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Analysis of the causes of failure in carpal tunnel syndrome surgery and the results of reoperation

Year 2002, Volume: 36 Issue: 4, 346 - 353, 11.09.2006

Abstract

Objectives: We investigated the causes of failure and ensuing problems and findings in patients with unrelieved or recurrent carpal tunnel syndrome (CTS) and evaluated the results of revision surgery.
Methods: The study included 26 patients (21 women, 5 men; mean age 52 years; range 30 to 71 years) who underwent reoperation for unrelieved or recurrent symptoms following at least a year (range 1 to 4 years) after the initial surgery. A total of 34 operations had been carried out in 31 hands. All patients were investigated clinically and electrophysiologically. The mean follow-up after reoperation was 19 months (range 12 to 38 months).
Results: The diagnosis was confirmed in all patients by clinical and electrophysiologic studies. The primary operations had been performed using 11 transverse incisions, three incisions confined proximally to the wrist crease, 10 incisions without insufficient distal extension, and seven appropriate incisions. The transverse carpal ligament release was inadequate in 23 hands; it had not been released in three hands at all. Excessive fibrous tissue developed in one patient, leading to complete bilateral median nerve compression. Bilateral and unilateral tenosynovitis resulting from rheumatoid arthritis and tuberculosis was detected in two patients, respectively. All patients underwent repeat open carpal tunnel release. Neurolysis and tenosynovectomy were performed in both hands of one patient and in one hand of two patients, respectively. Clinical results were excellent in 24 hands, good in six hands, and fair in one hand.
Conclusion: Selection of appropriate incision and achievement of complete carpal tunnel release without any injury to the median nerve or its branches are of great importance with regard to postoperative results. Careful imaging studies of the carpal tunnel should be carried out especially in patients with unilateral involvement, presenting with an atypical age or occupation.

Karpal tünel sendromu cerrahisinde başarısızlık nedenleri ve revizyon sonuçları

Year 2002, Volume: 36 Issue: 4, 346 - 353, 11.09.2006

Abstract

Amaç: Karpal tünel sendromu (KTS) nedeniyle yapılan ameliyattan sonra iyileşme sağlanamayan ya da semptomların yeniden ortaya çıktığı hastalarda başarısızlık nedenleri, revizyon cerrahisi bulguları ve sonuçları araştırıldı.
Çalışma planı: Karpal tünel sendromu tanısı ile en az bir yıl önce (dağılım 1-4 yıl) ameliyat edilen, ancak klinik olarak iyileşme sağlanamamış 26 hasta (21 kadın, 5 erkek; ort. yaş 52; dağılım 30-71) çalışmaya alındı. Otuz bir elde toplam 34 ameliyat yapılmıştı. Tüm hastalar klinik ve elektrofizyolojik olarak yeniden incelendi. Revizyon cerrahisi sonrasında hastalar ortalama 19 ay (dağılım 12-38 ay) izlendi.
Sonuçlar: Klinik ve elektrofizyolojik incelemeler sonucunda hastaların tümünde KTS tanısı doğrulandı. Ellerin 11’inde transvers, üçünde el bileği çizgisinin proksimalinde kalan, 10’unda distale yeterince uzanmayan ve yedisinde doğru insizyonlar kullanılmıştı. Yirmi üç elde transvers karpal ligament gevşetmesi yetersiz yapılmış, üç elde hiç yapılmamıştı. Bir hastada aşırı fibrosis gelişmiş ve her iki median sinir bu doku içinde boğulmuştu. Bir hastanın iki elinde romatoid artritten kaynaklanan, bir hastanın bir elinde ise tüberküloza bağlı tenosinovit saptandı. Hastaların tümüne yeniden açık karpal tünel gevşetmesi yapıldı. Bir hastanın iki eline nöroliz, iki hastanın birer eline tenosinovektomi yapıldı. Klinik olarak 31 elin 24’ünde mükemmel, altısında iyi, birinde orta sonuç alındı.
Çıkarımlar: Karpal tünel sendromu cerrahisinde doğru insizyon seçimi ve karpal tünelin median sinire ve dallarına zarar vermeden bütünüyle gevşetilmesi çok önemlidir. Yaş ve meslek açısından KTS beklenmeyen tek taraflı semptomatik hastalarda, ameliyat öncesi karpal tünel görüntülemesine dikkat edilmelidir.

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Details

Primary Language English
Journal Section Original Article
Authors

Erdem Bagatur This is me

Publication Date September 11, 2006
Published in Issue Year 2002 Volume: 36 Issue: 4

Cite

APA Bagatur, E. (2006). Analysis of the causes of failure in carpal tunnel syndrome surgery and the results of reoperation. Acta Orthopaedica Et Traumatologica Turcica, 36(4), 346-353. https://doi.org/10.3944/aott.v36i4.884
AMA Bagatur E. Analysis of the causes of failure in carpal tunnel syndrome surgery and the results of reoperation. Acta Orthopaedica et Traumatologica Turcica. September 2006;36(4):346-353. doi:10.3944/aott.v36i4.884
Chicago Bagatur, Erdem. “Analysis of the Causes of Failure in Carpal Tunnel Syndrome Surgery and the Results of Reoperation”. Acta Orthopaedica Et Traumatologica Turcica 36, no. 4 (September 2006): 346-53. https://doi.org/10.3944/aott.v36i4.884.
EndNote Bagatur E (September 1, 2006) Analysis of the causes of failure in carpal tunnel syndrome surgery and the results of reoperation. Acta Orthopaedica et Traumatologica Turcica 36 4 346–353.
IEEE E. Bagatur, “Analysis of the causes of failure in carpal tunnel syndrome surgery and the results of reoperation”, Acta Orthopaedica et Traumatologica Turcica, vol. 36, no. 4, pp. 346–353, 2006, doi: 10.3944/aott.v36i4.884.
ISNAD Bagatur, Erdem. “Analysis of the Causes of Failure in Carpal Tunnel Syndrome Surgery and the Results of Reoperation”. Acta Orthopaedica et Traumatologica Turcica 36/4 (September 2006), 346-353. https://doi.org/10.3944/aott.v36i4.884.
JAMA Bagatur E. Analysis of the causes of failure in carpal tunnel syndrome surgery and the results of reoperation. Acta Orthopaedica et Traumatologica Turcica. 2006;36:346–353.
MLA Bagatur, Erdem. “Analysis of the Causes of Failure in Carpal Tunnel Syndrome Surgery and the Results of Reoperation”. Acta Orthopaedica Et Traumatologica Turcica, vol. 36, no. 4, 2006, pp. 346-53, doi:10.3944/aott.v36i4.884.
Vancouver Bagatur E. Analysis of the causes of failure in carpal tunnel syndrome surgery and the results of reoperation. Acta Orthopaedica et Traumatologica Turcica. 2006;36(4):346-53.