Internal neurolysis and flexor tenosynovectomy: Adjuncts in the treatment of chronic median nerve compression at the wrist in hemodialysis patients

Abstract

This retrospective clinical study reports our results with surgical treatment of chronic median nerve compression at the wrist in 27 hemodialysis patients with a mean follow-up of 22 months. Due to the high incidence of amyloidosis in our patient population, an extensive tenosynovectomy was done in all patients. Statistically significantly (P = .03) better results were obtained when a microsurgical internal neurolysis was added to the procedure, than simple decompression alone (82% vs. 63% good to excellent results).

Carpal tunnel syndrome: A review

“…Finally, internal neurolysis has been proposed to make the still healthy fibres of MN free of the scar and fibrous tissue that sometimes surrounds them after long-standing nerve compression preventing a full recovery. Though the results of internal neurolysis are controversial (83)(84)(85)(86)(87)(88) and, at the moment, it does not seem to improve significantly the outcome. After the surgical release the wrist should be kept slightly extended by means of a splint.…”

Karpaltunnelsyndrom-Rezidive bei Langzeithämodialyse

“…Nach Untersuchungen von Corradi und Mitarb. [7] sowie Hirasawa und Ogura [12] kommt es nach fünf, nach unseren Untersuchungen nach durchschnittlich sechs Jahren zum ersten Rezidiv, die weiteren folgen dann mit jeweils kürzeren Abständen. Die Rezidivhäufigkeit scheint auch nicht von der Art des Ersteingriffs (offen oder endoskopisch) abzuhängen [25].…”

“…Ein Unterschied zur Peritoneal-Dialyse (CAPD) besteht nicht [4]. Da sich die Amyloidfibrillen auch in den Gelenken (früher Befall des Schultergelenks), den Sehnen und Nervensträngen anreichern und zu entzündlichen Reaktionen führen, sind typische Begleiterkankungen wie Trigger-Finger und schwere destruktive Arthropathien fast die Regel [1,5,7]. Infolge der Arthropathie der Fingergelenke und Verklebung der Beugesehnen kommt es zu einer zunehmenden Einschränkung des Faustschlusses und der Spitzgriffe.…”

Beta-2-Microglobulin-Associated Amyloidosis

“…As in the patient described, carpal tunnel syndrome is often bilateral and usually requires surgical release of the transverse ligament and/or synovectomy of tendon sheaths [59]. While during sur gery hypertrophic and amyloid-laden synovial membrane or perineural connective tissue may be detected, this may not be the case in other long-term hemodialysis patients, in whom only a shrunken transverse ligament but no amy loid is noted [2,60], This illustrates the multifactorial ori gin of carpal tunnel syndrome [61], Postoperative recur rence of the carpal tunnel syndrome may be observed in patients within the next 2-3 years [16,54].…”