Artikel
The Hypothenar Fat Pad Flap Surgery for End Stage Carpal Tunnel Syndrome
Suche in Medline nach
Autoren
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Tom Lattré
- Ziekenhuis Waregem, Waregem, Belgium
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Simone Brammer
- Independant, Waregem, Belgium
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Steven Parmentier
- Ziekenhuis Waregem, Waregem, Belgium
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Carlo Van Holder
- Ziekenhuis Waregem, Waregem, Belgium
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: "End Stage Carpal Tunnel Syndrome" (ECTS) is occasionally seen in an elderly population. In this condition, there is no neurophysiological continuity of the median nerve at wrist level and it is classified as the last grade in the electrophysiological scale of Bland.
Methods: A prospective study was made of 20 patients with ECTS who were treated with the "Hypothenar Fat Pad Flap" surgery. This surgery was initially described by Cramer for treating recurrent CTS.
Our patients did not have a history of carpal tunnel release.
Assessments of sensibility, strength, symptoms and functional status were made pre-operative and post-operative after 3, 6, 12 months.
Strength tests were grip force (Jamar), key-, tripod- and tip pinch recording the maximum/average strength.
The Semmes Weinstein Monofilament Test and the Shape Texture Identification were used for the sensibility assessments.
The Boston Carpal Tunnel Questionnaire (BCTQ) evaluated the symptoms and functional status.
A control EMG was suggested after 1 year.
One sided paired statistical analyses were made with the t-test or Wilcoxon test according to their normal distribution and the results were significant if p < 0.05.
Results and Conclusions: Significant results were found for all sensibility tests on every post-operative test moment. Loss of protective touch was seen before surgery but improved after one year to a level between diminished protective touch and diminished light touch.
The maximum and average key- and tripod pinch were significant better after one year. The results for maximum- and average tip pinch were already significant after 6 months. The Jamar did not reveal any significant results.
On every post-operative test moment the BCTQ scores for symptoms and functional status were significantly better. After one year ending with a score close to one, which is the minimum score.
A limited number of cases agreed to an EMG control at one year and improved electrophysiological values were demonstrated.
The hypothenar fat pad flap provides a valid and safe solution in the treatment of patients with end stage carpal tunnel syndrome.
Our study showed that sensibility and strength of the hand were significant improved, moreover the hand function returned to a nearly normal level.
