Artikel
Revision surgery in carpal tunnel syndrome: Considerations about value of preoperative high resolution sonography (13 cases)
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Autoren
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A. Schmidinger
- Kliniken für Neurochirurgie, Universitätsklinikum Gießen und Marburg
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R. Reyes-Garcia
- Kliniken für Neurochirurgie, Universitätsklinikum Gießen und Marburg
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H. Kele
- Kliniken für Neurologie, Universitätsklinikum Gießen und Marburg
| Veröffentlicht: | 20. Mai 2009 |
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Gliederung
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Objective: If symptoms of carpal tunnel syndrome persist following release of the flexor retinaculum or recur within short time after first surgery, revision should be considered.
Methods: From May 2007 to May 2008, we operated on 13 patients with suspected recurrence of carpal tunnel syndrome. First surgery was performed using endoscopic technique in 2 patients, and open technique in 11 patients. In addition to clinical signs and symptoms and nerve conduction studies we used high-resolution sonography to evaluate the patients before as well as 3-12 months after revision surgery. The Levine score was taken to score pre- and postoperative complaints.
Results: Time from first surgery to revision surgery was 3 to 215 months. Before surgical revision, ultrasound had shown regrown or incompletely split proximal transverse ligament in 11 patients. An opened Loge-de-Guyon without split transverse ligament was seen in one patient. In another patient, massive scarring and nerve swelling did not allow a precise description of the carpal ligament. Cross sectional nerve area was out of normal in all but one patient (0.11 to 0.25cm2, mean 0.18cm2).
Intraoperative findings matched the preoperative ultrasound findings in all patients. In all but one patient, who developed a neuropathic pain syndrome, a remarkable clinical benefit was seen shortly after surgery. Levine score was significantly reduced from pre-surgery 34-82 points (mean 60) to post-surgery 20-58 points (mean 39).
Cross-sectional area of the median nerve was reduced following surgery in 4, remained unchanged in 2, and had increased in 3 patients at follow-up 3-12 months. Anatomical variants (median artery and bifid median nerve) were shown in 2 patients.
Conclusions: High-resolution sonography detected a failed or incomplete transsection of the flexor retinaculum as the major cause of postoperative CTS. Along with the clinical and electrophysiological evaluation the method helps in deciding on an indication for surgery. Whether the cross-sectional area of the median nerve diminishes over time following surgery needs to be further investigated.
