Nuri Karabay, Tulgar Toros, Erkin Cetinkol, Sait Ada

Karpal tünel sendromunda gevşetme cerrahisi sonrasında ısrarcı ve tekrarlayıcı hastalıkta ultrasonografik bulgular ve cerrahi korelasyonu

Amaç: Karpal tünel sendromunda (KTS), karpal tünelin cerrahi yöntemle gevşetilmesi şikayetlerin ortadan kaldırılmasında oldukça etkili bir tedavi yöntemidir. Ancak cerrahiye rağmen şikayetlerin devam etmesi nadir bir durum değildir. Bu çalışmanın amacı KTS’da cerrahi girişim sonrası devam eden semptomların olası nedenlerini saptamada ultrasonografinin gücünü belirlemektir. Çalışma planı: Otuz dört hasta geriye dönük olarak değerlendirilmiştir. Bulgular: Ultrasonografi 25 hastada (%74.5) devam eden şikayetlerin nedenini belirlemede başarılı olmuştur. En yaygın patolojik bulgu median sinirde ödem (%70.6), transvers karpal ligamanın yetersiz gevşetilmesi (%23.5) ve perinöral fibrozis (%17.6) idi. Bununla birlikte dokuz (%26.5) hastada ultrasonografi şikayetleri açıklayabilecek herhangi bir patoloji ortaya koyamamıştır. Çıkarımlar: Çalışmaya dahil olan vakaların çoğunda ultrasonografi cerrahiye sonrası var olan şikayetlerin etiyolojisini ortaya koyabilmiştir. Bu sonuç cerrahi girişime rağmen ısrarcı veya tekrarlayan şikayetlerin değerlendirilmesinde ve tedavinin şekillendirilmesinde ultrasonografinin tamamlayıcı bir yöntem olarak kullanılabileceğini göstermektedir.

Anahtar Kelimeler:

Karpal tünel sendromu; karpal tünel gevşetme cerrahisi; ultrasonografi.

Correlations between ultrasonography findings and surgical findings in patients with refractory symptoms after primary surgical release for carpal tunnel syndrome

Objective: Surgical carpal tunnel release is very effective for symptom relief in carpal tunnel syndrome, and it remains the preferred choice of treatment. However, refractory symptoms following surgical release are not uncommon. We aimed to assess the usefulness of ultrasonography for determining the potential causes of ongoing symptoms following surgical release.Methods: This retrospective study included 34 patients (32 women; mean age, 54.7±16.65 years;range: 30 to 81 years) with carpal tunnel syndrome who underwent surgical carpal tunnel release.Results: A pathology related to the cause of the ongoing symptoms was detected by ultrasonography in 25 (74.5%) patients. The most common pathological findings were median nerve swelling (70.6%), incomplete transection of the transverse carpal ligament (23.5%) and perineural fibrosis (17.6%).Conclusion: In the majority of the patients the pathology related to the ongoing symptoms was detected by ultrasonography, suggesting that ultrasonography could be used as a complementary imaging method for identifying the causes of failure following surgical carpal tunnel release. Detection of an ongoing pathology might help clinicians in managing persistent disease cases and aid in planning an exploration.

Keywords:

Carpal tunnel release surgery, carpal tunnel syndrome, refractory symptoms ultrasonography,

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