• Journal of Korean Neurosurgical Society
• /
• 제62권1호
• /
• pp.90-95
• /
• 2019

Objective : Anomalous muscles of the wrist are infrequently encountered during carpal tunnel surgery. Anatomic variants of the palmaris longus (PL), flexor digitorum superficialis, lumbricalis and abductor digiti minimi (ADM) have been reported but are usually clinically insignificant. Anomalies of the wrist muscles, encountered during endoscopic carpal tunnel surgery have rarely been described. I conducted this study to evaluate muscular anomalies of the volar aspect of the wrist, encountered during endoscopic carpal tunnel surgery. Methods : I studied a consecutive series of 1235 hands in 809 patients with carpal tunnel syndrome who underwent single-portal endoscopic carpal tunnel release (ECTR) from 2002 to 2014. Nine hundred seventy-three hands in 644 patients who had minimal 6-month postoperative follow-up were included in the study. The postoperative surgical outcome was assessed at least 6 months after surgery. Results : In eight patients, anomalous muscles were found under the antebrachial fascia at the proximal wrist crease and superficial to the ulnar bursa, passing superficial to the transverse carpal ligament. Those anomalous muscles were presumed to be variants of the PL or accessory ADM muscle, necessitating splitting and retraction to enter the carpal tunnel during the ECTR procedure. Other muscle anomalies were not seen within the carpal tunnel on the endoscopic view. The surgical outcome for all eight wrists was successful at the 6-month postoperative follow-up. Conclusion : Carpal tunnel surgeons, especially those using an endoscope should be familiar with unusual findings of anomalous muscles of the wrist because early recognition of those muscles can contribute to avoiding unnecessary surgical exploration and unsuccessful surgical outcomes.

• Journal of Korean Neurosurgical Society
• /
• 제29권3호
• /
• pp.372-378
• /
• 2000

The carpal tunnel syndrome is one of the most common entrapment neuropathy. Surgical treatments consist of conventional open technique, alternative technique using retinaculatome, and endoscopic surgery. This study compares the outcomes of surgical treatment of carpal tunnel syndrome following conventional versus endoscopic release. The authors reviewed 56 cases of 33 patients with carpal tunnel syndrome treated surgically in our institute from January 1991 to May 1998. The follow-up evaluation was possible in 36 cases of 20 patients who had conventional release and in 11 cases of 7 patients with endoscopic release. The following parameters were evaluated for comparison : improvement of symptom, return to normal work, recovery of strength of grip and pinch, rate of complication, follow-up electrophysiologic finding. Compared with open decompression, the group of endoscopic decompression needed significantly less time to go back to work(p<0.001). Also strength of grip and pinch improved faster in the group of endoscopic decompression as well, compared with open decompression(p<0.05). These results indicate that endoscopic procedure is an excellent, minimally invasive method to treat carpal tunnel syndrome, performed by surgeons who are fully aware of the anatomy.

• Journal of Korean Neurosurgical Society
• /
• 제48권4호
• /
• pp.380-382
• /
• 2010

The authors present an extremely rare case of a pseudoaneurysm of the ulnar artery as a complication of a two-portal endoscopic carpal tunnel release (ECTR). A 70-year-old man with chronic renal failure and on maintenance hemodialysis with a left arteriovenous fistula presented with paresthesia of his right hand. A clinical diagnosis of right carpal tunnel syndrome was confirmed by ultrasonography and an electro physiologic study. He underwent two-portal ECTR, and the paresthesia was much improved. However, he presented to us one month after operation with severe pain, a tender mass distal to the right wrist crease and more aggravation of the paresthesia in the ulnar nerve distribution. Doppler ultrasound was performed and revealed a hypo echoic lesion 20 mm in diameter in the right palm, with arterial Doppler flow inside connected to the palmar segment of the ulnar artery. An ulnar artery pseudoaneurysm was diagnosed and treated by ultrasound-guided percutaneous thrombin injection. Transverse color Doppler ultrasound image showed complete thrombosis of the pseudoaneurysm and flow cessation after a total injection of 500 units of thrombin. The symptoms were also improved.

• 대한관절경학회지
• /
• 제5권2호
• /
• pp.120-123
• /
• 2001

목적 : 수근관 증후군의 치료로서 내시경적 수근관 절개술을 시행할 때 저자들은 유연한 투명 도관을 활용하여 정중신경 및 주변 구조물을 직접 눈으로 확인하며 횡수근인대를 절개하는 방법을 고안하여 시행함으로써 합병증을 줄일 수 있을 것으로 사료되어 그 술기의 안전성을 평가해 보고자하였다. 대상 및 방법 : 1997년 3월부터 2000년 3월까지 본원 정형외과에서 수근관 증후군으로 진단되어 유연한 투명도관을 이용한 내시경적 수근관 절개술을 시행 받은 12명(20례)의 환자를 대상으로 하였으며 수술방법은 two portal 술식을 사용하여 유연한 투명 도관을 삽입하여 정중신경 및 주변 구조물을 직접 눈으로 확인하면서 횡수근인대를 절개하였다. 결과 : 술전에 보였던 임상증상은 14례$(70\%)$에서 소실되었으며 6례$(30\%)$에서 부분적인 개선을 보였다. 절개 부위나 수근 관절부위의 압통을 호소하는 예는 없었으며 신경 손상 등의 심각한 합병증은 없었다. 결론 : 수근관의 내시경적 절개술시 저자들은 유연한 투명도관을 사용하여 정중신경을 직접 눈으로 보면서 횡수근인대를 절개하는 방법으로 $360^{\circ}$의 좋은 시야를 확보할 수 있어 신경 손상 등의 합병증을 피할 수 있었으며 유연한 도관을 사용하므로 수술중 항상 수근관절의 과신전 상태를 유지하지 않아도 되며 또한 수액의 정맥 주사용 line 이나 병원에서 흔히 사용하는 도관을 이용함으로서 기존의 비싼 수술장비를 구입하지 않아도 된다는 장점이 있다.

• 대한관절경학회지
• /
• 제4권2호
• /
• pp.159-165
• /
• 2000

목적 : 전통적인 개방적 수근관 감압술 시행 후의 병적 상태와 합병증을 줄이고자 내시경적 수근관 감압술이 개발되어 시행되어지고 있다. 이에 저자들은 단일 입구를 이용한 내시경적 수근관 감압술의 결과와 임상적 유용성을 알아보고자 한다. 대상 및 방법 : 임상증상, 이학적 검사, 전기 진단학적 검사로 수근관 증후군으로 진단되고, 수근관절부에 전완부 종축에 대해 비스듬히 약 1cm 정도의 소절개를 가하여 단일입구를 만들고 수근관 감압술을 시행하였던 18명 30례에 대해 임상증상 및 이학적 소견과 전기 진단학적 검사소견의 결과를 분석하고 주관적 증상의 회복정도를 환자 스스로 평가하는 판정 기준을 이용하여 최종 추시시의 결과를 분석하였다. 추시기간의 범위는 술 후 6개월에서 13개월이었다. 결과 : 술 후 임상증상과 이학적 검사상 및 전기 진단적 검사에서 호전을 보였다. 최종 추시시 23례$(76.7\%)$에서 감각 이상증상이 완전히 해소되었고, 정상적인 일상활동 및 직장으로의 복귀는 27례$(90\%)$에서 6주 이내에 가능 하였고, 전례에서 8주 이내에 가능하였다. 악력은 6개월째에 29례 $(96.6\%)$에서 술전의 힘을 회복하였다. 무지구근의 위축을 보인 22례중에서 술 후 6개월 추시시 12례$(55\%)$에서 호전되는 소견을 보였다. Cseuz 및 Kelly의 판정 기준상 우수 23례 $(76.7\%)$, 양호 6례 $(20\%)$, 보통 1례$(3.3\%)$이었다. 결론 : 저자들은 단일 입구를 이용한 수근관 감압술은 술자가 적응증에 맞는 환자를 선별하여 손과 손목의 충분한 해부학적 지식을 가지고 안전 영역내에서 시행한다면 기술적으로 안전하고 간단한 수술방법이며, 개방적 방법에 비해 많은 장점이 있고 임상적으로 유용한 방법이라고 사료된다. 또한 기술적 문제점이 생기거나 기구를 수근관내로 삽입하기가 어렵거나 내시경 시야에서 횡수근 인대의 횡섬유가 분명히 보이지 않는 경우 등에서는 개방적 방법으로 전환할 준비가 되어야 한다고 사료된다.

• Korean Journal of Radiology
• /
• 제22권7호
• /
• pp.1132-1141
• /
• 2021

Objective: To investigate changes in the median nerve, retinaculum, and carpal tunnel on ultrasound after successful endoscopic carpal tunnel release (ECTR). Materials and Methods: This prospective study involved 37 wrists in 35 patients (5 male, 30 female; mean age ± standard deviation [SD], 56.9 ± 6.7 years) with primary carpal tunnel syndrome (CTS). An in-house developed scoring system (0-3) was used to gauge the clinical improvement after ECTR. Ultrasound was performed before ECTR, and at 1, 3, and 12 months post-ECTR. Changes in the median nerve, flexor retinaculum, and carpal tunnel morphology on ultrasound after ECTR were analyzed. Ultrasound parameters for different clinical improvement groups were compared. Results: All patients improved clinically after ECTR. The average clinical improvement score ± SD at 12 months post-ECTR was 2.2 ± 0.7. The median nerve cross-sectional area proximal and distal to the tunnel decreased at all time intervals post-ECTR but remained swollen compared to normal values. Serial changes in the median nerve caliber and retinacular bowing after ECTR were more pronounced at the tunnel outlet than at the tunnel inlet. The flexor retinaculum had reformed in 25 (68%) of 37 wrists after 12 months. Conclusion: Postoperative changes in median nerve and retinaculum parameters were most pronounced at the tunnel outlet. Even in patients with clinical improvement after ECTR, nearly all ultrasound parameters remain abnormal at one year post-ECTR. These ultrasound parameters should not necessarily be relied upon to diagnose persistent CTS after ECTR.

• Journal of Korean Neurosurgical Society
• /
• 제37권1호
• /
• pp.8-15
• /
• 2005

Objective: We evaluate temporal correlations between postoperative symptomatic and electrophysiological improvements, and assessed the recovery time required for patients with carpal tunnel syndrome(CTS) before returning to routine activities. Methods: 30 CTS patients were treated via the endoscopic monoportal approach, from March 2001 to September 2003. We assessed the symptoms (hyperesthesia in the finger tips, or abnormal sensations and painful numbness or night pain) and electrophysiological changes in the preoperative state, 1 month and 6 months after surgery. We marked the times at which patients became able to return to activities of daily living and work, after undergoing endoscopic carpal tunnel release. Results: At the end of the follow-up period, high levels of achievement and good outcomes were observed, with respect to both the symptoms and electrophysiological studies. We discovered significant differences between the preoperative and postoperative periods, especially in terms of motor nerve onset latency from $4.50{\pm}1.43$ to $3.97{\pm}0.69$ and sensory nerve conduction velocity, the wrist-to-finger from $19.81{\pm}10.03$ to $28.18{\pm}11.01$ and wrist-to-palm from $23.34{\pm}13.40$ to $31.79{\pm}13.38$(P<0.05 for each comparison). The average time interval required before return to activities of daily living was 26.4 days, and time interval required before return to work was 48.08 days. Conclusion: Electrophysiological improvements are largely consistent with symptomatic relief, but there is some disparity between electrophysiological and symptomatic improvement.

• Journal of Korean Neurosurgical Society
• /
• 제29권11호
• /
• pp.1451-1455
• /
• 2000

Objective : The goal of this study is to present whether endoscopic release(ER) is superior to open release(OR) for the treatment of carpal tunnel syndrome(CTS). Method and Material : Fifty-nine wrists in 43 patients who had clnical signs and symptoms consistent with CTS, not responded to non-operative management, were entered into the study. Authors retrospectively compared 27 wrists treated with ER(February 1999-June 1999) with 32 wrists treated with OR(October 1997-March 1999). We performed conventional open surgery in 25 patients(mean age ; 46 years) and Brown's two-portal technique in 18 patients(mean age ; 53 years) under intravenous regional block or general anesthesia. Results : Sixteen patients had CTS on both hands and left hands were affected more frequently than right hand, 34 and 25 respectively. Successful and poor results of ER were similar to those of OR. For patients in OR group, mean duration of symptoms was 5 years(range 1 month-30 years), and postoperative outcome was good in 27(84.4%) of wrists and poor in 5(15.6%). For patients in ER group, mean duration of symptoms was 7 months (range 2 months-25 years), outcome was good in 23(85.2%) of wrists and poor in 4(14.8%). The average time for complete relief of pain was 1.3 weeks and 7.6 weeks, respectively for OR and ER groups. No complication was noted in either group. Conclusion : This preliminary analysis suggests that faster relief of pain was achieved when the endoscopic method was used, although there were no significant differences in their efficacies regarding the improvement of symptoms.

• Journal of Korean Neurosurgical Society
• /
• 제46권3호
• /
• pp.199-204
• /
• 2009

Objective : This study was done to evaluate the correlation between carpal tunnel pressure (CTP), electrodiagnostic and ultrasonographic findings in patients with carpal tunnel syndrome (CTS). Methods : CTP was measured during endoscopic carpal tunnel release (ECTR) for CTS using Spiegelberg ICP monitoring device with parenchymal type catheter. Neurophysiologic severity and nerve cross sectional area were evaluated using nerve conductive study and ultrasonography (USG) before ECTR in all patients. Results : Tests were performed in a total of 48 wrists in 39 patients (9 cases bilateral). Maximum CTP was $56.7{\pm}19.3$ mmHg ($Mean{\pm}SD$) and $7.4{\pm}3.3$ mmHg before and after ECTR, respectively. No correlation was found between maximum CTP and either neurophysiologic severity or nerve cross sectional area, whereas we found a significant correlation between the latter two parameters. Conclusion : CTP was not correlated with neurophysiologic severity and nerve cross sectional area. Dynamic, rather than static, pressure in carpal tunnel might account for the basic pathophysiology of CTS better.

• Journal of Korean Neurosurgical Society
• /
• 제56권5호
• /
• pp.390-394
• /
• 2014

Objective : In most patients with carpal tunnel syndrome (CTS), pain and/or paresthesia disappeared or decreased in a month after endoscopic carpal tunnel release (ECTR). However, subpopulation of patients showed delayed improvement following ECTR. We analyzed the delayed improvement hands to investigate the characteristics of those patients and to determine the predictable factors of delayed improvement. Methods : Single-portal ECTRs were performed in 1194 hands of 793 CTS patients from 2002 to 2011. Five-hundred seventy hands with minimal 1-year postoperative follow-up were included. We divided the 545 satisfied hands into early (group A) and delayed (group B) groups according to improvement period of 1 month. Demographic data, clinical severity and electrodiagnostic abnormality were compared between groups. Results : Group A included 510 hands and group B included 35 hands. In group B, 11 hands improved in 2 months, 15 hands in 3 months and 9 hands in 6 months, respectively. In group A/B, according to clinical severity, 60/1 hands were graded to I, 345/24 hands to II, 105/10 hands to III. In group A/B, based on electrodiagnostic abnormality, 57/3 hands were classified to mild, 221/11 hands to moderate and 222/21 hands to severe group. Statistical analysis between groups did not reach significance but electrodiagnostic or clinical severity had a tendency to affect the delayed response. Conclusion : It is difficult to predict the factors contributing to postoperatively-delayed response in subpopulation of CTS patients. However, we recommend that postoperative observation for at least 6 months is necessary in patients without symptomatic improvement.