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Thermography by Specialty
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Carpal tunnel syndrome, a common form of peripheral nerve entrapment, is caused by compression of the median nerve as it traverses under the flexor retinaculum at the wrist, accompanied by the flexor tendons of the fingers and thumb. Irritation of the flexor tendons or their synovial sheaths can result in swelling that narrows the carpal tunnel, placing pressure on the nerve. Bony deformities at the wrist due to injury or arthritis can also compress the median nerve. The neural distribution of the median nerve includes the volar thumb, index, and middle fingers, and the radial half of the ring finger (see Figure 11.48). Classically, CTS patients experience numbness, weakness, tingling, burning, and pain affecting at least two of the digits supplied by the median nerve.89
Compression Neuropathies
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
The carpal tunnel is open at its proximal and distal ends and maintains a characteristic fluid pressure level. The median nerve is accompanied by the four tendons of the flexor digitorum superficialis (FDS) muscle, the four tendons of the flexor digitorum profundus (FDP) and the flexor pollicis longus (FPL) tendon. The median nerve lies just beneath the flexor retinaculum. The FPL tendon is the most radial element, the median nerve most palmar. The diameter of the carpal tunnel syndrome is narrowest 2 cm from the leading edge where the median nerve gets compressed with all morphological signs of compressive neuropathy (Figure 11A.2).
Resource-Limited Environment Plastic Surgery
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Johann A. Jeevaratnam, Charles Anton Fries, Dimitrios Kanakopoulos, Paul J. H. Drake, Lorraine Harry
To decompress the thenar and hypothenar compartment and median and ulnar nerves (Figure 17.6).A step incision is made across the distal wrist crease, continuing as a longitudinal incision between the thenar and hypothenar eminences up to at least the proximal palmar crease (Figure 17.7).The flexor retinaculum is divided to release the carpal tunnel and median nerve, which lies immediately underneath.The motor branch of the median nerve passes radially into the thenar muscles, at the distal end of the carpal tunnel, and should be preserved.The thenar compartment is decompressed by incising the overlying fascia.Guyon’s canal, through which the ulnar nerve and artery run, is decompressed by deepening the incision in an ulnar direction, superficial to the flexor retinaculum.Continuing in an ulnar direction allows decompression of the hypothenar compartment.
Efficacy comparison between ultrasound-guided injections of 5% dextrose with corticosteroids in carpal tunnel syndrome patients
Published in Neurological Research, 2023
Aref Nasiri, Farzaneh Rezaei Motlagh, Mohammad Amin Vafaei
Despite the unclear 5% dextrose mechanism of action for entrapment neuropathies, it is hypothesized to relate to the analgesic effect of dextrose on tender peripheral nerves [40]. Dextrose can inhibit the activation of transient receptor potential vanilloid receptor-1. This inhibition can block the release of substance P and calcitonin gene-related peptide, which are pro-nociceptive substances that contribute to neurogenic inflammation [41–44]. Also, elevated concentration of extracellular dextrose may hyperpolarize C-fibers, which can decrease the transduction of noxious signals [45]. Moreover, perineural injection (also in case of 5% dextrose) induced detachment and mobilization of the median nerve from the flexor retinaculum and flexor tendons at the carpal tunnel inlet might be another mechanism [23,46].
Neurological manifestations of hereditary transthyretin amyloidosis: a focus on diagnostic delays
Published in Amyloid, 2022
Michelle C. Kaku, Shivkumar Bhadola, John L. Berk, Vaishali Sanchorawala, Lawreen H. Connors, K. H. Vincent Lau
For each patient, we abstracted 118 independent variables in the categories of (1) demographic information, (2) symptoms, signs and neurophysiological studies related to carpal tunnel syndrome (CTS) and completion and results of flexor retinaculum staining, (3) symptoms, signs and neurophysiological studies related to large fibre neuropathy (LFN), (4) symptoms and signs related to small fibre neuropathy (SFN) and completion and results of skin biopsies, (5) symptoms of dysautonomia and presence of orthostatic hypotension, (6) symptoms, neurophysiological studies and neuroimaging related to cervical or lumbar radiculopathy, (7) symptoms and signs attributable to other potential neuromuscular manifestations, (8) laboratory studies relevant to potential competing causes of neuropathy and other neuromuscular manifestations and (9) evidence of other organ involvement. The rates of patient variables were recorded using standard descriptive statistics.
Coincidence or complication? A systematic review of trigger digit after carpal tunnel release
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Fu-Yu Lin, Chao-I Wu, Hsu-Tang Cheng
Hombal and Owen hypothesized that the changes in anatomical grounds may contribute to this condition [13]. Division of the flexor retinaculum results in a bowstring effect manifested by the increased friction force of the flexor tendons against the proximal pulleys, especially when the fingers are functioning with the wrist in flexion. The flexor pollicis longus and superficial tendons to the ring and middle fingers are the most superficial tendons in the carpal tunnel. In our systematic review, the thumb was the most commonly involved digit in eight of the nine studies, whereas the only RCT reported the highest likelihood of trigger digits occurrence in the ring finger. In addition, Lee et al. used ultrasonography to confirm the hypothesis that patients with greater volar migration of the flexor tendons after CTR were at a higher risk of developing trigger digits [19].