Surgical treatment of upper limb tunnel syndromes

Abstract

Introduction. People usually are affected by entrapment neuropathies, sometimes past without some health problem, other evolet to chronic stage, especially common among individuals with predisposing occupations or caused by main medical conditions. Aim of the study. Analyzing the intermediate term results (follow up of two years) of entrapment neuropathies of upper limb according to data from medical records, classification and surgery tactics. Materials and methods. We have proposed a study of patients with carpal tunnel syndrome, neuropathy of ulnar nerve at the elbow and wrist level, which consecutively was treated in department of Hand Surgery with the application of microsurgical techniques, of Traumatology and Orthopedics Clinical Hospital, Chisinau in the period 2018-2019. Final outcomes was determined by using Disabilities of Arm and Shoulder and Hand (DASH) score and the wrist MAYO score. All results were presented as mean ± standard deviation (±SD). Results. Were determined 289 clinical cases of of entrapment neuropathies of upper limb. Most of them were female with a prevalence of 3:1 (W:M=217:72). The average age is 58,1 years (max 88, min 17 SD ±11,68). From rural area population were the main part of patients - 158 patients (54,67%). Average hospitalization was 6 days(max 12, min 1), 33 cases were practiced with 1 day surgery, also in mild cases 2(56 cases), 3(118 cases), 4(56) days after surgery patients, rest patient with severe stages 5 or more days (26 cases) with additional kinesiotherapy. According by stage entrapment neuropathies of carpal tunnel syndrome were 85 cases - stage II, 149 - stage III and 18 cases - stage IV. With entrapment, neuropathies of ulnar nerve at the elbow were 28 cases and 3 cases at the wrist level. Common entrapment neuropathies of median and ulnar nerve of the wrist zone were determined in 6 cases. Main type of treatment in carpal tunnel syndrome were decompression of carpal tunnel with resection a part of anterior transverse ligament of the wrist - 237(82%), and when at the sonographic examination compression zone were more the 40% of pattern nerve has been apply neurolysis (15 cases). Surgery of cubital tunnel syndrome has been consist of transposition of ulnar nerve in 18 cases and with neurolysis in 10 cases. Guyon tunnel syndrome were treated with neurolysis in all 3 cases. Carpal tunnel and Guyon tunnel syndromes of the hand were treated by neurolysis(6 cases). All had well evolution after surgery at an average of 1,5-3 months. Was possible to investigate MAYO and DASH scores at 40 patients with a mean of 82±1 and 12±00. Conclusions. A good surgery management of entrapment neuropathies of upper limb involved to take decision that making to avoid later entrapment neuropathies complications.