Patient Outcomes after Open Release of the Carpal Ligament on the Carpal Tunnel Syndrome / 대한정형외과학회잡지

We present at least a one-year follow up of the 19 patients(twenty-two hands) of a open release of carpal ligament and external neurolysis in surgery for carpal tunnel syndrome. The transverse carpal ligament is exposed through a three centimeter paJmar incision in line with the axis of the third finger, started at the mid-point of the distal wrist crease and then straightly advanced. We analysed clinical manifestations and the following results were obtained; The average follow-up period was 27 months (12 - 120months). 1. According to the patients satisfaction of results(Cseuz criteria), the large majority of patients(91%) obtained good results. In 9% of the case (two hands) symptoms were siightly improved followed the operation but pain, numbness and paresthesia remained troublesome. 2. The mean grip and pinch strength of the fifteen hands were 23.4kg and 5.97kg respectively. 3. Thirteen(87%) of the fifteen hands that had thenar atrophy regained normal muscle bulk. 4. Six(50%) of the twelve hands that had denervation findings such as fibrillation or sharp wave were disappeared. 5. Twenty(91%) of the twenty-two hands that had increased values for two-point discrimination had normal values at follow-up.

Comparison of Percutaneous and Open Decompression in the Treatment of Carpal Tunnel Syndrome / 대한정형외과학회잡지

Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome that characterized by pain, especially in night, sensory disturbance in median nerve dermatome of the hand, and thenar muscle atrophy. Open decompression was a treatment of choice, when operative intervention is necessary. But, endoscopic or percutaneous decompression is introduced recently. Authors analyzed 21 cases of open decompression and 22 cases of percutaneous decompression and they could be follow up over 6 months at Dept. of Orthopedics, Chonnam University Hospital from June 1990 to January 1995. The results are as follows. 1. There were no difference in age, sex, lesion side, symptoms duration until operation, etiology and occupation between percutaneous and open decompression. 2. There were excellent or good results in clinical symptom in 19 cases(90%) of open procedures and 19 cases(86%) of percutaneous procedure and more rapid relief of the pain, and grip power in percutaneous procedure than open procedure. 3. The EMG, recorded at 1 week, 4 weeks, 3 months and 6 months after operation, revealed improvement in sensory than motor function. There was more rapid recovery in percutaneous procedure than open procedure especially latency and amplitude of sensory nerve. There were 2 cases in open procedure and 3 cases in percutaneous procedure who did not respond to treatment. As a result, percutaneous procedure was more simple and rapid recovery than open procedure in clinical progressions and EMG reports, but recovery rate of symptomatic relief was similar. Therefore percutaneous procedure is thought to be more reasonable method in the treatment of carpal tunnel syndrome if surgical intervention is indicated.

The Results of Open Release in Carpal Tunnel Syndrome / 대한정형외과학회잡지

Forry-two symptomatic hands of 29 patients with carpal tunnel syndrome operated during the period from Marth 1986 to December 1993 were analized in clinical aspect. Among 29 patients, 3(10.3%) were male and 26(89.7%)were female. The syndrome occured on the right side in 10(34.5%) patients, on the left in 6(20.7%) patients, and on both in 13(44.8%) patients. The causes of the syndrome were idiopathic(90.5%), trauma(7.1%), mass(2.4%). Paresthesia(57.1%) was the most common chief complanit, followed by numbness(35.7%), pain(21.4%), weakness(9.5%). Thenar muscie atrophy occured in 84.8%, positive Tinel sign in 83.3% and positive Phalen sign in 90.0%. Delay of motor conduction velocity of median nerve was noted in all cases and delay of sensory nerve conduction velocity in all cases. Denervation finding such as fibrillation or sharp waves were seen in all cases. The carpal tunnel release was performed in all cases, and 31 cases were treated by carpal tunnel tunnel release with internal neurolysis. 35 cases(83.3%) were excellent or good results. The cases were long duration were poorer results. No significant difference was found between the results in cases treated by carpal tunnel release alone and those in cases treated by carpal tunnel release with internal neurolysis of median nerve.