Comparative study between mini-incision and conventional surgical approaches for carpal tunnel release

Background: Conventional approach is an effective method for carpal tunnel release, however it causes scar discomfort, pillar pain and cosmetic complaints. Several mini-incision techniques were introduced to avoid such complications. Aim of the study The aim of this study is to compare the results of two surgical techniques, the conventional longitudinal incision over the transverse carpal ligament (TCL), and the mini-incision at the distal wrist crease and near the proximal border of the TCL for carpal tunnel release. Patients and Methods: This study included 20 patients with carpal tunnel syndrome. 10 were operated upon by classical open palmar incision (group A) and 10 through mini-incision technique at distal wrist crease (group B). Follow up was after 2 weeks, 1, 3 and 6 months. Incisional pain, pillar pain using Visual Analog Scale (VAS), Levine symptom and function severity scores were evaluated at 3rd and 6th months postoperatively. Patients' satisfaction about surgery and cosmetic results were evaluated using Visual Analog Patient Satisfaction Scale (VAPSS). Patients graded their cosmetic results from poor to excellent. Results: There were no intraoperative complications. Group B showed significantly less incisional and pillar pain. Patients were significantly more satisfied about cosmetic results in group B. There was no significant difference between both groups regarding time taken to return to daily life activities. Conclusion: Conventional and mini-incision surgical approaches are both safe effective methods for carpal tunnel release. Mini-incision technique provided smaller and less painful scar, hidden in the wrist crease

Assessment of musculoskeletal ultrasound guided injection of the new regenerative medicine techniques (neural prolotherapy and platelet rich plasma) impact versus well established techniques (steroid injection) in cases of carpal tunnel syndrome secondary to rheumatoid arthritis

Background: Rheumatoid arthritis is a systemic rheumatic disease characterized by symmetrical, often erosive and deforming poly-arthritis with extra-articular manifestations in 10­20% of patients, especially those with high titers of rheumatoid factor. Extra articular pathology includes bursitis, tendonitis and neuritis, which results from entrapment, nerve ischemia due to vasculitis or drugs used to treat this condition. Carpal tunnel syndrome is the most common compression neuropathy associated with rheumatoid arthritis. Aim of the Work: To evaluate the efficacy of Neural Prolotherapy and Platelet Rich Plasma in treatment of carpal tunnel syndrome secondary to rheumatoid arthritis. Patients and Methods: Ninety patients with Rheumatoid Arthritis (RA) that were all fulfilling the 2016 ACR/EULAR classification criteria for RA. All were over the age of sixteen years at time of diagnosis, complaining of burning pain or paresthesia in the median nerve distribution of the hand. They were recruited from Rheumatology and Rehabilitation Department at Al-Hussein and Sayed Galal University Hospitals during the period from December 2018 to July 2019. Results: Neural Prolotherapy and Platelet Rich Plasma (PRP) have improved all measured parameters like visual analogue scale (VAS), nerve conduction studies and neuromuscular ultrasonography parameters in carpal tunnel syndrome secondary to rheumatoid arthritis. Conclusion: Neural Prolotherapy and Platelet Rich Plasma proved to be effective treatments of carpal tunnel syndrome secondary to rheumatoid arthritis

Deux observations de syndrome canalaire du membre superieur d'etiologie exceptionnelle

Les syndromes canalaires du membre superieur couvrent des pathologies variees. Les manifestations vasculaires au cours de ces syndromes sont rares mais graves. Nous rapportons deux cas atypiques d'etiologie exceptionnelle; dont un cas du syndrome de canal carpien provoque par une tumeur de type rhabdomyosarcome alveolaire; de la partie distale de la face anterieure de l'avant bras et un cas de syndrome de la traversee cervico-thoraco-brachiale du a une exostose de l'extremite superieur de l'humerus. Notre objectif est de rapporter ces deux cas et de realiser une revue de la litterature sur les aspects clinique et therapeutique de ces affections