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Comparative study between endoscopic technique by a proximal port and mini palmary incision in the surgical treatment of carpal tunnel syndrome
Pereira, Eduardo A.R.;Mattar Jr., Rames;Azze, Ronaldo J.;
Acta Ortopédica Brasileira , 2003, DOI: 10.1590/S1413-78522003000100007
Abstract: the authors present a prospective study comparing two surgical techniques for carpal tunnel release. a minimal - incision open decompression(3) is compared with an endoscopic release(2), that utilizes only a single proximal portal. there were operated on, 28 wrists in 28 patients, with clinical signs and emg changes consistent on idiopathic carpal tunnel syndrome, that failed under previous conservative treatment. they were randomized into two groups , undertaken surgical treatment, either by endoscopic release or by open decompression. grip strength (measured by dynamometric), sensitivity (measured by semmes-weinstein monofilaments), presence of pain and paresthesia, date of return to activities of daily living and complications were evaluated pre-operative and at 1, 2, 4, 6, 12 weeks after surgery. after 12 months average follow up, the results indicated that this proximal portal endoscopic technique can be safely performed, showing advantages over open conventional method, in terms of sooner return of grip strength, date of return to activities of daily living, and less incidence of pillar pain. no differences in paresthesia resolution, sensibility improvement or complications incidence were found.
Comparative study between endoscopic technique by a proximal port and mini palmary incision in the surgical treatment of carpal tunnel syndrome  [cached]
Pereira Eduardo A.R.,Mattar Jr. Rames,Azze Ronaldo J.
Acta Ortopédica Brasileira , 2003,
Abstract: The authors present a prospective study comparing two surgical techniques for carpal tunnel release. A minimal - incision open decompression(3) is compared with an endoscopic release(2), that utilizes only a single proximal portal. There were operated on, 28 wrists in 28 patients, with clinical signs and EMG changes consistent on idiopathic carpal tunnel syndrome, that failed under previous conservative treatment. They were randomized into two groups , undertaken surgical treatment, either by endoscopic release or by open decompression. Grip strength (measured by dynamometric), sensitivity (measured by Semmes-Weinstein monofilaments), presence of pain and paresthesia, date of return to activities of daily living and complications were evaluated pre-operative and at 1, 2, 4, 6, 12 weeks after surgery. After 12 months average follow up, the results indicated that this proximal portal endoscopic technique can be safely performed, showing advantages over open conventional method, in terms of sooner return of grip strength, date of return to activities of daily living, and less incidence of pillar pain. No differences in paresthesia resolution, sensibility improvement or complications incidence were found.
Evaluation of release surgery for idiopathic carpal tunnel syndrome: endoscopic versus open method.
Hasegawa K,Hashizume H,Senda M,Kawai A
Acta Medica Okayama , 1999,
Abstract: To evaluate the usefulness of endoscopic carpal tunnel release (ECTR) on patients with idiopathic carpal tunnel syndrome, multiple aspects of the results of 44 hands (42 patients) treated by ECTR and 40 hands (40 patients) treated by open carpal tunnel release (OCTR) were compared. Results of ECTR were compared with those of OCTR to study not only recovery rate and surgical safety but also cost-effectiveness. Although ECTR was much less invasive than OCTR, recovery of median nerve palsy in the ECTR group was not as good as that in the OCTR group one month after the surgery. Three months after surgery, the palsy of patients treated by ECTR had improved to almost the same extent as in those treated by OCTR. There were no major surgical complications in both ECTR and OCTR groups. The cost and time needed for ECTR treatment was 1/3 of those needed for OCTR. ECTR reduced both cost and treatment time, which is beneficial for both doctors and patients.
Time course changes of nerve conduction velocity in idiopathic carpal tunnel syndrome after endoscopic surgery.
Kabuto Y,Senda M,Hashizume H,Kinoshita A
Acta Medica Okayama , 2001,
Abstract: A total of 49 patients (71 hands) underwent endoscopic carpal tunnel release according to the method of Okutsu accompanied by electrophysiological studies performed for idiopathic carpal tunnel syndrome at our department between August 1993 and May 1998. Among them, 41 patients (55 hands) who were followed-up for 12 months or more postoperatively were studied. The clinical outcome was favorable in 50 out of 55 hands (90.9%). In the 5 hands showing poor surgical results, distal motor latency or sensory nerve conduction velocity was not recordable before surgery and had not improved at 1 month postoperatively. In the present study, it is highly likely that the long-term prognosis will be poor when distal motor latency or sensory nerve conduction velocity is not recordable at 1 month after surgery as well as preoperatively. It is possible to identify patients with a poor outcome by performing electrophysiological studies at 1 month after surgery.
Bifid median nerve as a determinant of carpal tunnel syndrome recurrence after endoscopic procedures. A case report
C. Rossi,P. Cellocco,G. Costanzo
Journal of Orthopaedics and Traumatology , 2003, DOI: 10.1007/s10195-003-0017-2
Abstract: A number of complications have been associated with endoscopic technique in treating carpal tunnel syndrome (CTS). We observed a female patient who had previously undergone endoscopic surgery for CTS. Shortly after surgery, this patient complained of pain, numbness and strength deficiency, as severe as it was before the operation. A new, open, surgical procedure was performed. During this second-look surgery, we found a bifid median nerve, which divided into two branches at the second third of the forearm, proximal to the flexor retinaculum. We strongly suggest a careful exploration of the median nerve in the carpal tunnel. Moreover, we believe that an extensive preoperative assessment of median nerve morphology and function is mandatory prior to endoscopic approach in treating CTS.
Bifid median nerve as a determinant of carpal tunnel syndrome recurrence after endoscopic procedures. A case report
C. Rossi,P. Cellocco,G. Costanzo
Journal of Orthopaedics and Traumatology , 2003, DOI: 10.1007/BF02637323
Abstract: A number of complications have been associated with endoscopic technique in treating carpal tunnel syndrome (CTS). We observed a female patient who had previously undergone endoscopic surgery for CTS. Shortly after surgery, this patient complained of pain, numbness and strength deficiency, as severe as it was before the operation. A new, open, surgical procedure was performed. During this second-look surgery, we found a bifid median nerve, which divided into two branches at the second third of the forearm, proximal to the flexor retinaculum. We strongly suggest a careful exploration of the median nerve in the carpal tunnel. Moreover, we believe that an extensive preoperative assessment of median nerve morphology and function is mandatory prior to endoscopic approach in treating CTS.
Adequacy and long-term prognosis of endoscopic carpal tunnel release.
Hirooka T,Hashizume H,Senda M,Nagoshi M
Acta Medica Okayama , 1999,
Abstract: Forty-one hands of 37 patients with idiopathic carpal tunnel syndrome treated by endoscopic carpal tunnel release (ECTR) were followed up for more than one year after surgery. Surgical results were evaluated using Kelly's criteria, the Semmes-Weinstein test, the static and moving 2-point discrimination tests, tip-pinch strength, and motor and sensory nerve conduction studies. Clinical results, according to Kelly's criteria three months after surgery, were excellent or good in 36 hands, and fair or poor in five hands. No recovery was evident at six months and 12 months after surgery in fair and poor hands. Based on these findings, we conclude that a neurolysis of the median nerve and release of constriction of the thenar muscle branch should be performed using the conventional open technique for patients with poor results three months after ECTR if the patients are dissatisfied with ECTR results.
Simple in situ decompression for idiopathic cubital tunnel syndrome using minimal skin incision  [PDF]
Jeon In-Ho,Mici? Ivan,Lee Byung-Woo,Lee Seong-Man
Medicinski Pregled , 2010, DOI: 10.2298/mpns1010601j
Abstract: Cubital tunnel syndrome is one of the most frequently occurring compression neuropathy in the upper limb next to carpal tunnel syndrome. Recent minimal invasive technique has prompted us to gain clinical experience with simple in situ decompression with minimal skin incision for idiopathic cubital tunnel syndrome. Sixty six consecutive patients with cubital tunnel syndrome were treated using minimal skin incision technique. The mean age of the patients was 49.7 (range: 15-77) years and average follow up period was 23.9 months (range: 12-60 months). The severity of ulnar neuropathy was classified according to the McGowan classification: there were 17 in grade I , 47 in grade II and 2 in grade III. A preoperative nerve conduction study was done by inching method, which revealed motor conduction delay around the medial epicondyle. All operations were carried out in a day surgery unit under local anesthetics. The postoperative outcome was evaluated by Messina classification. The mean duration of the operation was 12 minutes. The technique was highly satisfactorily esthetic for all. Over 80% of the patients were completely satisfied with the procedure taking into consideration their symptoms. Postoperative outcome measures and patient satisfactions (pain, return to normal activities and work, scar and pillar tenderness) were comparable with published series of anterior transposition. The overall satisfactory results were recorded 81% in the patients of McGowan stage I and II. There were 2 cases of hematoma as a postoperative complication. This procedure is comparably effective alternative which involves less surgical trauma, morbidity and rehabilitation time with good surgical outcomes especially in mild and moderate degrees. Minimal skin incision is a simple, safe and effective method to treat patients with idiopathic cubital tunnel syndrome.
Modified Altissimi and Mancini technique for carpal tunnel decompression  [PDF]
A Sigdel,S Uprety,Govind KC
Journal of Institute of Medicine , 2012, DOI: 10.3126/joim.v34i1.9116
Abstract: Introduction: Carpal tunnel syndrome is the commonest compressive peripheral nerve neuropathy; open carpal tunnel decompression still remains the preferred method as a day case procedure using local ?anaesthesia. The local anaesthetic is commonly administered by subcutaneous infiltration alone (the Gale technique) or by infiltration of the local anaesthetic into the carpal tunnel in addition to the subcutaneous infiltration (the Altissimi and Mancini technique). The purpose of this study was to evaluate the efficacy of the modified Altissimi and Mancini technique of local anesthesia. Methods: Fourteen hands of twelve patients age ranged from 26 to 55 years, two patients with bilateral involvements were recruited. Most involved hand was operated first with the modified Altissimi and Mancini technique of local anaesthesia. Results: Intra-operative pain was evaluated using visual analog score. Patients experienced no to very little intra-operative pain VAS 0- 2. Only one patient experienced tourniquet discomfort which subsided after release. There was neither any intra-operative nor during follow up, the signs of iatrogenic median nerve injury. Conclusion: We concluded that open carpal tunnel decompression using modified Altissimi and Mancini technique under local anaesthesia and with tourniquet control is a safe, effective and acceptable novel technique. DOI: http://dx.doi.org/10.3126/joim.v34i1.9116 Journal of Institute of Medicine, April, 2012; 34:1 9-12
Carpal tunnel syndrome: Diagnosis and surgical treatment  [PDF]
Faton Morina, Cen Bytyqi, Aziz Mustafa, Gentian Morina
Health (Health) , 2012, DOI: 10.4236/health.2012.44035
Abstract: Carpal tunnel syndrome (CTS) is a compressive idiopathic neuropathy, most commonly affecting the median nerve in the upper extremity. CTS have high prevalence, with up to 70% of cases in women aged between 45 and 60 years. Typical manifestations of CTS are numbness of the index and middle fingers, which also become painful and cause the patient to awaken from sleep. In the period from January 2008 to October 2011 at the Orthopedics Clinic of the University of Kosovo, surgery for decompression of the median nerve was performed for 32 patients with CTS. The patients had an average age of 49.1 years. After surgery, 81.25% of the patients experienced complete improvement, whereas partial improvements were noted in 18.75% of the patients. This treatment is easy and feasible, has high efficiency, can be performed under local anaesthesia, and confers improvements in terms of return to daily activities, with low risk of complications or relapse.
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