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Endoscopic carpal tunnel release using the modified Chow's extrabursal dual portal technique: Clinical results of 640 patients  [PDF]
Kim Poong-Taek,Mici? Ivan D.,Park Il-Hyng,Jeon In-Ho
Medicinski Pregled , 2007, DOI: 10.2298/mpns0702054k
Abstract: During a 4-year period, a total of 784 wrists of 640 patients were treated using a modified Chow's extrabursal dual portal endoscopic technique. All surgeries were performed under local anesthesia. A 1-cm incision was marked 1 - 2 cm proximal to the distal wrist crease, in the midline, ulnar to the palmaris longus. A distal portal was established along a line bisecting an angle created by the intersection of the ulnar border of the abducted thumb and the third web space. An obturator and cannula assembly were inserted under the portal, and three blades were used to cut under endoscopic vision. Subjective results showed that 706 hands (90%) had a reduction in the severity of pain after carpal tunnel release, 706 hands (90%) had a reduction in the severity of paresthesia and 729 hands (93%) had a reduction in the severity of numbness. Nocturnal pain and paresthesia were relieved in 745 cases (95%). Compared with the conventional open carpal tunnel release, less postoperative pain and faster recovery have been reported following endoscopic carpal tunnel release. This study suggests that extrabursal dual portal technique is a safe and reliable treatment option for carpal tunnel syndrome with a high success rate.
Midpalmar Accurate Incision for Carpal Tunnel Release.  [PDF]
Wen-Ching Tzaan,Tai-Ngar Lui,Shih-Tseng Lee
Chang Gung Medical Journal , 2005,
Abstract: Background: Carpal tunnel syndrome is the most common entrapment neuropathy inhumans today. For patients in whom conservative treatment fails, surgicaldecompression is indicated. Among the various surgical techniques currentlyin use, endoscopic techniques are becoming increasingly popular. Due to therapid postoperative recovery shown after endoscopic operations, midpalmaraccurate incision for carpal tunnel release is a comparative alternative.Methods: From February 1998 through January 2003, 84 patients had undergone 96midpalmar carpal tunnel releases with accurate skin incisions under regionalblock or general mask anesthesia. The postoperative evaluations were performedvia subjective assessment with a standardized telephone interviewover an average follow-up period of 22.4 months.Results: The average operation time was 16 minutes (range, 5 to 40 minutes). A totalof 87 hands (91%) had excellent or good recovery in terms of symptom relief(improvement of 70% or greater). The incidence of postoperative sensorymorbidity, i.e., pillar pain or scar tenderness, was 7% (7 hands). The motorfunctional morbidity of a persistent subjective decrease in grip strength wasnoted in 8% (8 hands), and the mean period for returning to work was 4.5weeks. In addition, no operation-induced neurovascular or tendinous injuryoccurred in any patient.Conclusions: The outcomes were similar to those of endoscopic carpal tunnel release.Based on these results, midpalmar carpal tunnel release with accurate locationof skin incision is as effective as any other surgical procedures for carpaltunnel release. Furthermore, it is also a safe and simple procedure.
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.
Endoscopic decompression of the median nerve for idiopathic Carpal tunnel syndrome  [PDF]
Hamdy Mohammed Behairy
Neuroscience & Medicine (NM) , 2018, DOI: 10.4236/nm.2018.91001
Abstract: Carpal tunnel syndrome is one of the commonest entrapment neuropathies. Hand pain and numbness are mostly the presenting symptoms. Endoscopic carpal tunnel release (ECTR) has been demonstrated to reduce recovery time and allow faster return to the work. The purpose of this prospective descriptive study was to evaluate the efficacy and advantages of (ECTR) through single proximal incision. In this study, the procedure was done for 36 hands in 36 patients. The results showed that females:male = 9:1, mean age was 42 years. Right hand dominance was 90% and affected in 67%. Preoperatively, the condition was moderate in 61% and severe in 39%. The average operating time was 10 minutes and the mean follow up period was 6 months with no major postoperative complications. In 8%, transient neurapraxia was found and resolved in 1 week and tenderness was found in 70% and resolved in 4 weeks. we concluded that endoscopic carpal tunnel release is an effective minimal incisional safe procedure with a high success rate, rapid return to work.
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.
Ultrasound Role in Diagnosis of Carpal Tunnel Syndrome and Postoperative Evaluation in Endoscopic Carpal Tunnel Release  [PDF]
Hossam Elsobky, Mohamed Kassem, Tamer Youssif, Ahmed Abd-Elkhalek, Amr Farid Khalil
Open Journal of Modern Neurosurgery (OJMN) , 2019, DOI: 10.4236/ojmn.2019.93024
Abstract: Carpal tunnel syndrome (CTS) represents about 90% of all entrapment neuropathies and is caused by entrapment of the median nerve while passing in the carpal tunnel. US has revealed equal effectiveness as magnetic resonance imaging (MRI) in diagnosis of CTS; however further attention should be given in case of equivocal results from nerve conduction studies (NCS) and/or before endoscopic surgical intervention. This study was conducted to evaluate the role of US in diagnosis and treatment of CTS which was done by endoscopic release. This is a prospective study including patients having CTS who were treated by endoscopic release between December 2017 and December 2018. All cases were evaluated by electrophysiological studies and US at the preoperative period. US was used to measure the cross sectional area (CSA) of the median nerve. Patients underwent endoscopic carpal tunnel release and were called for follow up after 1, 3, and 6 months for clinical and US assessment of the median nerve. Forty cases were included with mean age of 27.85 years. Numbness was the predominant symptom (92.5%) followed by wrist pain (85%). The mean diameter of median nerve showed a significant decrease at different time points (P < 0.001). The sensitivity of US in diagnosis of CTS was 87.5% in the preoperative assessment as compared to electrophysiological study. The sensitivity of US in detecting the improvement of CTS as compared to clinical examination increased from 28% at 1 month postoperative, 53.4% at 3 months to 92.1% at 6 months. Ultrasonography is a sensitive non-invasive diagnostic tool in diagnosis of CTS preoperative and diagnosis of improvement of the patients postoperatively especially at 6 months.
Locally made instruments for endoscopic carpal tunnel release.  [cached]
Adulkasem W,Hirunyachot P,Prathumsuwan C
Journal of Orthopaedic Surgery , 2000,
Abstract: Endoscopic carpal tunnel release (ECTR) was introduced into Thailand when this technique became widely accepted. However, the technique was limited to only a few institutions because of the training required and the very high cost of the instruments. Because of the economic crisis in Thailand, most hospitals in the public health ministry had no budget to invest in new instruments. However, new technology cannot be ignored so the authors modified some unused instruments in conjunction with an arthroscope in order to perform ECTR. A 5 cm by 4 mm slot was made at the mid-portion of an old unused 5 mm arthroscopic sheath. One end of this sheath was reshaped to fit the meniscectomy hook blade. A 4.5 mm Steinmann pin was reshaped to be the obturator of the arthroscopic sheath. ECTR was performed with this instrument in conjunction with an arthroscope (modified from Chow's 2-portals technique). The transverse carpal ligament was clearly viewed and identified, and the transverse carpal ligament was completely divided by the menisectomy hook blade. The operation time was 10 to 20 minutes. 30 patients received ECTR with this set of instruments, and they were completely relieved from the symptoms and returned to work early without any complications. The advantages of this instrument are that it is very cheap, it has a low learning curve, and it is safe and effective.
Carpal tunnel syndrome: treatment with small transverse incision
Kaleff, Paulo Roland;Lima, Marcelo Senna Xavier de;Fernandes, Yvens Barbosa;Honorato, Danylo José Palma;Vargas, Antonio Augusto Roth;Honorato, Donizeti César;
Arquivos de Neuro-Psiquiatria , 2010, DOI: 10.1590/S0004-282X2010000100020
Abstract: objective: to evaluate the application of a limited transverse incision technique to treat the carpal tunnel syndrome, with concern to its safety and efficacy in the opening of the flexor retinaculum (fr). method: a prospective analysis of thirty fr release procedures performed on twenty-eight patients subjected to the proposed incision technique. safety and total opening of the fr were evaluated through a questionnaire and an endoscopic inspection respectively. results: no major complications were observed. two cases presented small local hematoma. one patient presented with transient neuropraxia of digital branch. in two of the first five cases, incomplete fr opening was identified during endoscopic revision with need of complementary opening. all patients reported relief of paresthesias and nocturnal pain symptoms. conclusion: the technique was safely performed on the prospection group, no major complications were detected and the opening of fr was observed in the majority of the patients.
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.
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