RESUMO
Carpal tunnel syndrome is median nerve symptomatic compression at the level of the wrist, characterized by increased pressure within the carpal tunnel and decreased nerve function at the level. Carpal tunnel release decreases pressure in Guyon's canal, via open techniques, with symptom and two-point discrimination improvement in the ulnar nerve distribution. We hypothesize that endoscopic carpal tunnel release improves two-point discrimination in the ulnar nerve distribution as well. This study includes 143 patients who underwent endoscopic carpal tunnel release between April 2016 to June 2019 in a single, community-based teaching hospital. A comprehensive retrospective chart review was performed on patient demographics, pre- and post-operative two-point discrimination test results, and complications. The effects of sex, age, and diabetes mellitus in the ulnar and median nerve territories with two-point discrimination tests were analyzed. As well as the differences in two-point discrimination among patient's based on their smoking status. There were significant post operative improvements in both the median (7.7 vs 4.4 mm, p < 0.001) and ulnar (5.7 vs 4.1 mm, p < 0.001) nerve territories. Smoking status, sex, age and diabetes did not significantly affect two-point discrimination outcomes. In conclusion the endoscopic release of the transverse carpal ligament decompresses the carpal tunnel and Guyon's canal, demonstrating improvement in two-point discrimination in both the ulnar and median nerve distributions.
El síndrome de túnel carpiano es la compresión sintomática del nervio mediano al nivel de la muñeca. Se caracteriza por un aumento de presión dentro del túnel y una disminución de la función del nervio a ese nivel. La liberación del túnel carpiano descomprime el canal de Guyon, con mejoría sintomática y en la prueba de discriminación de dos puntos en la distribución del nervio cubital. Hipotetizamos que la liberación endoscópica mejora de la misma manera en la distribución del nervio cubital. Este trabajo incluye 143 pacientes que tuvieron liberación endoscópica del túnel carpiano entre abril del 2016 y junio del 2019 en un hospital Universitario de la comunidad. Se evaluaron retrospectivamente las historias clínicas para los datos demográficos, los resultados pre y post quirúrgicos en la prueba de discriminación de dos puntos y complicaciones. Se analizaron los efectos del sexo, edad, tabaco y diabetes en los resultados de la prueba de discriminación de dos puntos para los nervios cubital y mediano. Hubo mejoría significativa post quirúrgica en la prueba de discriminación de dos puntos para los nervios mediano (7.7 vs 4.4 mm, p < 0.001) y cubital (5.7 vs 4.1 mm, p < 0.001). Fumadores, sexo, edad, y diabetes no afectaron de forma significativa. Concluimos que la liberación endoscópica del ligamento transverso del carpo descomprime el túnel carpiano y el canal de Guyon con mejoría en la prueba de discriminación de dos puntos para los nervios cubital y mediano.
Assuntos
Síndrome do Túnel Carpal , Nervo Mediano , Síndrome do Túnel Carpal/cirurgia , Humanos , Estudos Retrospectivos , Nervo Ulnar , PunhoRESUMO
Abstract Carpal tunnel syndrome is median nerve symptomatic compression at the level of the wrist, characterized by increased pressure within the carpal tunnel and decreased nerve function at the level. Carpal tunnel release decreases pressure in Guyon's canal, via open techniques, with symptom and two-point discrimination improvement in the ulnar nerve distribution. We hypothesize that endoscopic carpal tunnel release improves two-point discrimination in the ulnar nerve distribution as well. This study includes 143 patients who underwent endoscopic carpal tunnel release between April 2016 to June 2019 in a single, community-based teaching hospital. A comprehensive retrospective chart review was performed on patient demographics, preand post-operative two-point discrimination test results, and complications. The effects of sex, age, and diabetes mellitus in the ulnar and median nerve territories with two-point discrimination tests were analyzed. As well as the differences in two-point discrimination among patient's based on their smoking status. There were significant post operative improvements in both the median (7.7 vs 4.4 mm, p < 0.001) and ulnar (5.7 vs 4.1 mm, p < 0.001) nerve territories. Smoking status, sex, age and diabetes did not significantly affect two-point discrimination outcomes. In conclusion the endoscopic release of the transverse carpal ligament decompresses the carpal tunnel and Guyon's canal, demonstrating improvement in two-point discrimination in both the ulnar and median nerve distributions.
Resumen El síndrome de túnel carpiano es la compresión sintomática del nervio mediano al nivel de la muñeca. Se caracteriza por un aumento de presión dentro del túnel y una disminución de la función del nervio a ese nivel. La liberación del túnel carpiano descomprime el canal de Guyon, con mejoría sintomática y en la prueba de discriminación de dos puntos en la distribución del nervio cubital. Hipotetizamos que la liberación endoscópica mejora de la misma manera en la distribución del nervio cubital. Este trabajo incluye 143 pacientes que tuvieron liberación endoscópica del túnel carpiano entre abril del 2016 y junio del 2019 en un hospital Universitario de la comunidad. Se evaluaron retrospectivamente las historias clínicas para los datos demográficos, los resultados pre y post quirúrgicos en la prueba de discriminación de dos puntos y complicaciones. Se analizaron los efectos del sexo, edad, tabaco y diabetes en los resultados de la prueba de discriminación de dos puntos para los nervios cubital y mediano. Hubo mejoría significativa post quirúrgica en la prueba de discriminación de dos puntos para los nervios mediano (7.7 vs 4.4 mm, p < 0.001) y cubital (5.7 vs 4.1 mm, p < 0.001). Fumadores, sexo, edad, y diabetes no afectaron de forma significativa. Concluimos que la liberación endoscópica del ligamento transverso del carpo descomprime el túnel carpiano y el canal de Guyon con mejoría en la prueba de discriminación de dos puntos para los nervios cubital y mediano.
Assuntos
Humanos , Síndrome do Túnel Carpal/cirurgia , Nervo Mediano , Nervo Ulnar , Punho , Estudos RetrospectivosRESUMO
BACKGROUND: Ulnar nerve mononeuropathy diagnosis can be challenging depending on where neural lesion is present. Repetitive trauma during cycling is a rare cause of ulnar neuropathy. CASE DESCRIPTION: We describe two patients who developed the handlebar syndrome, an ulnar nerve palsy at Guyon's canal after cycling. The first patient had the syndrome after a short-distance ride and she was treated surgically, while the second patient developed the classical syndrome after a long ride and received conservative treatment. Surgical treatment of the first patient led to functional recovery. CONCLUSION: Handlebar syndrome is a neuropathy caused by extrinsic repetitive compression of ulnar nerve at wrist. Increasing incidence of this disease can be expected after increasing popularity of cycling sports. Avoid of repetitive trauma is the main management goal, with surgical treatment reserved for failure of conservative treatment.
RESUMO
The supernumerary fascicles of abductor digiti minimi muscle have been implicated in vascular and nerve compression. During routine dissection of an old male cadaver we observed an anomalous muscle was found to take it's origin from the antebrachial fascia and flexor retinaculum, traversed ulnar canal (Guyon's) superficial to ulnar vessels and nerves to reach the proximal part of abductor digiti minimi. The anomaly is one of a kind. Its course through Guyon's canal could be a cause for Guyon's canal syndrome. It was innervated by the ulnar nerve.
Los fascículos supernumerarios del músculo abductor del dedo mínimo han sido implicados en la compresión neurovascular. Durante una disección de rutina de un cadáver masculino adulto, se observó un músculo anómalo que se originaba en la fascia antebraquial y en el retináculo flexor, atravesaba el canal ulnar, superficial a los vasos y nervio ulnares para llegar a la parte proximal del músculo abductor del dedo mínimo. La anomalía es única en su tipo. Su curso a través del canal ulnar puede causar el síndrome del canal ulnar. El músculo estaba inervado por el nervio ulnar.