beta 1. Moreover, the PDGF-AB response was extracellular Ca(2+)-independent, while TGF-beta 1 was Ca(2+)-dependent.     

Is physiotherapy useful following surgery for carpal tunnel syndrome?

A prospective follow-up-study of 97 patients operated because of a carpal tunnel syndrome was carried out to investigate postoperative use of physiotherapy. Postoperative 32 patients were treated at least 12 times and 65 patients were not treated physiotherapeuticly. Physiotherapists postoperatively treated by activating joints of fingers and hand. We examined the patients one day preoperative and on an average of 9 months postoperative. Complaints of the patients, local findings, vigorimetrically measured strength and electromyography were registered. The vigorimetrically measured strength of the operated hand improved significantly less in patients treated physiotherapeutically compared to not treated patients. All other complaints and findings improved equally. We interpreted this difference as a result of spare caused by awareness of a sick hand.     

Histology of the transverse carpal ligament and flexor tenosynovium in idiopathic carpal tunnel syndrome

Histology of the transverse carpal ligament and flexor tenosynovium was investigated in 166 wrists from 130 patients with idiopathic carpal tunnel syndrome. Nine wrists from 9 controls were used for comparison. In the patients, 73.5% of the ligament and 56.0% of the tenosynovium showed normal histology. In the remaining specimens, the ligament showed mucoid change (17.5%), amyloid deposits (7.8%), inflammation (3.0%), and chondrometaplasia (2.4%), and the tenosynovium showed fibrosis (25.3%), edema (7.2%), inflammation (10.2%), amyloid deposits (8.4%), and vascular hypertrophy (4.8%). The majority of these changes were mild in degree and the pathophysiology did not appear to be meaningful. We conclude that in idiopathic carpal tunnel syndrome, the ligament and tenosynovium often show normal histology and there are no typical or consistent changes with which idiopathic carpal tunnel syndrome can be associated.     

Operative treatment of carpal tunnel syndrome in Denmark. Results of a questionnaire

The aim of our study was to determine the incidence of operative treatment for carpal tunnel syndrome in Denmark and to see whether there was a consensus about the place of preoperative electromyography and nerve conduction studies. A questionnaire was mailed to all surgical departments (n = 70) and all registered private surgical practices (n = 214) in Denmark. The incidence of operation was about 0.61 per 1,000 population. Most surgeons used preoperative electromyograms and nerve conduction studies in less than 50% of cases. The use of preoperative testing was related to the surgical speciality.     

The differential indication for "open" or "endoscopic" carpal tunnel release

Carpal tunnel syndrome is one of the most common nerve compression syndromes. Nocturnal paresthesia and pain are early symptoms, and hypesthesia and thenar atrophy are late symptoms. These days endoscopic and open operation techniques are available. Minimal trauma after endoscopic release allows early return to work. The endoscopic technique should be performed by experienced surgeons to avoid severe complications.     

Critical study of electrophysiologic techniques for exploration of carpal tunnel syndrome

Carpal tunnel syndrome is the most frequent entrapment neuropathy. Nerve conduction studies and electromyography are useful to appreciate the localization and the degree of nerve involvement, and help to the therapeutic management. Various electrophysiological procedures may be used and are reviewed. For each of them, positive (sensitivity and specificity) and negative points (technical difficulties, errors and false positive) are reported. A guideline is proposed.     

Single-portal endoscopic treatment of carpal tunnel syndrome. Results of a preliminary series]

The authors assessed social-evaluative anxiety in 50 cocaine abusers attending an outpatient therapeutic-community (TC)-oriented clinic. This group-based modality presumes that the ability of clients to self-disclose is key to recovery. Fully half of the clients tested, some of whom had been attending treatment for a number of months, showed an elevation of social withdrawal and distress. Newcomers with higher social anxiety scores were less likely to drop out of treatment over the first 3 months, and self-reported level of social anxiety decreased over this time interval. These findings suggest that social anxiety may be an important consideration in treatment for cocaine abuse and that the rigors of a modified TC with intense focus on group involvement may reduce social anxiety.