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@#Introduction: Single-portal endoscopic carpal tunnel release using modified Agee technique is widely used in Vietnam. Yet information on the anatomy of the target space of Vietnamese people regarding this technique is scarce. We aimed to characterise the anatomical landmarks and variations of the carpal tunnel to propose a safer surgery. Materials and methods: All twenty hands of ten fresh frozen, unembalmed cadavers of Vietnamese adults were included. Dissection was performed after the vertical line, Kaplan’s cardinal line and the distal wrist crease were drawn. The transverse carpal ligament (TCL), ulnar neurovascular bundle and superficial palmar arch were exposed. Measurements were made using Mitutoyo calliper. The variants of the median nerve and in the course of the thenar motor branch were recorded. Results: The median distances from the TCL distal margin to the distal wrist crease and superficial palmar arch were 31.2mm and 12.7mm, respectively. The ulnar neurovascular bundle was located 5.7mm and 4.4mm ulnar to the vertical line at the level of the TCL proximal margin and at the level of the TCL distal margin, respectively. The thenar motor branch of the median nerve was extra-ligamentous in 19 hands and preligamentous in 1 hand. Conclusion: If endoscopic portal is made along the distal wrist crease, blade assembly should not be inserted beyond the 35mm mark on its scale. Instruments should be aimed toward the radial border of the patient’s ring finger. Surgeons should be aware of the preligamentous course of the thenar motor branch although this variant type is rare.
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@#Introduction: Carpal tunnel syndrome (CTS) is one of the most common peripheral neuropathies affecting patients' life. Performing endoscopic carpal tunnel release is now a new technique that is being gradually applied in Vietnam. This paper seeks to investigate the effectiveness of Chow’s method for CTS treatment. Materials and methods: This is a prospective cohort study involving seventy-seven patients with CTS who underwent Chow’s endoscopic method at our hospital from March 2019 to January 2020. The Boston Carpal Tunnel Questionnaire and electromyography (EMG) were used primarily to evaluate surgical decompression pre-operatively, one week, three weeks, three months, and six months after surgery. We also recorded incision length, pain at the scar, the improvement of symptoms and thenar atrophy and return-towork time after surgery. Results: A total of 85.7% of the patients were women. A moderate severity of EMG was seen in 64.9% of cases. Sixmonth post-operative functional status scale (FSS) (1.05±0.1) and symptom severity scale (SSS) (1.05±0.1) showed significant improvement when compared with preoperative FSS (2.8±0.5) and SSS (3.2±0.5). Post-operative EMG showed the distal sensory latency (DSL) and distal motor latency (DML) had returned to the norm in 88% and 89.3%, respectively. The average incision length was 12.1±1.2mm. Six months after surgery, numbness and hand pain had resolved in 97.4%, a painless scar was seen in 94.7%, but full recovery of thenar atrophy was only seen in 9.1%. Patients could get back to work after 10.2±2.4 days. Conclusion: Chow’s endoscopic carpal tunnel release is a safe and effective procedure for patients suffering from carpal tunnel syndrome that showed promising outcomes on clinical symptoms and functions on EMG with minimal pain and scarring, and early return to work.
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Objective To explore the MRI characteristics of saddle transverse carpal ligament (TCL)of patients with idiopathic carpal tunnel syndrome (CTS). Methods The clinical diagnosis of 21 cases of idiopathic CTS patients (22 wrists) were retrospectively analyzed and as the idiopathic CTS group. Thirty two patients without CTS symptoms or TCL and volar soft tissue lesions (33 wrist joints) were selected as the control group. Patients in two groups were both conducted with sagittal and axial MRI scan of wrist joint to observe the form of the TCL, determine whether the TCL saddle and calculate the TCL palmar concave curvature and the median nerve compression rate. The differences of the morphology of the TCL of patients in two groups were compared by Chi?square criterion, and the difference of the TCL palmar concave curvature were compared by non parametric test. The relativity of TCL palmar correlation concave curvature and compression ratio of the median nerve of patients with idiopathic CTS was evaluated by the Pearson correlation analysis.Results The sagittal plane of patients with idiopathic CTS was upper, saddle shaped TCL was dented to the palmar and the concave point most frequently located in the hamate hook. Thirty one patients were with saddle shaped TCL (20 patients with idiopathic CTS and 11 patients in the control group) and 24 patients were with non saddle shaped TCL (2 patients with idiopathic CTS and 22 patients in the control group) as the standard of saddle shaped TCL concave 0.25 mm and the difference of the morphology of the TCL of patients in two groups had statistical significance (χ2= 17.791, P<0.01). The median of TCL palmar concave curvature of patients with idiopathic CTS and patients in the control group was 8.49%and 0.00%, respectively, the difference of which was statistically significant (Z=-4.79, P<0.01). The level of the median nerve, the TCL palmar concave curvature [(7.88+4.28)%] and the median nerve compression rate [(39.36 + 19.43)% ] of patients with idiopathic CTS were positively correlated (r=0.714, P<0.01). Conclusions Saddle shaped TCL is the characteristic manifestation of patients with idiopathic CTS. The TCL sagittal concave palm and median nerve compression percentage rate are both helpful to the accurate diagnosis.
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PURPOSE: Complete release of the transverse carpal ligament(TCL) is accepted as the standard treatment for carpal tunnel syndrome(CTS). However, loss of grip and pinch power are reported in some patients after complete release of the TCL. This study was designed to evaluate the effectiveness of complete versus partial carpal tunnel release by using the inching technique. METHODS: Nineteen patients(a total of 27 hands) who each had a confirmed diagnosis of CTS were selected from September 2002 to February 2003. The cases were divided into three groups(mild, moderate and severe) based on preoperative electrodiagnostic studies. The patients with partial carpal tunnel syndrome were classified into the mild or moderate groups, while patients with complete carpal tunnel syndrome were classified into the moderate or severe groups. Patient oriented data (functional and symptomatic) were collected and electrophysiologic studies were undertaken preoperatively and postoperatively(on the 2nd week, 1st month, 3rd month and 6th month after surgery). RESULTS: In this study, the mild and moderate groups showed both good functional and symptomatic results and improvements in electrophysiologic studies. CONCLUSION: Carpal tunnel syndrome patients classified into mild or moderate groups based on nerve conduction studies, and whose precise compression sites were pinpointed using the inching technique, can be treated by partial carpal tunnel release.
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Humanos , Síndrome del Túnel Carpiano , Diagnóstico , Estudios de Seguimiento , Fuerza de la Mano , Ligamentos , Conducción NerviosaRESUMEN
Objective To study the force and pressure transmission through normal wrist,and the effect of transverse carpal ligament release on the biomechanics of carpal tunnel.Methods A 3-D finite element model of the wrist based on CT scan images was established.The load transmission of carpus and the distribution of contact stress on radiocarpal joint under axial compressive force on metacarpals as well as the effect of transverse carpal ligament(TCL)release on the displacement of carpal bones were computed and analyzed.Results The computational results of force and pressure transmission through normal carpus matched well with previous studies.The release of TCL resulted in radial and palmar displacement of the scaphoid,flexion and radial rotation of radiocarpal joint as well as a further radial deviation of the whole carpal tunnel.Conclusion A 3-D finite element model of the wrist that includes the carpal tunnel,distal radius and ulna and proximal metacarpals is developed.This model may simulate the load transmission better and contact stress distribution of carpal tunnel and radiocarpal joint,as well as provide an operational plateform for further deeply studing on biomechanical behavior of carpal structure.The computed and analyzed results of the effect of TCL release on the displacements of carpal bones can be served as related theoratic base on carpal tunnel syndrome,carpal tunnel release surgery and recovery after operation.
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[Objective]To evaluate the application of sonographic measurements of the thickness of transverse carpal ligaments in CTS(carpal tunnel syndrome) patients.[Methods]Fifty-two wrists from 40 patients with CTS confirmed by surgery and 32 wrists from 20 healthy individuals(control group) underwent sonographic examination of the thickness of transverse carpal ligaments at the level of pisiform bone and the hook of the hamate bone in transverse plane by the same operator.[Results]The thickness of transverse carpal ligaments in CTS patients was(0.41?0.10) cm at hamate hook level and(0.35?0.11) cm at pisiform level versus(0.28?0.11) cm and(0.20?0.08) cm in the control group.There was significant difference in the mean value of thickness of transverse carpal ligaments hetween the two groups at the two levels.[Conclusion]Ultrasonography examination of the thickness of transverse carpal ligaments is a new and valuable technique in the diagnosis of carpal tunnel syndrome and is much helpful to choose operation methods.
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[Objective]To evaluate the diagnostic value of ultrasonography in patients with carpaltunnel syndrome (CTS) by measuring the thickness of transverse carpal ligament.[Method]Forty patients who had clinically and electrophysiologically confirmed as CTS underwent surgery and ultrasonographic examination by the same operator for the thickness of transverse carpal ligaments at the level of the hook of the hamate bone in transverse plane preoperatively.Twenty-four asymptomatic normal wrists served as control.Data of the ultrasonography and surgey from patients and the control groups were compared to determine the diagnostic parameters.[Result]The ultrasonographic thickness of transverse carpal ligaments in CTS patients was (0.42?0.08)cm at hamate hook leve and the data from surgey was (0.40?0.10).The data in control group was (0.29?0.07)cm.There was significant difference in the mean value of thickness of transverse carpal ligaments between the two groups at the same level.There was no significant difference between the data of CTS from surgey and ultrasonography.[Conclusion]Ultrasonography examination of the thickness of transverse carpal ligamentsis is a new and feasibile method in the diagnosis of carpal tunnel syndrome.
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PURPOSE: The aim of this study was to determine differences in the specific collagen types of the transverse carpal ligament (TCL) in patients with carpal tunnel syndrome (CTS) and a control group without CTS. MATERIALS AND METHODS: Surgical specimens from 19 dissected TCLs in patients with idiopathic CTS and 5 controls without CTS were taken (1x1 cm2). We analyzed the manifestations of collagen types I and III by immunohistochemical staining. RESULTS: We found a homogeneous manifestation of type I and III collagens in the control group. However, in CTS patients, type III collagen was sporadically found around the perivascular and pericellular area, and type I collagen showed no definite differences between the two groups. The cellularity in CTS patients was much lower than that in the control group. CONCLUSION: The TCL in CTS patients shows reduced manifestation of type III collagen and less cellularity. These intrinsic changes may play a role in the different manifestations of collagen types in TCL.