Tunnel In Patients Research Articles

Outcomes of combined single-bundle anterior cruciate ligament reconstruction and anterolateral structure reconstruction through a modified single femoral tunnel.

To explore the clinical outcomes of combining anterior cruciate ligament (ACL) reconstruction and anterolateral structure (ALS) reconstruction through a modified single femoral tunnel in patients with high risk of clinical failure. From December 2018 to August 2022, a total of 62 patients with ACL injury in our institution were enrolled in this study. All patients were associated with high risk of clinical failure, meeting the indications of ALS reconstruction. All patients accepted arthroscopic single-bundle ACL reconstruction and ALS reconstruction using hamstring autograft through a modified single femoral tunnel. Perioperative clinical outcome measurements consisted of functions, stability and safety evaluation at different time points (preoperative, postoperative threemonth, sixmonth, oneyear, twoyear, threeyear and more). Functional evaluation included Lysholm score, Tegner activity scale, subjective and objective International Knee Documentation Committee (IKDC) score. All patients, including 47 males and 15 females, aged 16-52years with an average age of 29.3 ± 9.2years, were followed up for 12-58months. At the last follow-up, the Lysholm, subjective IKDC and Tegner activity scale (93.8 ± 7.0, 88.8 ± 10.7 and 5.8 ± 1.4 respectively) were significantly higher than those before surgery (65.0 ± 20.8, 51.2 ± 21.1 and 2.3 ± 1.3 respectively)(P < 0.05). Postoperative pivot shift and Lachman test were markedly improved (P < 0.05). One patient still had grade II pivot shift, defined as clinical failure. During follow-up, no graftruptureoccurred according to magnetic resonance imaging and physical examination, no lateral compartment osteoarthritis were found in all patients. Combined single bundle ACL reconstruction and ALS reconstruction through a modified single femoral tunnel could significantly improve knee function and stability with low related risk in patients with high risk of failure in ACL injury.

Novel lateral tunnel Fontan operation in children promotes continued pathway growth into adulthood

ObjectiveMost Fontan operation techniques currently used in children are limited by a blood flow pathway with no growth potential. The external pericardial lateral tunnel Fontan is a novel technique using the patient's pedicled pericardium and atrial wall in situ to create a Fontan pathway. We hypothesize that viable, autologous tissue will allow growth potential of the pathway and adapt to increasing physiologic demands of somatic growth. MethodsWe performed a single-center retrospective review of serial echocardiographic measurements of the inferior vena cava junction and mid tunnel in patients with an external pericardial lateral tunnel Fontan. Linear mixed model and Pearson correlation tests were used for analysis of changes in pathway size with time and body surface area. ResultsA total of 1592 echocardiographic studies from 172 patients up to 23 years after the procedure were identified. Significant enlargement of the pathway at the inferior vena cava junction and mid tunnel was observed over time (P < .0001, P < .0001, respectively). There is a strong positive correlation between increasing size of the inferior vena cava junction and increasing body surface area (R = 0.81, P < .0001). There is also a strong positive correlation between increasing size of the mid tunnel with increasing body surface area (r = 0.67, P < .0001). ConclusionsThe external pericardial lateral tunnel Fontan technique creates a Fontan pathway that enlarges into adulthood. The correlation of increasing pathway size with increasing body surface area suggests pathway growth, responding to increasing physiologic demands of somatic growth into adulthood. Further studies are needed to investigate the impact of this novel technique on Fontan physiology and long-term patient outcomes.

52756 Bimekizumab impact on draining tunnels in patients with moderate to severe hidradenitis suppurativa: Pooled 48-week data from BE HEARD I & II

52756 Bimekizumab impact on draining tunnels in patients with moderate to severe hidradenitis suppurativa: Pooled 48-week data from BE HEARD I & II

Role of blood flow in intracanal pressure: a novel theory of carpal tunnel syndrome etiology

Carpal tunnel syndrome is the most common compressive neuropathy of the upper extremity. It is believed that the cause of carpal tunnel syndrome is an increase in intracanal pressure, which leads to disruption of the blood supply to the median nerve and the occurrence of neurological disorders. The level of interstitial pressure is an indicator that describes the state of the microvasculature of the surrounding tissues. However, the question of the influence of changes in blood flow on the development of carpal tunnel syndrome still remains open. Purpose: to study the role of blood flow in the formation of intracanal pressure and the development of carpal tunnel syndrome. Objectives of the study: 1. To evaluate pressure levels in the carpal tunnel in patients with carpal tunnel syndrome and in healthy volunteers; 2. To study changes in pressure in the carpal tunnel in the absence of blood circulation in the limb in patients with carpal tunnel syndrome and in healthy volunteers; 3. To assess changes in carpal tunnel pressure before and after median nerve decompression in patients with carpal tunnel syndrome. We studied 40 people of both sexes aged from 21 to 82 years (mean age 50.1 years), divided into 2 groups. Group I included 20 patients with an established diagnosis of primary carpal tunnel syndrome. Group II, the control group, included 20 healthy volunteers. All participants had interstitial pressure measured in the carpal tunnel. In group I, the patients with carpal tunnel syndrome, 4 measurements were performed: before the start of surgery before a tourniquet was applied, 5 minutes after the tourniquet was applied (in the absence of blood circulation), then intraoperatively after decompression was performed in the conditions of a tourniquet applied and 5 minutes after its removal and restoration of blood circulation. In group II, 2 measurements were taken: before applying the tourniquet and after removing it. It was revealed that with carpal tunnel syndrome, the pressure inside the tunnel increased from 8 mm Hg normally to 24.5 mm Hg. When decompression is performed in patients with primary compressive neuropathy of the median nerve, a significant decrease in pressure in the carpal tunnel is observed from 24.5 mm Hg to 8 mm Hg. Even a short-term cessation of blood circulation in the upper limb leads to an increase in pressure inside the carpal tunnel.

The discovery of in situ thrombus attached to the patent foramen ovale channel in myocardial infarction with normal coronary arteries

Objective: Paradoxical embolism caused by a patent foramen ovale (PFO) is a rare cause of myocardial infarction (MI) in individuals presenting with normal coronary arteries on angiography; however, the deduction is often made due to the inability to identify the exact thrombus that penetrates the atrial septum. Previous studies using optical coherence tomography (OCT) have reported in situ thrombi attached to PFO tunnel in patients with cryptogenic stroke. However, the presence of such thrombi in patients with cryptogenic MI (without a definite cause) remains uncertain. Method: We retrospectively analyzed OCT data collected from February to July 2023 on PFO tunnels in MI adults with normal coronary arteries on angiography. Results: Three patients diagnosed with cryptogenic MI and a PFO underwent OCT examination. These patients exhibited varying OCT findings. White thrombi and endocardial abnormalities in the channel were observed in two patients with MI. No thrombus or anomalous morphology on the endocardial surface was noted in the third patient. PFO closure was performed on all patients, and follow-up was completed by October 1, 2023. None of the patients reported recurrence of chest pain. Conclusion: In situ thrombus was identified within the PFO channel in patients with cryptogenic MI, potentially serving as a novel etiological factor for coronary thrombosis.

Clavicular hook: Cuffed haemodialysis catheter insertion using a paramedian tunnel in patients with recurrent tip migration.

Tunnelled, cuffed central venous catheters are commonly used for the provision of haemodialysis. Internal jugular vein catheters are generally tunnelled subcutaneously to the anterolateral chest wall. However, the lateral subcutaneous tract may increase the risk of catheter migration, particularly in the setting of obesity or large breast tissue. Catheter tip migration is an important cause of catheter failure. We describe two cases in which a paramedian tunnel was fashioned in patients experiencing recurrent catheter migration.

Electrodiagnostic Testing and Nerve Ultrasound of the Carpal Tunnel in Patients with Type 2 Diabetes.

In diabetic patients, controversies still exist about the validity of electrodiagnostic and nerve ultrasound diagnosis for carpal tunnel syndrome (CTS). We analyzed 69 patients with type 2 diabetes. Nerve conduction studies and peripheral nerve ultrasound of the median nerve over the carpal tunnel were performed. CTS symptoms were assessed using the Boston Carpal Tunnel Questionnaire. Polyneuropathy was assessed using the Neuropathy Symptom Score and the Neuropathy Disability Score. Although 19 patients reported predominantly mild CTS symptoms, 37 patients met the electrophysiological diagnosis criteria for CTS, and six patients were classified as severe or extremely severe. The sonographic cross-sectional area (CSA) of the median nerve at the wrist was larger than 12 mm2 in 45 patients (65.2%), and the wrist-to-forearm-ratio was larger than 1.4 in 61 patients (88.4%). Receiver operating characteristic analysis showed that neither the distal motor latency, the median nerve CSA, nor the wrist-to-forearm-ratio could distinguish between patients with and without CTS symptoms. Diagnosis of CTS in diabetic patients should primarily be based upon typical clinical symptoms and signs. Results of electrodiagnostic testing and nerve ultrasound have to be interpreted with caution and additional factors have to be considered especially polyneuropathy, but also body mass index and hyperglycemia.

Stereological and comparative evaluation of the carpal tunnel in patients with carpal tunnel syndrome using magnetic resonance images

Introduction: In this study, the relation between carpal tunnel syndrome (CTS) severity and the carpal tunnel volume (CTV), volume and the volume fraction of the carpal tunnel contents on subjects with CTS and healthy individuals were examined. Material and Methods: 30 female patients diagnosed with CTS clinically and electrophysiologically and 16 healthy female patients were included in this study. In patient group, 50 and in control group 30 hand wrists were examined. CTS severity was ranked electrophysiologically. T1-weighted axial magnetic resonance images (MRIs) were examined by the Cavalieri principle. Results: CTV in the patient group (4.26 ± 0.57 cm3) was found to be lower than that of the control group (4.66 ± 0.73 cm3), while the volume (0.41 ± 0.07 cm3) of the median nerve (Vnm) in the patient group was found to be higher than the control group (P < 0.05). Besides, the volume and volume fraction of the median nerve increase when the CTS severity increases (r = 0.610; r = 0.778). Discussion and Conclusion: Our study has shown that stereological studies with MRI are successful in determining the CTV in differentiating patients and healthy people. In addition, the volume and volume fraction of the median nerve were found to be quite effective in differentiating the severity of CTS. It is anatomically confirmed that when the severity of CTS increases, the space volume fraction of the carpal tunnel decreases.

A prospective comparative study of surgical release of carpal tunnel syndrome with and without flexor tenosynovectomy

Background: Carpal tunnel syndrome (CTS) is a common condition causing hand pain and numbness. The rationale of tenosynovectomy is to remove the flexor tenosynovium that is contributing to increased volume within the carpal canal, thus removal of this tenosynovium should give more space for the median nerve and there by relief from symptoms. Aims and Objectives: The main objective of our study was to assess the role of routine flexor tenosynovectomy in the treatment of CTS. Materials and Methods: Eighty-six hands with CTS were randomized into two groups, either to carpal tunnel release with or without flexor tenosynovectomy. All patients were requested to fill up the self-administered questionnaire for the assessment of symptom severity and functional status, examined for 2-point discrimination, grip and pinch strength, scar tenderness and patient satisfaction score preoperatively, 2 weeks, 1 month, and 6 months follow-up. Results: After the surgical release, both groups improved significantly with respect to symptom severity and functional status, 2-point discrimination, grip and pinch strength, scar tenderness and patient satisfaction score but there was no significant difference between the two groups. There were two cases of post-operative wound infection and one case of mild reflex sympathetic dystrophy. Conclusion: We conclude that routine flexor tenosynovectomy during surgical release of carpal tunnel in patients with CTS does not provide any added benefit nor does it increase any morbidity.

Median Nerve and Carpal Tunnel Morphology Before and After Endoscopic Carpal Tunnel Release: A 6-Year Follow-up Study.

Our purpose was to describe structural and morphological features of the median nerve and carpal tunnel on magnetic resonance imaging (MRI) studies obtained before, immediately after, 6 weeks after, and 6 years after endoscopic carpal tunnel release (ECTR). In this prospective cohort study, 9 patients with a diagnosis of carpal tunnel syndrome (CTS) underwent ECTR. Standardized MRI studies were obtained before ECTR, immediately after ECTR, and 6 weeks and 6 years after surgery. Structural and morphological features of the median nerve and carpal tunnel were measured and assessed for each study with comparisons made between each time point. All 9 patients had complete symptom resolution postoperatively. On the immediate postoperative MRI, there was a discrete gap in the transverse carpal ligament in all patients. There was retinacular regrowth noted at 6 weeks in all cases. The median nerve cross-sectional area and the anterior-posterior dimension of the carpal tunnel at the level of the hamate increased immediately after surgery and these changes were maintained at 6 years. We defined structural and morphological changes on MRI for the median nerve and carpal tunnel in patients with continued symptom resolution 6 years after ECTR. Changes in median nerve and carpal tunnel morphology that occur immediately after surgery remain unchanged at mid-term follow-up in asymptomatic patients. Established imaging criteria for CTS may not apply to postoperative patients. Magnetic resonance imaging appears to be of limited clinical utility in the workup of persistent or recurrent CTS.

Bone ingrowth into open architecture PEEK interference screw after ACL reconstruction

PurposeOpen or fenestrated interference screw design that allow bone ingrowth is a concept for improved bone healing to softtissue graft and bone filling in bone tunnels after anterior cruciate ligament reconstruction (ACLR) The aim of the current study was to assess CT scanning evaluated bone ingrowth into an open architecture interference screws in the tibial tunnel of patients undergoing ACL with soft tissue grafts. It was hypothesized that open architecture interference screws would stimulate bone ingrowth into the screw cavities.MethodsTwelve patients requiring ACLR were included. They underwent arthroscopic ACLR with semitendinosus−/gracilis tendon graft and an open architecture polyetheretherketone (PEEK) interference screw. The patients were scanned with a multi-slice CT scanner two weeks, six and twelve months postoperatively. On CT reconstruction slices bone ingrowth into the screw was measured. Subjective and objective clinical outcome international knee documentation committee score and instrumented knee laxity determination were collected.ResultsAt six months no implants demonstrated more than 10% bone ingrowth. At twelve months 42% (5/12) implants had more than 10% bone ingrowth (p = 0.009). The average bone filling into the screws was 7.7%. There was no tunnel widening or cyst formation seen in relation to any of the implants. Subjective IKDC score improved significantly from 50.6 baseline to 80.1 at 24 month follow-up. Preoperative side-to-side knee laxity improved from 3.7 (2.1) to 1.4 (1.2) mm at twelve months. There were no serious adverse events in relation to the new open architecture thread PEEK interference screw during or after hamstring ACL reconstruction.ConclusionThe present study demonstrated that open architecture thread PEEK interference screw can stimulate bone ingrowth into the screws after soft tissue ACL reconstruction with at 12 months with an average bone filling into screws was 7.7%. Knee stability, functional, subjective and objective outcomes were similar to large volume ACL outcome studies.Trial registrationThe study was registered at ClinicalTrials # NCT02382341. 12-09-2014.Level of evidenceIV.

Role of Ultrasonography in Severe Distal Median Nerve Neuropathy.

Electrodiagnostic studies do not differentiate severe lesions of the median nerve in the distal forearm from those within the carpal tunnel when compound muscle action potential over the abductor pollicis brevis and sensory nerve action potential are absent; needle electromyography showing denervation confined to the abductor pollicis brevis is presumed to suggest localization to the carpal tunnel, although the lesion may be in the forearm. Under these circumstances, the patient may undergo carpal tunnel release without benefit. This retrospective study looked at patients with clinical picture of severe carpal tunnel syndrome who had no compound muscle action potential or sensory nerve action potential on median nerve stimulation; the goal was to determine how often ultrasonic imaging pointed to a location other than the carpal tunnel. Patients with clinical picture of severe carpal tunnel syndrome with no sensory nerve action potential and no compound muscle action potential over the abductor pollicis brevis and second lumbrical underwent ultrasonic imaging; criteria for localization to the carpal tunnel included significant increase in the cross-sectional area of the median nerve at the carpal tunnel inlet and increase in the wrist/forearm cross-sectional area ratio. In 42 of 46 cases, entrapment at the carpal tunnel was confirmed by ultrasonography; in four patients, other causes were located proximal to the carpal tunnel. Ultrasonic imaging is useful not only for confirming entrapment of the median nerve at the carpal tunnel in patients with nonlocalizing electrodiagnostic studies but also in detecting pathology in the forearm, which may mimic severe carpal tunnel syndrome.

Radiological evaluation of the femoral tunnel positioning in anterior cruciate ligament reconstruction

ObjectiveTo evaluate the inclination and the length of the femoral tunnel in patients submitted to anterior cruciate ligament reconstruction (ACL) surgery by transtibial and anatomical techniques. MethodsThis is an analytical observational study in patients with ACL injury that underwent arthroscopic reconstruction through transtibial and anatomical surgical techniques. In the immediate postoperative period, computed tomography (CT) and anteroposterior (AP) view digital radiographs (X-rays) were performed to evaluate the inclination and length of the femoral tunnel. ResultsForty-two patients were analyzed: 27 underwent anatomical reconstruction and 15, transtibial reconstruction. The inclination angle and tunnel length by the transtibial technique are always greater than by the anatomical technique. The mean inclination angles were 59.75° (53.9–66.1°) in the X-rays and 54.17° (43.5–62.3°) in CT for the transtibial technique, and 42.91° (29.3–57.4°) in the X-rays and 39.10° (23.8–50.6°) in CT for the anatomical technique. Regarding the length of the femoral tunnel, the transtibial technique promotes longer tunnels: mean 55.7mm (40.0–70.2mm) in the transtibial and 35.5mm (24.5–47mm) in the anatomical technique. No statistically significant correlation was observed between the length and the inclination of the tunnel, regardless of the technique used. Thus, these variables can be considered as independent. ConclusionThe anatomical reconstruction technique presented shorter femoral tunnels and lower angle of inclination than the transtibial technique. The CT showed smaller inclination angle than the X-rays, regardless of the surgical technique.

Intratunnel Pressure Measurement in Patients with Carpal Tunnel Syndrome in Vietnam

Objective: Measure the intratunnel pressure of carpal tunnel in patients who underwent surgical treatment for carpal tunnel syndrome in Hanoi Medical University Hospital Patients and method: Prospective cross-sectional study of 33 carpal tunnel syndrome patients (61 hands) treated surgically at Hanoi Medical University Hospital. Measure the preoperative intratunnel pressure with manometer using needle catheter with 3 positions: neutral position, 90º of flexion and 90º of extension. Results: the average intratunnel pressure was 13.87 ±1.56 mmHg, it increased when wrist at 90º of flexion and 90º of extension (27.60 ± 2.53 and 34.76 ± 3.25, respectively). Conclusion: There is a high intratunnel pressure situation in the carpal tunnel syndrome.

Blood Flow Changes in Subsynovial Connective Tissue on Contrast-Enhanced Ultrasonography in Patients With Carpal Tunnel Syndrome Before and After Surgical Decompression.

Although qualitative alteration of the subsynovial connective tissue in the carpal tunnel is considered to be one of the most important factors in the pathophysiologic mechanisms of carpal tunnel syndrome (CTS), little information is available about the microcirculation in the subsynovial connective tissue in patients with CTS. The aims of this study were to use contrast-enhanced ultrasonography (US) to evaluate blood flow in the subsynovial connective tissue proximal to the carpal tunnel in patients with CTS before and after carpal tunnel release. The study included 15 volunteers and 12 patients with CTS. The blood flow in the subsynovial connective tissue and the median nerve was evaluated preoperatively and at 1, 2, and 3 months postoperatively using contrast-enhanced US. The blood flow in the subsynovial connective tissue was higher in the patients with CTS than in the volunteers. In the patients with CTS, there was a significant correlation between the blood flow in the subsynovial connective tissue and the median nerve (P = .01). The blood flow in both the subsynovial connective tissue and the median nerve increased markedly after carpal tunnel release. Our results suggest that increased blood flow in the subsynovial connective tissue may play a role in the alteration of the microcirculation within the median nerve related to the pathophysiologic mechanisms of CTS. The increase in the blood flow in the subsynovial connective tissue during the early postoperative period may contribute to the changes in intraneural circulation, and these changes may lead to neural recovery.

Radiologic assessment of femoral and tibial tunnel placement based on anatomic landmarks in arthroscopic single bundle anterior cruciate ligament reconstruction.

Background:Accurate tibial and femoral tunnel placement has a significant effect on outcomes after anterior cruciate ligament reconstruction (ACLR). Postoperative radiographs provide a reliable and valid way for the assessment of anatomical tunnel placement after ACLR. The aim of this study was to examine the radiographic location of tibial and femoral tunnels in patients who underwent arthroscopic ACLR using anatomic landmarks. Patients who underwent arthroscopic ACLR from January 2014 to March 2016 were included in this retrospective cohort study.Materials and Methods:45 patients who underwent arthroscopic ACLR, postoperative radiographs were studied. Femoral and tibial tunnel positions on sagittal and coronal radiographic views, graft impingement, and femoral roof angle were measured. Radiological parameters were summarized as mean ± standard deviation and proportions as applicable. Interobserver agreement was measured using intraclass correlation coefficient.Results:The position of the tibial tunnel was found to be at an average of 35.1% ± 7.4% posterior from the anterior edge of the tibia. The femoral tunnel was found at an average of 30% ± 1% anterior to the posterior femoral cortex along the Blumensaat's line. Radiographic impingement was found in 34% of the patients. The roof angle averaged 34.3° ± 4.3°. The position of the tibial tunnel was found at an average of 44.16% ± 3.98% from the medial edge of the tibial plateau. The coronal tibial tunnel angle averaged 67.5° ± 8.9°. The coronal angle of the femoral tunnel averaged 41.9° ± 8.5°.Conclusions:The femoral and tibial tunnel placements correlated well with anatomic landmarks except for radiographic impingement which was present in 34% of the patients.

Influence of change of tunnel axis angle on tunnel length during double-bundle ACL reconstruction via the transportal technique

BackgroundCommercially available flexible reamer and curved guide systems allow a certain degree of control over intra-articular tunnel orientation, therefore allows a wide range of intra-osseous femoral tunnel orientations, contrary to the femoral tunneling technique using a straight guide pin, which are determined by knee flexion angle. We sought to find the clinical relevance of intra-osseous femoral tunnel orientations in the respect of tunnel length. To evaluate the relationship between the tunnel axis angle in three orthogonal planes and tunnel length in the anteromedial (AM) and posterolateral (PL) femoral tunnels in patients who underwent anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using the transportal (TP) technique with a 42o curved guide.MethodsA total of 40 patients who underwent primary DB-ACLR with the TP technique using a curved guide were evaluated retrospectively. The tunnel axis angle in three orthogonal planes were evaluated on a three-dimensional surface model constructed using an axial computed tomography scan obtained after reconstruction. Then, correlations with tunnel length were analyzed.ResultsIn the AM tunnel, tunnel axis angles in the coronal (β = 0.0252, p = 0.022) and sagittal (β = 0.0168, p = 0.029) plane showed significant correlations with tunnel length, while the axial plane did not (p = 0.493) (adjusted R2 = 0.801). In the PL tunnel, only tunnel axis angles in the axial plane (β = 0.0262, p = 0.008) showed a significant relationship with tunnel length (adjusted R2 = 0.700).ConclusionDrilling at a higher angle in the coronal and sagittal planes in AM tunnels and at a higher angle in the axial plane in PL tunnels decreases the incidence of short femoral tunnels.

Morphologic change of nerve and symptom relief are similar after mini-incision and endoscopic carpal tunnel release: a randomized trial

BackgroundThe symptoms in carpal tunnel syndrome (CTS) can be ameliorated by open and endoscopic release of the transverse carpal ligament. It is unknown whether a mini-incision or endoscopic carpal tunnel release more effectively reverses the pathological changes that are observed in the median nerve in patients with CTS and these morphologic changes correlates with the subjective outcomes after carpal tunnel release. We hypothesized that (1) at 24 weeks after surgery, the subjective outcomes of mini-incision release and endoscopic release would not differ in patients with CTS; and (2) the ultrasonographic (US) morphology of the median nerve reverses similarly after mini-incision and endoscopic release; (3) the subjective outcomes correlates with these morphologic changes.MethodsBetween November 2011 and January 2013, 67 patients with CTS in their dominant wrist were randomized to either mini-incision (n = 32) or endoscopic (n = 35) release. Each patient was assessed by both the Boston Carpal Tunnel Questionnaire (BCTQ) and the Disabilities of the Arm, Shoulder, and Hand (DASH) pre-operatively and 24 weeks’ post-operation. An US examination was conducted at both time points to measure the cross-sectional area (CSA) at the inlet, middle, and outlet (CSA-I, CSA-M and CSA-O) and the flattening ratio (FR) at the middle and outlet (FR-M and FR-O) of the median nerve.ResultsThe post-operative mean BCTQ and DASH scores were improved significantly from the pre-operative scores in both groups (p < 0.001). The mean CSA-I decreased and CSA-M and CSA-O increased similarly in both groups (by 3.3, 3.0, and 3.8 mm2 in the mini-incision group and 2.9, 3.1. and 2.7 mm2 in the endoscopic group. The mean FR-M/FR-O decreased similarly from 3.6/4.2 to 3.2/3.0 in the mini-incision group and 3.8/4.3 to 3.2/2.9 in the endoscopic group. There were no significant differences in the subjective outcome scores or median nerve measures between the two groups. Improvement in the BCTQ-S only was significantly correlated with changes in the CSA at the inlet.ConclusionsMini-incision and endoscopic release both similarly relieved subjective symptoms and functions along with the pathological changes in the median nerve morphology along the carpal tunnel in patients with idiopathic CTS. Symptom relief after surgical decompression seems to correlate with reduced nerve swelling at carpal inlet and reversed nerve flattening inside carpal tunnel.Trial registrationThis study was retrospectively registered in “ClinicalTrials.gov” at Oct 18th, 2013, and the registration number was NCT01972165.

Neurolysis of the Median Nerve to the Carpal Canal by the Way Mini-Open: Review of 68 Files at Brazzaville University Hospital

Objective: To evaluate the results of neurolysis of the median nerve to the carpal tunnel in patients operated by the mini-open technique. Methods: The prospective study included 68 patients (16 men and 52 women) aged 43 to 80 years (mean age: 64 years). Patients were evaluated in pre- and post-operative by a questionnaire. The mini open technique with cutaneous approach to the heel of the hand following the 4th ray was performed in all patients under local, locoregional or general anesthesia. Results: The results were evaluated in 3 consultations, in the 1st, 3rd and 6th month. We obtained very good results in 54.4% of the cases (n = 37) and 30.9% (n = 21) of good results and 14.70% (n = 10) of poor results. No vascular, tendinous or neurological complications were noted. Two patients were reoperated for incomplete resection of the carpal ring ligament. The mini-open technique has achieved good results in all neurolysis despite the delay in surgical management. Conclusion: The results of the surgical treatment of the carpal tunnel syndrome depend on the precocity of the diagnosis and the surgical indication.

Ultrasound-guided Hydrodissection for Severe Carpal Tunnel Treatment

Aims: The main aim of the present study was to assess the clinical outcome after ultrasound-guided hydrodissection and triamcinolone injection into the carpal tunnel in patients with severe carpal tunnel syndrome. Materials and Method: Participants—The prospective study design of the present observational investigation measured the therapeutic effect of ultrasound-guided hydrodissection and corticosteroid injection of the carpal tunnel in 36 consecutive participants with carpal tunnel syndrome, following American Academy of Neurology (AAN) clinical criteria, and classified as severe in the baseline neurophysiological study. Each participant completed the Boston and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires and underwent median motor and sensory nerve conduction studies (NCS) at baseline and 6 months after injection. Median nerve ultrasonography was assessed at baseline (prior to steroid injection) and at 3 and 6 months after injection. The ultrasound examination included measurement of the median nerve cross-sectional area at the distal wrist crease (DWC) and 12 cm proximal to calculate the wrist-to-forearm median nerve area ratio. Injection—At the initial visit, an ultrasound-guided hydrodissection and steroid injection was performed. In all cases, a baseline electrical and ultrasonography measurements were recorded prior to the injection. Ultrasound imaging of the median nerve was done using an ultrasound device, with a 8.0 a 13 MHz linear-array transducer. We used a linear array transducer with a 8-13 Mhz frecuency range which is the standard for musculoskeletal ultrasound examination. A 21-gauge needle was used for 2 punctures. After proper disinfection of the volar aspect of the wrist, the entry point of the first puncture was located at the ulnar side of the wrist, as described by Smith et al. for the transverse ulnar (short-axis or axial) approach. For the sagittal (long-axis or sagittal) approach, the puncture was performed following the indications by Grassi et al. A combination of lidocaine (1 ml), 40 mg of triamcinolone acetonide (1 ml), and saline serum (9 ml) was injected into the area surrounding the median nerve. Statistical Analysis—Changes in the following variables were assessed at 3 and 6 months after the index procedure: Boston symptom and function scores, DASH score, median nerve motor and sensory latencies (converted to velocity for sensory studies), as well as the median nerve cross-sectional area. Results: The following mean baseline values were recorded: Boston score: 2.99, DASH score: 47.03, motor latency 5.74 ms, sensory velocity 25.52 m/s, DWC area of 13.93 mm2, wrist-to-forearm ratio (WFR) of 6.56 mm2. The following variables showed significant changes within treatment responder patients at 6 months follow-up: 26.8% improvement upon Boston score ( P &lt; .001), 39.9% upon DASH score ( P = .006), 19.6% decrease at DWC area ( P &lt; .001), 19.6% decrease of the WFR ( P = .001). Conclusions: Ultrasound-guided hydrodissection and corticosteroid injection of the carpal tunnel seems an effective treatment for severe carpal tunnel syndrome in the short-term, with a success rate estimated at 56% of the patients.