T Crnković1,2, V Trkulja3, R Bilić4, D Gašpar5, R Kolundžić6. 1. Department of orthopedic and trauma surgery, County General Hospital Požega and School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia. tomislav_crnkovic@inet.hr. 2. Department of orthopedic and trauma surgery, County General Hospital Požega, Osječka 107, 34000, Požega, Croatia. tomislav_crnkovic@inet.hr. 3. Zagreb University School of Medicine, Zagreb, Croatia. 4. Bilić Vision Polyclinic, Zagreb, Croatia. 5. Department of orthopedic and trauma surgery, County General Hospital Požega and School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia. 6. Department of trauma surgery, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia.
Abstract
PURPOSE: Our aim was to study the dynamics of the post-surgical canal and nerve volumes and their relationships to objective [electromyoneurography (EMNG)] and subjective (pain) outcomes. METHODS: Forty-seven patients with carpal tunnel syndrome (CTS) (median age 52, range 23-75 years) with a prominent narrowing of the median nerve within the canal (observed during carpal tunnel release) were evaluated clinically using EMNG and magnetic resonance imagining (MRI) before and at 90 and 180 days post-surgery. RESULTS: Canal and nerve volumes increased, EMNG findings improved and pain resolved during the follow-up. Increase in tunnel volume was independently associated with increased nerve volume. A greater post-surgical nerve volume was independently associated with a more prominent resolution of pain, but not with the extent of EMNG improvement, whereas EMNG improvement was not associated with pain resolution. CONCLUSIONS: Data confirm that MRI can detect even modest changes in the carpal tunnel and median nerve volume and that tunnel release results in tunnel and nerve-volume increases that are paralleled by EMNG and clinical improvements. Taken together, these observations suggest that MRI could be used to objectivise persistent post-surgical difficulties in CTS patients. Level of evidence 3 (follow-up study).
PURPOSE: Our aim was to study the dynamics of the post-surgical canal and nerve volumes and their relationships to objective [electromyoneurography (EMNG)] and subjective (pain) outcomes. METHODS: Forty-seven patients with carpal tunnel syndrome (CTS) (median age 52, range 23-75 years) with a prominent narrowing of the median nerve within the canal (observed during carpal tunnel release) were evaluated clinically using EMNG and magnetic resonance imagining (MRI) before and at 90 and 180 days post-surgery. RESULTS: Canal and nerve volumes increased, EMNG findings improved and pain resolved during the follow-up. Increase in tunnel volume was independently associated with increased nerve volume. A greater post-surgical nerve volume was independently associated with a more prominent resolution of pain, but not with the extent of EMNG improvement, whereas EMNG improvement was not associated with pain resolution. CONCLUSIONS: Data confirm that MRI can detect even modest changes in the carpal tunnel and median nerve volume and that tunnel release results in tunnel and nerve-volume increases that are paralleled by EMNG and clinical improvements. Taken together, these observations suggest that MRI could be used to objectivise persistent post-surgical difficulties in CTS patients. Level of evidence 3 (follow-up study).
Authors: Georgia Ntani; Keith T Palmer; Cathy Linaker; E Clare Harris; Richard Van der Star; Cyrus Cooper; David Coggon Journal: BMC Musculoskelet Disord Date: 2013-08-15 Impact factor: 2.362