Revision Surgery after Carpal Tunnel Release for Idiopathic Carpal Tunnel Syndrome

PURPOSE: To report the causes of recurrent and persistent symptoms after carpal tunnel release and to evaluate the result of revision surgery. MATERIALS AND METHODS: wenty one patients who underwent surgery for recurrent or persistent carpal tunnel syndrome after carpal tunnel release were studied. The mean age was 59 years. There were 2 men and 19 women. The mean time interval between first operation and revision surgery was 29.8 months, and mean follow up period was 10.6 months. The operations were done by single surgeon. RESULTS: The most common cause of failed carpal tunnel release was scar adhesion, which was observed in nine cases. Other causes included incomplete release of transverse carpal ligament in six, scar adhesion with incomplete release in three, iatrogenic median nerve injury in two, and unrecognized calcification in one. Following revision surgery, 15 cases (71%) showed alleviation of symptoms. CONCLUSION: In cases of recurrent or persistent carpal tunnel syndrome following carpal tunnel release, evaluation of the causes is essential in performing revision surgery.

Diagnosis and Management of Carpal Tunnel Syndrome Caused by Local Lesions

PURPOSE: To discuss the diagnosis and treatment of nonidiopathic carpal tunnel syndrome (CTS) caused by variable local lesions. MATERIALS AND METHODS: Fifteen patients who underwent surgery for CTS caused by local lesions were studied. The average age was 53.3 years. There were 5 men and 10 women. Plain radiographs including carpal tunnel view and ultrasonography were routinely performed, and magnetic resonance imaging and computed tomography were taken in selected cases. Carpal tunnel release were done by a single surgeon. RESULTS: Lesions causing CTS included calcification in five cases, ganglion in two, malunion after distal radius fracture in one, osteophyte of carpal bone in one, tuberculosis tenosynovitis in one, synovitis by foreign body in one, acute lunate dislocation in one, lipoma in two, median artery in one. Following surgery, all cases showed alleviation of symptoms. CONCLUSION: Prior to surgical decompression of CTS, it is important to assess any lesion around median nerve and carpal tunnel through physical examination, radiographs including carpal tunnel view and ultrasonography.

The Diagnostic Availability of Multidetector-Row Computed Tomography(MDCT) in Deep Vein Thrombosis Developed after Joint Arthroplasty / 대한정형외과학회잡지

PURPOSE: To evaluate the accuracy and availability of Multidetector-Row Computed Tomography (MDCT) and Color Doppler Sonography as a method for making an early diagnosis of DVT after joint arthroplasty. MATERIALS AND METHODS: A total of 71 cases (63 patients) were selected. 32 cases (32 patients) underwent a THRA and 39 cases (31 patients) underwent a TKRA between April 2004 to August 2004. All cases underwent both Color Doppler Sonography and MDCT, before and after surgery. No prophylactic medications for DVT were given. Patients who previously had DVT or pulmonary embolism or a medication history of anticoagulation therapy were excluded. RESULTS: DVT was found by MDCT in 33 cases (46.5%) and by Color Doppler Sonography in 15 cases (21.1%). In the 33 cases of DVT diagnosed by MDCT, 24 cases developed in the calf vein, among them, only 4 cases were positive and remaining 20 were negative in Color Doppler Sonography. In the 15 cases of DVT diagnosed by Color Doppler Sonography, 13 cases were positive and only 2 cases were negative in MDCT. CONCLUSION: MDCT is effective in diagnosing DVT after joint arthroplasty in terms of the objectivity, efficacy and accuracy.