Long-Term Changes of the Clinical and Nerve Electrophysiological Findings after Endoscopic Carpal Tunnel Release / 대한정형외과학회잡지

PURPOSE: The aim of this study was to analyze the clinical symptoms and function and the nerve electrophysiological changes between the pre-operative and long-term post-operative states of patients who underwent surgical treatment with endoscopic release of the carpal tunnel for idiopathic carpal tunnel syndrome. MATERIALS AND METHODS: This study was performed in 48 patients and 88 wrists with idiopathic carpal tunnel syndrome. All patients were treated with endoscopic carpal tunnel release using a single portal. The preoperative and the 3 years 5 months long-term postoperative clinical symptoms and function were evaluated using the Boston carpal tunnel questionnaire. The nerve electrophysiological status was evaluated using the Bland grade system. RESULTS: When the preoperative Bland grade was 2, 3, 4, 5, and 6, the range of the change of the symptom severity score was 1.38, 1.68, 2.40, 1.61 and 1.28, respectively, and the range of the change of the functional status score was 0.60, 1.34, 1.58, 0.93 and 0.88, respectively, at the long-term follow-up. The clinical symptoms were signifi cantly improved at the fi nal follow-up when the preoperative Bland grade was 2, 3, 4 and 5. The function was signifi cantly improved for all the preoperative Bland grades. On the nerve electrophysiological study, there was statistical improvement of the distal motor latency of the motor nerve and the nerve conduction velocity and amplitude of the sensory nerve. When the preoperative Bland grade was 2, 3, 4, 5 and 6, the extent of improved grade was 0.60, 0.75, 2.17, 2.87 and 4.25, respectively, at the long-term follow-up, and the Bland grade was signifi cantly improved when the preoperative Bland grade was 3, 4, 5 and 6. However, there was no statistical signifi cance between the Bland grade and the clinical state at the long-term follow-up. CONCLUSION: The clinical and nerve electrophysiological states were significantly improved at the long-term follow-up after endoscopic carpal tunnel release. When the preoperative Bland grade was 3, 4 and 5, the clinical symptoms, function and the nerve electrophysiological states were signifi cantly improved at the long-term follow-up.

Detection of Synovial Hypertrophy in Idiopathic Carpal Tunnel Syndrome Using Ultrasongraphy / 대한정형외과학회잡지

OBJECTS: Synovial thickness in carpal tunnel was measured by high-resolution ultrasonography to evaluate the relation of synovial hypertrophy in idiopathic carpal tunnel syndrome. MATERIALS AND METHODS: Thickness of synovium of flexor tendons in 46 hands of idiopathic carpal tunnel syndrome and 50 hands of normal control were measured quantitatively by high-resolution ultrasonography. The patients were classified into three groups according to the clinical severity: Group I had typical clinical symptoms and positive provocation test (17 cases) , Group II had sensory decreation on the dermatome of median nerve (21 cases) , and Group III had sensory decreation and thenar muscle weakness. The thickness of flexor tendons in the three groups and control group were statistically compared. RESULTS: The mean value of thickness of carpal tunnel syndrome was 1.06mm and that of control group was 0.87mm (p=0.012) . Positive correlation was revealed according to the clinically classified three groups. CONCLUSION: Synovial hypertrophy in carpal tunnel has positive relationships with idiopathic carpal tunnel syndrome, and it reveal possibly the progression of the disease.