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61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010
Joint Meeting mit der Brasilianischen Gesellschaft für Neurochirurgie am 20. September 2010

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21. - 25.09.2010, Mannheim

Relevant anatomical variations of the origin of the thenar muscles for the operation of carpal tunnel syndrome

Meeting Abstract

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  • Francisco Marin - Klnik für Neurochirurgie, Klinikum Amberg, Deutschland
  • Richard Megele - Klnik für Neurochirurgie, Klinikum Amberg, Deutschland
  • Andrea Kleindienst - Klnik für Neurochirurgie, Universitätsklinikum Erlangen-Nürnberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1815

DOI: 10.3205/10dgnc286, URN: urn:nbn:de:0183-10dgnc2861

Veröffentlicht: 16. September 2010

© 2010 Marin et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The carpal tunnel syndrome (CTS) is the most frequent entrapment syndrome of peripheral nerves. Within the carpal tunnel, a mismatch between width and content of the tunnel causes a pressure damage of the median nerve. With open surgery und midline incision, beneath the palmar fascia there is sometimes muscle tissue, which has to be transsected before reaching the retinaculum. We wanted to see how often this muscle tissue is present and if there is any correlation to gender, age, electrophysiology und clinical outcome after surgery.

Methods: In our previous autopsy series, the existence of muscle tissue between thenar and hypothenar mostly associated with a variation of very ulnar origin of thenar muscles was confirmed. In 100 consecutive patients diagnosed with CTS and operated on, we examined incidence of muscle origin variations. We recorded patient’s characteristics in order to verify predisposing factors, and followed the patients clinically and neurologically after 1 week and 3 months. Statistical analysis was performed by a rank sum test: CTS patient with variations (CTS+V) versus CTS patient without variations (CTS-V).

Results: In 20 percent of patients, we confirmed the muscle origin variation. One of these patients was operated on both hands, and a bilateral the variation was present. Women (70%) were more often affected than men. Postoperative assessment revealed a higher incidence of symptom relief in the CTS+V groups at 1 week and 3 months. However, neurological function and electrophysiological function did not differ significantly.

Conclusions: We report for the first time about a muscular anomaly of the wrist present in 20% of CTS patients. The surgical minimal incision allows an optimal inspection of the anatomical structures of the CT and the subsequent therapy. Endoscopic methods have to consider the variations to avoid bleeding. The better outcome of CTS-patients with a broad origin of the thenar muscles at the retinaculum may be explained by keeping the tunnel more open with muscle tension.