S W Wilson1, R E Pollard, V C Lees. 1. Department of Plastic Surgery, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK.
Abstract
BACKGROUND: Chronic dialysis patients are susceptible to median nerve compression. This may be due to oedema or vascular insufficiency related to a dialysis shunt or fistula. Patients with renal failure may also develop amyloid disease. Amyloid infiltration of the synovium within the carpal canal may be a contributing factor to the nerve compression. Traditional carpal tunnel release, although simple to perform, is associated with a much higher recurrence rate in this group than in nonrenal patients. Our aim was to modify the carpal tunnel release procedure and prevent these recurrences. METHODS: A retrospective review of 24 extended carpal tunnel decompressions in 19 dialysis patients was performed, with reference to patient records. The surgical technique is detailed and the clinical results analysed. RESULTS: All patients noted an early and sustained improvement in symptoms; those patients with established sensory or motor signs had poorer results following surgery. There were no instances of recurrence of nerve compression during this follow-up period, range 2-6 years. CONCLUSIONS: Carpal tunnel decompression enhances hand function and quality of life in this group.
BACKGROUND: Chronic dialysis patients are susceptible to median nerve compression. This may be due to oedema or vascular insufficiency related to a dialysis shunt or fistula. Patients with renal failure may also develop amyloid disease. Amyloid infiltration of the synovium within the carpal canal may be a contributing factor to the nerve compression. Traditional carpal tunnel release, although simple to perform, is associated with a much higher recurrence rate in this group than in nonrenal patients. Our aim was to modify the carpal tunnel release procedure and prevent these recurrences. METHODS: A retrospective review of 24 extended carpal tunnel decompressions in 19 dialysis patients was performed, with reference to patient records. The surgical technique is detailed and the clinical results analysed. RESULTS: All patients noted an early and sustained improvement in symptoms; those patients with established sensory or motor signs had poorer results following surgery. There were no instances of recurrence of nerve compression during this follow-up period, range 2-6 years. CONCLUSIONS: Carpal tunnel decompression enhances hand function and quality of life in this group.
Authors: Jerzy Kopeć; Artur Gadek; Maciej Drozdz; Krzysztof Miśkowiec; Julian Dutka; Antoni Sydor; Eve Chowaniec; Władysław Sułowicz Journal: Med Sci Monit Date: 2011-09