ABSTRACT
A retrospective review of patients with carpal tunnel syndrome (CTS) identified 20 patients (26 wrists) who had persistent or recurrent CTS after having undergone endoscopic carpal tunnel release (ECTR). Seven wrists never had relief of the original CTS symptoms; for the remaining 19 wrists, the average time to recurrence of CTS following ECTR was 4.8 months. All cases recurred within 12 months from the ECTR. All but 1 patient reported nocturnal pain. All patients experienced morning numbness and stiffness. All wrists had positive Phalen's test results. Once diagnosed with persistent or recurrent CTS, each of the wrists underwent open carpal tunnel release (OCTR). Twenty-two wrists were available for follow-up, with all patients reporting greater satisfaction and relief after the OCTR compared with the ECTR. It is important to recognize that CTS may persist or recur after ECTR. These patients should be treated with OCTR to provide symptomatic relief and prevent the sequelae of ongoing CTS.
Subject(s)
Carpal Tunnel Syndrome/surgery , Endoscopy , Adult , Carpal Tunnel Syndrome/physiopathology , Female , Humans , Male , Middle Aged , Patient Satisfaction , Recurrence , Reoperation/methods , Retrospective StudiesABSTRACT
The effect of chronic propranolol administration (2 mg.kg-1.d-1 for 14d) and withdrawal on microvascular perfusion was studied in rabbit myocardium. Fluorescein isothiocyanate-dextran was injected into four groups of anaesthetised open chest rabbits. Fluorescent microscopy was used to identify the perfused vessels and alkaline phosphatase stain was employed to locate the total microvasculature. Beta adrenoceptor density (Bmax), measured using 125I-iodopindolol, increased from 20.3(SD 6.3) fmol.mg-1 protein in control to 52.4(8.9) in chronically treated rabbits. The proportion of the capillary bed which was perfused, 61.4(4.3)% was significantly decreased by acute injection of propranolol to 51.1(5.1)%, but not affected by chronic administration, remaining at 57.0(4.0)%. The percentage of the capillary bed perfused increased significantly after cessation of chronic propranolol treatment to 69.1(6.5)%. Similar results were seen for myocardial arterioles. Thus, while diffusion distances are increased by acute adrenoceptor blockade, this effect is not seen in the chronic condition. Diffusion distance decreased significantly after withdrawal of chronic propranolol treatment. We conclude that the percentage of perfused capillaries is strongly influenced by the number of beta adrenoceptors or their effect.
