- See:
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Anatomy of Carpal Tunnel:
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Carpal Tunnel Injection / Median Nerve Block:
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Differential Dx:
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Electrodiagnosis
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Enodscopic Carpal Tunnel Release
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References
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Nerve Entrapment
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Surgical Approach
- Initial Work Up:
- history:
- presence of pain in the wrist and/or fingers and presence of paresthesias in fingers;
- night pain may be especially predictive;
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physical exam:
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differential dx:
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EMG studies
- references:
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The surgical treatment of the carpal-tunnel syndrome correlated with preoperative nerve-conduction studies.
- Carpal tunnel syndrome: An evaluation of the provocative diagnostic tests. J Bone Joint Surg (Am) 68A:735-737, 1986 Gellman H, Gelberman RH, Tan AM, et al:
- Radiographic Studies:
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cross table lateral (for
cervical spondylosis)
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carpal tunnel view
- MRI: (indicated w/ atypical CTS, ie. ? tumor, ? anomalous muscle).
- references:
The use of routine wrist radiography in the evaluation of patients with carpal tunnel syndrome.
- Non Operative Treatment:
- note that non operative therapy needs to be aggressive, and patients who do not improve w/ non operative therapy often will not respond to operative therapy;
- Surgical Treatment:
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anatomy of carpal tunnel:
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preoperative considerations:
- if the patient believes that their CTS syndrome is work related, then he/she should work this out ahead of time;
- be clear with the patient ahead of time, regarding the goals of surgery;
- if the patient has over-reacted to steroid injections (excessive pain ect), they will probably react the same following surgery;
- in patients at risk for poor outcome or delayed return to work (such as workers compensation), consider 2 weeks of aggressive nonoperative
therapy inorder to assess their subjective response to treatment;
- for instance, consider combining a steroid injection, casting (to ensure compliance), and cessation of all repetitive activity for 2 weeks;
- remember that the patient that benefits most from operative treatment is the same patient who benefits from aggressive non operative treatment;
- ref: Carpal tunnel syndrome: An evaluation of the provocative diagnostic tests. Gellman H, Gelberman RH, Tan AM, et al: J Bone Joint Surg (Am) 68A:735-737, 1986
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goals of surgery:
- eliminate compression by the tenosynovium;
- tenosynovectomy is performed if tissue is bulky, displaces flexor tendons;
- restore the gliding capacity of the nerve
- remove constriction by external epineurium, & liberate fascicles from internal adhesions; (latter two goals are controversial);
- eliminate pain:
- females who do not perform manual labor may not experience as much relief as male patients who do perform manual labor;
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factors influencing outcomes:
- The influence of age on outcome after operation for the carpal tunnel syndrome. P. Porter et al. JBJS-Br. Volume 84-B Number 5 July 2002
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Carpal tunnel syndrome. Diagnostic and prognostic value of the tourniquet test.
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Pre-operative factors and treatment outcome following carpal tunnel release.
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open surgical release:
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enodscopic carpal tunnel release
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post op care and complications:
- References for Carpal Tunnel Syndrome:
