Avaliação clínica a longo prazo - pelo sinal de Phalen, Tinel e parestesia noturna - dos pacientes submetidos a cirurgia de liberação do túnel do carpo com instrumento de Paine®

Abstract

A liberação do retináculo dos flexores para o tratamento da síndrome do túnel do carpo (STC) é uma das cirurgias mais realizadas. Existem diversos métodos para a realização deste procedimento cirúrgico, como endoscópicos, via aberta clássica e mini-incisões. A longo prazo, poucos trabalhos mostram os resultados destas cirurgias. Este estudo tem como finalidade avaliar os pacientes submetidos à liberação do túnel do carpo com instrumento de Paine®, com no mínimo 84 meses de pós-operatório. Foram avaliados os parâmetros clínicos: teste de Phalen, sinal da percussão dolorosa e a queixa de parestesia noturna no pré e pós-operatório. Os resultados mostram que há significante melhora dos sinais avaliados (p.....), quando comparados com a avaliação inicial, e que estes sinais clínicos permanecem negativos ao longo do tempo.

Liberação do canal do carpo por mini-incisão transversa

“…It is the most common and most studied compressive neuropathy of human beings, with prevalence from 51 to 125:100,000 individuals. 7 CTS surgery is a routine procedure performed worldwide, often in an outpatient setting 2,15,16 and is habitually indicated due to low rates of clinical improvement with conservative treatment. 12 There were cases in which the patient returned to daily living activities or to work only after the sixth postoperative month.…”

“…18 The use of endoscopic techniques or special materials for CTS surgery, with the intention of reducing these postoperative signs and symptoms and possible complications, has a long learning curve and increases the cost of the procedure. 3,12,15,16,[19][20][21] The aim of this study is to diminish morbidity due to the scar, thus reducing the discomfort and "pillar" pain caused by the conventional longitudinal incision, and to provide a faster return to habitual activities for the patients, without increasing the treatment cost. In a study in 2003, Klein and collaborators concluded that the mini-incision technique was an effective method for CTS surgery, associated with significant improvement in symptoms, lower incidence of complications relating to the scar and improvement of general hand function, although this would not allow additional procedures to be executed, if these were necessary.…”

Evaluation of patients with carpal tunnel syndrome treated by endoscopic technique

“…The complications of surgery are well documented in the literature and can occur at any of the employed techniques. 4 , 5 In recent years there has been an increasing use of endoscopic methods for the release of the carpal tunnel in order to expedite the patient's return to work and reducing morbidity. 6 The disadvantages of this technique are the higher cost of surgery and the highest learning curve of the surgeon, compared to the open technique.…”

Prospective Comparative Study Between Proximal Transverse Incision and the Conventional Longitudinal Incisions for Carpal Tunnel Release

“…It is the most common and most studied compressive neuropathy among human beings, with a prevalence ranging from 51 to 125 cases per 100,000 individuals (7) . CTS surgery is a routine procedure carried out around the world, often on an outpatient basis 2 , 15 , 16 . It is usually indicated because of low rates of clinical improvement with conservative treatment (12) .…”

“…The use of endoscopic techniques or special materials for CTS surgery, with the aim of diminishing these postoperative signs and symptoms and the possible complications, has a long learning curve and increases the cost of the procedure 3 , 12 , 15 , 16 , 19 , 20 , 21 .…”