Effect of Ultrasound-Guided Partial Release of the Transverse Carpal Ligament with a Needle in Patients with Refractory Carpal Tunnel Syndrome.
4
Citation
0
Reference
10
Related Paper
Citation Trend
Abstract:
Neuropathic pain in the hands due to carpal tunnel syndrome (CTS) disturbs sleep and affects the quality of life.We evaluated the effect of ultrasound (US)-guided partial release of the transverse carpal ligament (TCL) using an 18-G needle in patients with refractory CTS.A prospective outcome study.The outpatient clinic of a single academic medical center.This study was prospectively conducted. A total of 155 consecutive patients (191 wrists) with refractory chronic CTS (M:F = 28:127; age = 54.7 ± 9.6 years; pain duration = 50.3 ± 36.3 weeks) were enrolled and underwent US-guided partial release of the TCL using a needle. The pain severity was measured using the Numeric Rating Scale (NRS) at 3 and 6 months after the treatment. Successful treatment outcomes were defined as more than 50% reduction in the NRS score at 6 months after the treatment compared with the score at pre-treatment and NRS score < 3 at 6 months after the treatment without any surgical intervention.There were 3 dropouts, and 188 wrists were included in the study. No side effects were reported. A total of 162 wrists (86.2%) showed successful treatment outcomes at 6 months after TCL release. Of the 26 wrists which had unsuccessful treatment outcomes, 6 received surgical treatment. The NRS scores at 3- and 6-month post-treatment were significantly reduced: the average NRS scores were 7.1 ± 0.6 at baseline, 1.9 ± 1.7 at 3 months after the treatment, and 1.7 ± 1.7 at 6 months after the treatment.We conducted our study without a control or a placebo group.We believe that US-guided partial release of the TCL using a needle can be an effective and safe technique for treating chronic refractory pain due to CTS. It can potentially be attempted before surgical treatment.Keywords:
Refractory (planetary science)
Cite
Cite
Citations (52)
We present a distinctly rare case of giant cell arteritis involving the small artery of the median nerve with symptoms that may be confused with carpal tunnel syndrome. The excision of the involved arterial segment cures the patient of the local symptoms, but the administration of corticosteroids as soon as the diagnosis is established is very important for these patients with multiple arterial involvement.
Arteritis
Cite
Citations (8)
Several studies have shown an increased incidence of Carpal Tunnel Syndrome (CTS) with increasing age, as well as a longer Median sensory latency in older CTS patients. In this study, data was analyzed from 19 patients with bilaterally normal UE EMG/NCS and no symptoms of CTS (38 hands), as well as 18 patients with unilateral CTS and 21 with bilateral CTS (60 hands) to determine the effect of age on the severity of nerve conduction abnormalities associated with CTS. Most of these parameters showed increasing severity with age. Median motor latency rises sharply with age (r = .41, p = .001), and amplitude falls (r = .34, p = .008). Median sensory rises significantly with age in CTS patients (r = .42, p = .001) and amplitude falls (r = .29, p = .022). Furthermore, the (Median-Ulnar) motor and sensory latency differences both rise with age (r = .40, p = .001, and r = .35, p = .004 respectively). This is crucial, for an increase in Median motor or sensory latency with age could represent a similar degree of pathologic slowing superimposed on normally slower conduction with age. However, the sharp rise in the (Median-Ulnar) latency differences (from 2.2 msecs at age 40 to 3.8 msecs at age 70 for motor, and 1.6 msecs to 2.5 msecs for sensory) shows that the compression is more severe with age.
Sensory nerve
Age groups
Motor nerve
Cite
Citations (21)
The relative frequency of carpal tunnel syndrome (CTS) among the patients referred for electrophysiological studies was studied. The case material included both inpatients and outpatients with various peripheral nerve disorders during the study period. CTS constituted 7 percent of all the peripheral nerve disorders and 83.6 percent of entrapment neuropathies. Eighty four patients were referred with the diagnosis of CTS and only 49 percent could be confirmed electrophysiologically. The presentation was that of acral and /or brachial paraesthesiae or pain.
Presentation (obstetrics)
Entrapment Neuropathy
Cite
Citations (8)
Nerve conduction study
Neurological examination
Cite
Citations (1)
The cross-sectional area, transverse and anteroposterior diameter of the carpal tunnel were investigated by CT scanning in 68 cases of carpal tunnel syndrome (CTS) and in 100 normal controls of both sexes. The cross-sectional areas of the carpal tunnel in idiopathic CTS of both sexes were significantly smaller, whereas those in secondary CTS were larger than in normal controls. In female wrists with idiopathic CTS narrowing of distal carpal tunnel was attributed to short transverse diameter in wrists with normally shaped hook of the hamate, or to decreased anteroposterior diameter in wrists with abnormally short hook of the hamate. The smallest cross-sectional area in both types of CTS and in normal controls is located at the proximal border of distal carpal tunnel (D 1 level). This coincides with the thickest portion of the flexor retinaculum and, together with our operative findings, supports the conclusion that the essential compression on the median nerve takes place at the D 1 level in idiopathic CTS.
Retinaculum
Cite
Citations (5)
The authors present the results of surgery of a short series cases of compression of the median nerve. All cases involved idiopathic acroparesthesia. The surgical technique was the same in all cases: opening and resection of the large annular ligament, and opening of "loge de Guyon". All the patients were seen again by the same observer 1 to 6 years later (average time after surgery 2 1/2 years). The results were excellent as regards pain and subjective sensory disorders. In contrast, the muscular atrophy was little improved. The results of comparative electric examinations (19 cases) were improved, except where there were pre-operative signs of considerable denervation. In conclusion, the authors think that surgical opening should be restricted to patients presenting signs of serious denervation and to those who no longer benefit from medical infiltration treatment.
Cite
Citations (0)
We examined the prevalence of abnormal median nerve conduction within the carpal tunnel in carpet weavers. Nerve Conduction Studies (NCS) were performed on both hands of 47 subjects. Subjects had worked previously for an average of 8.4 (range 6-21) years and a mean age of 34.8 (17-55) years. An abnormal median nerve latencies and, symptoms associated with carpal tunnel syndrome (CTS) were found 10 (21.2%) and 2 (4.2%) in the subjects studied, respectively. We conclude that the high prevalence of abnormal median nerve conduction without corresponding symptoms, may suggest a subclinical entity associated with CTS.
Subclinical infection
Nerve conduction study
Cite
Citations (10)
Cite
Citations (158)