Intraoperative Evaluation of Median Nerve Excursion in Carpal Tunnel Surgery

Authors

  • Khalid Ali
  • Esam Alnajar

DOI:

https://doi.org/10.37376/benunivmedj.v1i4.2476

Keywords:

Carpal tunnel, median nerve, excursion

Abstract

Patients complaining of pain and or paraesthesia along the forearm and hand with or without abnormal functions in the small muscles of the hand present with a condition that must be anatomically localized, mecanically understood and pathologically classifed. Numerous causes can produse peopathy including non-surgical causes that must be excluded. This may cause difficulty in the diagnosis even after clinical and radiological evaluation, so we resort to electrophysiological examination to confirm the diagnosis.
Methods: The study was carried out on twenty patients, admitted to Benghazi Medical Centre during the period of one year. All patients had a detailed history taken, and complete phyical examination with neurological evaluation. The diagnosis was confirmed by electrophysiological studies. Subsequently, the appropriate surgical procedure was performed. All the cases were followed up clinically and electrophysiologically.
Results: The mean age of the patients was (41.55± 10.44) with a high frequency of 30 to 40 years, 80% of cases were females and 20% were males, 75% of Cases were workers, 55% of the patients presented with their right hand and 45% with their left hand, The duration of symptoms prior to operation ranged from 2 to 30 months with a bean of (10.1±7.38). The latter difference had a statistically significant effect on the results. Clinical analysis showed that pain and numbness in the distribution of the median nerve were the most common complaints. The most common physical finding was a positive Phalen's test 1854. Preoperatively 35% of cases were graded mild, 25% were graded moderate and 40% were graded severe. After 6 months of regular follow up we found that 75 our patients showed good improvement as regarded the nerve conduction study result.90% improvement of pain, 77% in lessening of numbness, 66% in lessening of weakness and 50% in lessening of wasting of thenar eminence. A statistically significant difference was found between the preoperative and postoperative nerve conduction studies (motor and sensory). Intraoperatively, there was an increase in the significant excursion of the median nerve in association with the three wrist positions (neutral, flexion, extension) after release of the transverse carpal ligament. Only 10% of our patients developed post-operative complications wound infection and scar tenderness) which were dealt with appropriately. The overall result was good in 75% of cases, fair in 15% of cases and poor in 10% of cases.
Conclusion: The finding of this study showed that the position and movement of wrist had a profound effect on an ex-cursion of the median nerve, and may aid in the understanding of the pathophysiology of the carpal tunnel syndrome. Moreover, we should be considering the limitation of median nerve excursion as one of the causes of carpal tunnel syndrome. Also the longer the duration of preoperative symptoms the worse in the result, so early surgery in moderate and or severe grades is recommended.

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Published

2020-09-01

How to Cite

Ali, K. ., & Alnajar, E. . (2020). Intraoperative Evaluation of Median Nerve Excursion in Carpal Tunnel Surgery. Benghazi University Medical Journal, 1(4). https://doi.org/10.37376/benunivmedj.v1i4.2476

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