Gómez FMÁ, Linares PDI, Cruz PR

Language: Spanish
References: 11
Page: 47-49
PDF size: 43.52 Kb.

ABSTRACT

Objective: Determine if there exists difference between release of the median nerve alone and the release of the median nerve and flexor tendons in surgical carpal tunnel treatment.
Material and Methods: We performed between February 2004 to February 2005 a study of Two (2) historic cohorts with revision of patient files who were surgically treated with two different techniques and with electromyographical diagnosis of Carpal Tunnel Syndrome from August 1997 to December 2004. We excluded patients with spondilolisthesis C5-C6 level, cervical spondiloartrosis, Diabetes Mellitus, diabetic neuropathy, pregnancy, ocuppys tumors in that space The analysis was performed by differential proportions with Chi-Square testing. According to the surgical techniques, patients were grouped in two (2) groups: (a) release of median nerve alone, and (b) release of median nerve and flexor tendons. Information was gathered from daily medical records and surgical reports. The minimal follow up was two months.
Results and discussion: After performing the search, 20 female patients were found with the diagnosis, 10 of which presented with relapse episodes of carpal tunnel symptoms; they were treated with median nerve release alone.(p›0.001). Complications depends on which surgical technique is used (p‹0.05). It is suggested that the technique of section of carpal ligament with release of the median nerve with flexor tendon release be carried out to avoid a greater number of complications and relapse of carpal tunnel syndrome.

REFERENCES

1. Robert M. Szabo,MD, and David R. Steinberg,MD: Nerve entrapment syndromes in the wrist, J Am Acad Orthop surg 2: 1994;115-123.

2. Campbell: cirugía ortopédica, 9ª edición, vol. 4 Harcourt Brace Madrid 1998.

3. Harry B. Skinner: Current diagnosis and treatment in orthopedics, Connecticut, Appleton and lange 1995.

4. Barton NJ: Another cause of median nerve compression by a lumbrical muscle in the carpal túnel; J Hand surg 4: 189, 1979.

5. Pecket P. Gloobe H. Nathan H: Variations in the arteries of the median nerve with special considerations on the ischemia factor in the carpal túnel syndrome; clin. Orthop 97: 144,1973.

6. Steve K. Lee, MD, and Scout w. Wolfe, MD: Peripheral nerve injury and repair, J Am Acad Orthop surg 8: 2000; 243-252

7. Gellman H, Gilberman RH, Tan Am, Botte MJ: Carpal túnel syndrome: an evaluation of the provocative diagnostic test, J Bone Joint surg 68-A: 735,1986

8. Jinrok O, Zhao C, Amadio PC, An Kn, Zobitz ME, Wold LE: Vascular pathologic changes in the flexor tenosynovium subsynovial conective tissue in idiopathic carpal túnel syndrome, J Orthop Res. 22(6) 2004 Nov; 1310-5.

9. Menke w, Palme E, Cols. Resuls of the studies of surgically treated carpal túnel syndrome with obligate tenosynovectomy of the flexor tendons ; Z Orthop in the Grengeb, 1994 Mar- apr; 132 (2): 126-8

10. Charlotte Shum MD, May Parisien MD, Robert J Strauch, MD and Melvin P.Rosenwasser MD: The role of the flexor tenosynovectomy in the operative treatment of the carpal túnel syndrome; J Bone and Joint surg 84: 2002;221-225.

11. Gerritsen, A. A et. al. Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome. British Journal of Surgery. 88(10): October 2001 pp1285-1295