gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Article

Send article

Efficacy of endoscopic neurolysis for the motor (recurrent) branch of the median nerve during endoscopic carpal tunnel release surgery using the USE system

Meeting Abstract

Search Medline for

  • presenting/speaker Aya Yoshida - Dept. of Orthop. Surg., Toride Kitasouma Med. Assoc. Hosp., Okutsu Minimally Invasive Orthopaedic Clinic, Toride-shi, Ibaraki, Japan
  • Ichiro Okutsu - Okutsu Minimally Invasive Orthopaedic Clinic, Minato-ku, Tokyo, Japan
  • Ikki Hamanaka - Okutsu Minimally Invasive Orthopaedic Clinic, Minato-ku, Tokyo, Japan

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-117

doi: 10.3205/19ifssh0802, urn:nbn:de:0183-19ifssh08025

Published: February 6, 2020

© 2020 Yoshida et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation: Until now, there have been no studies regarding endoscopic neurolysis for the motor (recurrent) branch of median nerve. During endoscopic carpal tunnel release (ECTR) surgery, we identified the motor branch and performed endoscopic neurolysis using the Universal Subcutaneous Endoscope (USE) system, which consists of a transparent closed sheath and an arthroscope. The same external neurolysis principles used in open surgery are applied with this system. To evaluate the efficacy of this procedure, we analyzed and compared clinical and electrophysiological results between the "with" and the "without" endoscopic neurolysis groups.

Methods: From November 2016 to December 2017, we performed endoscopic neurolysis during ECTR surgery for 226 hands. To more precisely evaluate postoperative motor recovery, we selected patients with both "zero" preoperative abductor pollicis brevis muscles using MMT (APB-MMT) and undetectable distal motor latency (DML) of the median nerve for this study. Twenty-four hands of 24 patients followed-up for more than six months were analyzed.

The USE system was inserted along the median nerve toward the thenar muscle during our ECTR procedure. We were able to identify the motor nerve branching and the branch was released from surrounding tissues with an external neurolysis procedure using the USE sheath.

For the non-neurolysis (control) group, we selected patients with the same preoperative clinical and electrophysiological conditions (195 hands) and matched follow-up periods (from 6 to 18 months). Patients in this group had received ECTR without endoscopic neurolysis before November 2016. We analyzed and compared pre- and postoperative APB-MMT and DML results between two groups.

Results and Conclusions: APB-MMT recovery rates showed better improvement in the neurolysis group with a statistical difference (p<0.05). Recovery periods to manual APB-MMT [5] showed shorter improvement periods in the neurolysis group with a statistical difference (p<0.01). Electrophysiological testing results of DML showed no statistical difference.

From those results, we conclude that endoscopic neurolysis for the motor branch of the median nerve combined with ECTR is effective treatment for severely atrophied thenar muscles.