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Prevention of complications begins with a solid understanding of the normal anatomy and anatomic variations that may exist.
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Carpal tunnel release is among the most common hand surgical procedures performed, but complications occur in up to 25% of cases. Revision carpal tunnel surgery may be indicated in patients who present with recurrent, persistent, or new symptoms due to inadequate release, iatrogenic injury, recurrent symptoms, or perineural fibrosis.
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Cubital tunnel syndrome is the second
Complications of Compressive Neuropathy: Prevention and Management Strategies
Section snippets
Key points
Carpal tunnel syndrome
Carpal tunnel syndrome (CTS) is the most common compressive neuropathy, affecting 1.6% to 7.8% individuals.4, 5, 6 Carpal tunnel release (CTR) is one of the most frequently performed outpatient procedures in the United States, and is typically considered to be a minor elective and routine procedure.7 Complications are rare, but can result in devastating loss of hand function.
Cubital tunnel syndrome
Cubital tunnel syndrome (CuTS), or compression of the ulnar nerve at the elbow, is the second most common compression neuropathy, and up to 75,000 decompression releases are performed in the United States yearly (Fig. 2).68, 69 Although multiple strategies are described, no single technique has emerged as superior, and in situ decompression and anterior transposition are most commonly performed.69, 70 Nerve transpositions may be performed subcutaneously, intramuscularly (within the
Summary
Surgery for upper extremity compressive neuropathies is relatively common. To prevent iatrogenic injury, it is imperative for the surgeon to be aware of the structures associated with normal surgical anatomy and of those that are common variants. In addition, recurrent or persistent symptoms following a release are commonly associated with inadequate release, but can be associated with misdiagnosis. For either of these etiologies for failed decompression, it is crucial to perform a thorough
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Cited by (19)
Curved skin incision for Ulnar nerve transposition in Cubital Tunnel Syndrome: Cadaveric and clinical study to avoid injury of medial cutaneous nerve
2020, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :Interestingly, decreasing the incision length to 3 cm still bears the risk of medial antebrachial cutaneous nerve (MACN) injury [11] even though some authors have advocate the safety of mini-invasive incision [12]. When the complication of cutaneous nerve injury occurs, a number of treatments can be offered: conservative measures, resection of neuroma, and microsurgical repair of the injured cutaneous nerve [13]; however, the best way for the patients is to prevent the injury to these nerves. For preventing medial cutaneous nerve injury, the anatomic information on the locations and the numbers of both the MACN branches and the medial brachial cutaneous nerve (MBCN) branches along the conventional elbow medial incision site is mandatory.
Controllable forces for reproducible chronic constriction injury mimicking compressive neuropathy in rat sciatic nerve
2020, Journal of Neuroscience MethodsCitation Excerpt :Upper extremity chronic nerve compression (CNC) injuries such as carpal and cubital tunnel syndromes are common diseases treated by hand surgeons (Raducha et al., 2017; Santosa et al., 2015).
Anatomy of the Posterior Antebrachial Cutaneous Nerve, Revisited
2020, Journal of Hand SurgeryComplications of Carpal Tunnel Release
2016, Orthopedic Clinics of North AmericaCitation Excerpt :Reported outcomes after failed CTR vary widely with little high-level data or consistency in the literature, and outcomes vary widely with the cause of treatment failure and with the method of treatment. Historically, those treated for incomplete release have been thought to fare better than those revised for scar formation and fibrosis.49 However, some studies have shown that incomplete release does not correlate with final symptoms or satisfaction after revision CTR.28,29
The Proper Use of Neurostimulation for Hand Pain
2016, Hand ClinicsCitation Excerpt :The exact prevalence of neuropathy originating from the periphery is unknown, although it is a contributor in the 8% to 10% of the adults with neuropathic pain.5 There are many neuropathic pain states that affect the UE, including peripheral neuropathy; brachial plexus avulsion injuries; compressive neuropathies of the distal UE; median, ulnar, and radial neuropathy; and CRPS type 1 and type 2.6,7 Conservative care therapies for UE neuropathic pain syndromes of the hand are focused on the cause of disease.
State of the art review. Complications after carpal tunnel release
2024, Journal of Hand Surgery: European Volume
Disclosures: None.
Supported in part by a Midcareer Investigator Award in Patient-Oriented Research (K24 AR053120) to Dr K.C. Chung.