Carpal tunnel syndrome in the fist arthrosis, the clinical evaluation and approach of the treatment strategy

Abstract

Introduction: The clinical evaluation in patients with carpal tunnel syndrome in association with fist arthrosis, approach of the treatment strategy.

Material and methods: We have proposed a study of patients with carpal tunnel syndrome (CTS) in association with fist arthrosis (FA) which were in treatment in 6 Section of Traumatology and Orthopedics Clinical Hospital, Chisinau in the period 2011-2015. All patients present clinic of carpal tunnel syndrome unilateral, and were examined by ultrasound studies both wrists, determining the difference the narrowing percentage of the median nerve in the region of entrapment (N%MN, %). All results were presented as mean ± standard deviation (±SD).

Results: We proposed analysis of 60 cases, that were divided in four groups: I group carpal tunnel syndrome unilateral – 20(33,3%) patients; II group carpal tunnel syndrome in association with fist arthrosis without traumatic etiology– 8(13,33%) patients; and III group carpal tunnel syndrome in association with fist arthrosis and traumatic etiology – 32(53,33%) patients. We established these trends, from 60 patients, 24(40%) were male and 36(60%) woman, the ratio right / left draw up 3,3:1,0. There was no significant difference between the ages of the CTS patients (mean 47.8±11.80 yr). We found that in 58 healthy hands the USG studies show N%MN mean= 6,06% ±10,80. In according with stage of CTS in 60 hands the USG studies show N%MN mean: II: 31,57% ±3,33; III: N%MN mean= 49,64% ±4,51; IV: 79,59% ±16,38. Clinical evaluation of FA patients in the search for neuropathy is difficult since neuropathic symptoms are confused with arthrosis. Various physical maneuvers designed to stress the median nerve in the carpal tunnel may exacerbate the symptoms. Surgical interventions: in 52 cases was performed excision of the carpal ligament with median nerve decompression with/or without other surgical interventions., in 8 cases was performed incision of the carpal ligament with median nerve neurolysis and as an component of operation. Remote results were based on the Michigan Hand Outcome Questionnaire classified as good in 41 patients, satisfactory in 19 patients, results are greatly influenced by the basic pathology.

Conclusions: Therefore, the diagnosis of CTS in FA patients is difficult because of such clinical findings. If the narrowing percentage of the median nerve in the region of entrapment N%MN is higher 6,06% ±10,80, it confirm CTS diagnostic.