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.     

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.     

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.     

Midpalmar approach to the carpal tunnel: an alternative to endoscopic release

OBJECTIVE: To determine whether hysteroscopic adhesiolysis improves reproductive outcome in women with Asherman's syndrome and pregnancy failure. SUBJECTS: Ninety consecutive women who had undergone hysteroscopic adhesiolysis of intrauterine adhesions during a 5-year period. Only women in whom at least two previous pregnancies had ended with either a spontaneous abortion or a premature delivery accompanied by fetal or neonatal mortality and a hysteroscopic diagnosis of intrauterine adhesions were enrolled. RESULTS: Whereas pregnancy outcome prior to the operation was 18.3% term deliveries, 3.3% premature deliveries, 62.4% first-trimester abortions, and 16.0% late abortions, after hysteroscopic adhesiolysis pregnancy outcome was 68.6% term deliveries, 9.3% premature deliveries, 17.4% first-trimester abortions, and 4.7% late abortions. In women with two previous unsuccessful pregnancies, the operative success rate measured by delivering a healthy newborn improved from 18.3% preoperatively to 64% postoperatively. In women with three or more unsuccessful pregnancies the success rate improved from 18.3% to 75%. Successful outcome of adhesiolysis was observed in 61.9% of mild (stage I) and in 70.6% of moderate to severe cases (stages II and III) of intrauterine adhesions. CONCLUSION: Hysteroscopic adhesiolysis in women with Asherman's syndrome and poor reproductive performance contributes significantly to a successful reproductive outcome.     

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.     

Division of the transverse carpal ligament and flexor tendon excursion: open and endoscopic carpal tunnel release

Ten fresh cadaver upper extremities from 10 different subjects were used in this study of the effect of both open and endoscopic carpal tunnel release on flexor tendon excursion. The amount of excursion necessary to bring each finger from the fully extended to the fully flexed position with the fingertip just touching the palm was measured with the extremity mounted in a device that moved the wrist from extension through flexion. Endoscopic carpal tunnel release, open release, and transverse carpal ligament reconstruction were performed with tendon excursion measurements made in each of four wrist positions after each procedure. Fingertip to palm distance was also measured. The measurements of flexor tendon excursion in neutral wrist position with intact transverse carpal ligament served as the norm for each finger and as the denominator in the ratio of postoperative to preoperative excursion distances. The study confirmed the importance of the transverse carpal ligament as a flexor pulley; transection of the ligament increased the amount of flexor tendon excursion necessary to achieve finger flexion and fingertip-to-palm contact. Tendon excursion/digital flexion improved after transposition flap repair. Neither open nor endoscopic carpal tunnel release conferred any particular benefit to flexor tendon excursion postoperatively. The proximal palmar aponeurosis does not seem to have the same pulley effect as the transverse fibers of the distal palm.     

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.     

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.     

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.     

Myofascial manipulative release of carpal tunnel syndrome: documentation with magnetic resonance imaging

Four patients with carpal tunnel syndrome, unresponsive to routine conservative care, underwent treatment with myofascial release manipulation and self-stretching. Magnetic resonance imaging analysis of the cross-sectional area of the carpal tunnel and electrodiagnosis were performed before and after treatment. The patients improved clinically. The nerve conduction studies showed concomitant reduction in distal latencies or increase in motor response amplitudes. Magnetic resonance imaging demonstrated that the anteroposterior and transverse dimensions of the carpal canal significantly increased after treatment. This study demonstrates that the carpal canal is a distensible structure with the potential to yield to a relatively simple, aggressive, nonsurgical treatment for carpal tunnel syndrome.     

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.     

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.     

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.     

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.