Single-portal endoscopic carpal tunnel release: agee carpal tunnel release system

This single-group prospective cohort study was conducted to define the efficacy and safety of single-portal endoscopic carpal tunnel release using the redesigned carpal tunnel release system (3M Healthcare, St Paul, MN). Eighty-six procedures in 69 patients were evaluated by objective motor/sensory testing and clinical outcome questionnaire at 10 days, and 6 and 10 weeks postoperatively. All cases were performed by the same surgeon using a similar local anesthetic technique. The subjective symptoms of carpal tunnel syndrome, including paresthesia, numbness, and pain, demonstrated substantial improvement by 10 days postoperatively, and less than 2% of the subjects remained symptomatic by 10 weeks. The percentage of patients with normal, static, two-point discrimination in the median nerve distribution, demonstrated significant improvement by 6 weeks postoperatively. Preoperative grip and three-point pinch strength were regained by 6 weeks postoperatively, while lateral pinch demonstrated substantial improvement in the same time period. Workers' compensation cases required a significantly longer time to return to work (mean, 40.8 days) than nonworkers' compensation cases (mean, 22.2 days). No difference, however, was demonstrated between workers' compensation and nonworkers' compensation cases with respect to the time of return to activities of daily living (mean, 13.5 days). There were no major neurovascular injuries incurred during the performance of the study. The most important complications included one mild reflex sympathetic dystrophy, three transient digital neuropraxias, and one superficial wound infection. In conclusion, the performance of single-portal endoscopic carpal tunnel release using the redesigned Agee carpal tunnel release system is both a safe and efficacious procedure.     

Persistent or recurrent carpal tunnel syndrome following prior endoscopic carpal tunnel release

Immunohistochemistry was applied in the investigation of the possible existence of serotonin in human skin. It was found that epidermal melanocytes express a serotonin-like immunoreactivity. The immunoreactivity was associated with both the cytoplasm and the cellular membrane, though the latter was only found in certain cells. The serotonin anti-serum labeled the same cells as NKI-beteb, which is known as a reliable marker of melanocytes. Blocking experiments showed that both serotonin and NKI-beteb have different epitopes in the melanocytes. In in vitro studies, serotonin-like immunoreactivity appeared in approximately 90% of cultured human melanocytes, and was found both in the cytoplasm and also in the nuclei. Thus, we believe the melanocytes to be the origin of serotonin (or a serotonin-like molecule) in the skin.     

Endoscopic carpal tunnel release

The aspects of various techniques for endoscopic carpal tunnel release, including the Chow technique, the Japanese technique, and the Agee technique, are reviewed. Anesthesia, portal placement, and ligament cutting techniques are considered. Clinical results, complications, and long-term outcomes of the Chow technique are summarized.     

Endoscopic carpal tunnel release

We describe a computer program, named DNA-Protein Search (DPS), for comparing a megabase DNA sequence with a protein sequence database. The DPS program addresses the problems of frameshifts and introns in the DNA sequence. The DPS program was used to compare each of the following sequences with the Swiss-Prot database: the 1.8-megabase sequence of the Haemophilus influenzae Rd genome, the 0.58-megabase sequence of the Mycoplasma genitalium genome, and the 0.56-megabase sequence of Saccharomyces cerevisiae chromosome VIII. The comparisons found new regions that are similar to protein sequences. The sensitivity of DPS was evaluated using as test data the known coding regions of the three DNA sequences. The results demonstrate that the DPS program is a useful tool for finding the coding regions of the DNA sequence. The DPS program uses an order of magnitude less computer memory and is several times faster than the BLASTX program.     

Acute carpal tunnel syndrome

Although the carpal tunnel is open at both ends, it has the physiologic properties of a closed compartment bounded by synovium proximally and distally. When the intracarpal canal interstitial pressure rises above a critical threshold pressure, capillary blood flow is reduced below the level required for median nerve viability. Acute carpal tunnel syndrome is recognized frequently as occurring secondary to wrist trauma and infrequently due to a variety of infectious, rheumatologic, and hematologic disorders. This condition warrants prompt recognition and the treatment is early carpal tunnel release.     

Endoscopic carpal tunnel release: a cadaveric study

Monoclonal antibodies against the irreversible alkylator N-ethyl-1-[2-(4-isothiocyanothienyl)]cyclohexylamine (ITCE) of the 1-[1-(2-thienyl)cyclohexyl]piperidine (TCP) binding site of the N-methyl-D-aspartate receptor were raised. Each antibody was characterized in a competition enzyme-linked immunosorbent assay (ELISA) with a range of TCP analogs. It was found that each monoclonal antibody has a different affinity profile for the various TCP analogs. No correlation between the structure of the side chain groups of each compound and the selective affinities of the antibodies could be deduced, indicating that the overall affinity of the antibodies is determined by more than just the sum of the interaction forces with each ligand's functional groups. In addition to the possible identification of endogenous TCP-like compounds these antibodies could be used as a model to study the molecular interaction between drugs and their receptors' active sites.     

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.     

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.     

Functional psychomotor deficits associated with carpal tunnel syndrome

A reliable task was developed for investigating functional deficits associated with carpal tunnel syndrome (CTS). A rapid pinch and release psychomotor task utilizing muscles of the hand innervated by the median nerve was administered using a strain gauge dynamometer and providing limited force feedback. The motor performance characteristics studied were speed and force control. An experiment was conducted for studying the effects of force level, hand dominance, test-retest reliability, learning, and inter-subject variability using 13 subjects free from any hand disabilities or symptoms. A companion study was also conducted using 17 normal subjects and ten subjects diagnosed having CTS to investigate differences between CTS and control subjects. Dominant hands performed 4% to 8% better than the non-dominant hands by having a greater pinch rate, a smaller overshoot force, and less time above the upper force level and below the lower force level. Control subjects performed 25% to 82% better than CTS subjects. Age contributed 6% of the total variance for pinch rate and 7% of the total variance for the time below the lower force level. The results suggest that people suffering from CTS may experience similar functional psychomotor deficits in daily living and manual work activities.     

Less common causes of carpal tunnel syndrome

A new DRB3*02 allele (DRB3*0207) was detected in a female Luxembourg Caucasian blood donor by sequence-based typing. The new allele differs from DRB3*0202 by two substitutions in codon 57 resulting in an amino acid change from a charged aspartic acid to a neutral valine. This is the first example of a DRB3 allele pair differing only at codon 57.     

The electrophysiological diagnosis of carpal tunnel syndrome

Electrophysiological investigations were carried out both in patients with carpal tunnel syndrome (CTS) and in healthy individuals. The evoked potentials were examined during stimulation of sensitive branches of n. medianus and of other nerves. The most sensitive and important for diagnosis appeared to be the electrophysiological test of alteration of responsive reaction to the stimulation of the sensitive branch of n. medianus for 4 finger and the considerable difference of evoked reactions on stimulation of skin palm branch and branch of the 1-st finger of n. medianus. The diagnostic importance of these indices corresponds well to anatomical and pathophysiological characteristics of CTS.     

Predicting acute denervation in carpal tunnel syndrome

OBJECTIVE: Defects of the cochlear modiolus have been found to be associated with most cases of large vestibular aqueduct. The clinical significance of these modiolar defects has not been studied previously. The purpose of this article is to correlate clinical (functional) parameters, such as hearing outcomes, with the severity of the radiographic findings in these dysplastic inner ears. STUDY DESIGN: The study design was a retrospective chart review, supplemented with telephone interviews and clinic visits. SETTING: The study was conducted at an academic, tertiary care center. PATIENTS: Thirty consecutive patients with large vestibular aqueducts participated. RESULTS: Scores of modiolar deficiencies yielded inconsistent correlations with hearing loss. Vestibular aqueduct morphology and thickness correlated very strongly with the severity of hearing loss. CONCLUSIONS: These observations support the hypothesis that large vestibular aqueduct-related hearing loss may be caused by transmission of subarachnoid pressure forces into the inner ear. However, the thickness and morphology of the vestibular aqueduct may simply be markers for more subtle cochlear dysplasia manifest by modiolar deficiency.     

Silent period abnormalities in carpal tunnel syndrome

Zygosaccharomyces bailii inactivation was evaluated in oscillatory high hydrostatic pressure (HHP) treatments at sublethal pressures (207, 241, or 276 MPa) and compared with continuous HHP treatments in laboratory model systems with a water activity (aw) of 0.98 and pH 3.5. The yeast was inoculated into laboratory model systems and subjected to HHP in sterile bags. Two HHP treatments were conducted: continuous (holding times of 5, 10, 15, 20, 30, 60, or 90 min) and oscillatory (two, three, or four cycles with holding times of 5 min and two cycles with holding times of 10 min). Oscillatory pressure treatments increased the effectiveness of HHP processing. For equal holding times, Z. bailii counts decreased as the number of cycles increased. Holding times of 20 min in HHP oscillatory treatments at 276 MPa assured inactivation (< 10 CFU/ml) of Z. bailii initial inoculum. Oscillatory pressurization could be useful to decrease Z. bailii inactivation time.     

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.