New approaches to the diagnosis and surgical treatment of tunnel syndromes of the upper limb

Abstract

The purpose of the work was to evaluate the modern methods of diagnosis that determined the state of vegetative fibers, tunnel morphology, and surgical treatment of tunnel syndrome. There were 30 healthy individuals (control group) and 45 patients (16 with compression of the ulnar nerve in the zone of cubital canal, 27 with carpal canal syndrome and median nerve compression and 2 patients with Guyon canal syndrome). Clinical-roentgenologic methods, electroneuromyography (ENMG), ultrasonography, computer tomography, Lazer Doppler flowmetry (LDF), ultrasound dopplergraphy of wrist were used. The diagnosis of tunnel syndromes is based on a through clinical-roentgenologic and instrumental evaluation of the nerve trunk fibers function. Not only ENMG with assessment of the sensor and motor innervation is expedient but the evaluation of the neurogenic LDF indices stipulated by sympathic fibers as well. Auxiliary diagnostic method is ultrasonography of tunnel zone which provides information on the morphology of the canal structures, topography and general sizes of the nerves in the compression zone. All patients underwent surgical intervention for the decompression of nerve trunks. It is for the first time that the method of endoscopic dissection of the carpal ligament has been used at our clinic in 7 patients with early stages (I-II) of the disease. Endoscopic method of carpal canal syndrome treatment is an effective and lower invasive intervention that allows to restore the working ability of patients with early stages of the process in a short time.