Endoscopically assisted proximal radial nerve decompression: surgical technique.

STATE OF THE ART: The proximal radial nerve compression syndrome includes supinator syndrome and proximal radial nerve constrictions. This article presents a new endoscopic assisted radial nerve decompression surgical technique described for the first time by Leclère et al. in 2013. SURGICAL TECHNIQUE: Endoscopic scissor decompression of the proximal radial nerve is always performed under plexus anaesthesia. It includes 8 key steps documented in this article. We review the indications and limitations of the surgical technique. CONCLUSION: Early clinical results after endoscopic assisted decompression of the radial nerve appear excellent. However, they still need to be compared with conventional techniques. Clinical studies are likely to widely develop because of the mini-invasive nature of this new surgical technique.

[Endoscopically assisted decompression of the median nerve in the pronator and Kiloh-Nevin syndrome: Surgical technique]. / Décompression du nerf médian assistée par endoscopie dans le syndrome pronateur et le syndrome de Kiloh-Nevin : technique chirurgicale.

STATE OF THE ART: The proximal median nerve compression syndrome includes the pronator teres and the Kiloh-Nevin syndrome. This article presents a new surgical technique of endoscopic assisted median nerve decompression. MATERIAL AND SURGICAL TECHNIQUE: Endoscopic scissor decompression of the median nerve is always performed under plexus anaesthesia. It includes 6 key steps documented in this article. We review the indications and limitations of the surgical technique. RESULTS: Since 2011, three clinical series have highlighted the advantages of this technique. Functional and subjective results are discussed. We also review the limitations of the technique and its potential for future development. CONCLUSION: Although clinical results after endoscopic assisted decompression of the median nerve appear excellent they still need to be compared with conventional techniques. Clinical studies are likely to develop primarily due to the mini-invasive nature of this new surgical technique.

[Enlargement plasty of the first dorsal compartment for the surgical treatment of de Quervain's tenosynovitis]. / Die Erweiterungsplastik des ersten Strecksehnenfachs zur operativen Behandlung der Tendovaginitis de Quervain.

OBJECTIVE: Reliable reduction of pain, observance of anatomical variations, avoidance of complications. INDICATIONS: Failure of conservative treatment, clinically obvious diagnosis, positive Finkelstein test (pathognomonic). CONTRAINDICATIONS: Previous splitting of the retinaculum of the first dorsal compartment, uncertainty of diagnosis. SURGICAL TECHNIQUE: Skin incision with protection of the branches of the superficial radial nerve, exposure of the first dorsal compartment, w-shaped incision and preparation of the retinaculum lobes, exposure of all tendons, inspection of the whole compartment and possible anatomic variations. Loose adaptation of the lobes, irrigation, hemostasis, skin closing. POSTOPERATIVE MANAGEMENT: Consequent immobilization in a thumb cast for a total of 3 weeks (+ 3 weeks optional depending on load/profession). Sutures removed after 2 weeks, then the patient can start mobilization exercises (without the splint) after 3 weeks. RESULTS: Between August 2005 and July 2007, 38 patients (40 wrists) were operated without complications. No tendon subluxation/dislocation, one wrist with persistent slightly positive Finkelstein test, in all other cases complete relief of the symptoms. All patients would elect to repeat the surgery.

[Psammomatous tenosynovialitis of hand and forearm - three new cases]. / Psammomatöse Tenosynovialitis an Hand und Unterarm - drei neue Fälle.

We report about three new observations of psammomatous tenosynovialitis on hand and forearm and performed a review of literature. To the best of our knowledge cases 7, 8 and 9 in the medical literature are now published.

[Revision surgery after carpal tunnel release using a posterior interosseous artery island flap]. / Revisionschirurgie des karpaltunnelsyndroms - ergebnisse der behandlung mit der dorsalen vorderarmlappenplastik.

PURPOSE: The aim of this study is to evaluate the results of fasciocutaneous posterior interosseous artery island flaps in the treatment of recurrent or persistent carpal tunnel compression syndrome (CTS). PATIENTS AND METHODS: From 1997 to 2006, 14 patients (8 women, 6 men, ages ranging from 26 to 77 years with a mean age of 55.7 years) have been operated for recurrent or persistent CTS, or for a neuropathic pain syndrome. All patients were treated with a posterior interosseous island flap following neurolysis of the scarred median nerve. The patients were evaluated pre- and postoperatively using a pain visual analogue scale and the DASH score. Sensibility, motor dysfunction, pain and success of the treatment were classified as good, better or bad. RESULTS: Mean follow-up of the patients was 23.8 months (1.7 to 93.5 months). The pain evaluation showed a statistically significant improvement (p < 0.005) decreasing from a mean value of 6.7 to 1.5. The DASH score was also statistically significantly improved postoperatively (p < 0.005). The best results were observed in patients without extensive preliminary median nerve damage. The duration of symptoms before re-operation did not influence the outcome. Seven patients demonstrated good, five improved and two patients maintained poor results. The two patients with poor results suffered from extremely scarred and injured median nerves following previous carpal tunnel surgery. CONCLUSION: Protective coverage of the median nerve by use of a fasciocutaneous island flap after failure of carpal tunnel release provides a good gliding tissue cover and reduces the risk of adhesions between the nerve and the surrounding tissues after previous surgery. While this protection of the nerve can reduce painful symptoms it does not guarantee total pain relief in all patients. Pain relief and functional recovery strongly depend on the preexisting condition of the median nerve.