Objective To review the progress in the treatment method of carpal tunnel syndrome (CTS). Methods Recent l iterature concerning the treatment method of CTS was extensively reviewed, analyzed, and summarized. Results Wrist spl inting and local steroid injection are effective in patients with mild to moderate CTS in the short-term. however, patients with recurrent CTS have to accept surgical treatment. The main operative patterns include open carpal tunnel release (OCTR), mini-OCTR, and endoscopic carpal tunnel release. Conclusion The final conclusion of the most effective method to treat CTS needs more cl inical researches, and surgical treatment is one method recommended by some scholars.
Objective To study the effect of surgical treatment of carpal tunnel syndrome (CTS) by endoscope through a transparent combined with dilation conductor to cut the transverse carpal l igament. Methods Between April 2003 and April 2008, 56 patients with CTS were treated with endoscopic carpal tunnel release through a transparent combined with dilation conductor. There were 8 males and 48 females with an average age of 50 years (range, 38-65 years). CTS was caused bywrist injury in 5 cases, by forearm fracture in 12 cases, and by wrist strain in 39 cases. The locations were left hand in 14 cases and right hand in 42 cases with a disease duration range of 2-7 years (4 years on average). According to Hamada classification of CTS, 38 cases were classified as stage I, 12 cases as stage II, and 6 cases as stage III. Results All cases achieved the primary heal ing of incision. All patients were followed up 14-68 months (40 months on average). According to Kelly’ s evaluation, the results were excellent in 25 cases, good in 22 cases, fair in 4 cases, and poor in 5 cases with an excellent and good rate of 83.93%. The distal motor latency of median nerve was (4.48 ± 0.50) ms at 1 months, (4.06 ± 0.35) ms at 3 months, (3.79 ± 0.25) ms at 6 months, and (3.42 ± 0.24) ms at 12 months after operation, showing significant differences when compared with the preoperative one [(5.09 ± 0.61) ms, P lt; 0.05]. There were significant differences among different time points after operation (P lt; 0.05). Conclusion The method of endoscope through a transparent combined with dilation conductor to cut the transverse carpal l igament is a simple and effective surgical procedure for treament of CTS, which can precisely cut the transverse carpal l igament and completely release the pressure of carpal tunnel.
ObjectiveTo study the effectiveness of transverse carpal ligament release for carpal tunnel syndrome (CTS) with arthroscopic "two-portal" technique under local anesthesia. MethodsTransverse carpal ligament was released with arthroscopic "two-portal" technique in 31 patients with CTS between November 2002 and August 2008. There were 4 males and 27 females, aged 24-71 years (mean, 52 years). The disease duration was 1 month to 14 years (mean, 42 months). According to the guidelines of Bin Tian, 20 sides were rated as grade I, 16 sides as grade Ⅱ, and 5 sides as grade Ⅲ before operation. The sensation was S2+ in 7 cases, S3 in 19 cases, and S3+ in 5 cases. The muscle strength of the abductor pollicis brevis and opponens pollicis muscles was grade 2 in 5 cases, grade 3 in 14 cases, and grade 4 in 7 cases. Michigan hand function scoring system (MHQ) was used to evaluate the function of the hand before and after operation. ResultsAll incisions healed primarily, and no complications of median nerve injury and adhesion occurred. All of the 31 patients were followed up 6-11.8 years (mean, 9.6 years). After operation, numbness and paresthesia of fingers were relieved (S4); the muscle power returned to grade 4 in 8 cases, and to grade 5 in 23 cases. The MHQ scores of function, daily life, work, pain, appearance, and satisfaction were improved significantly at 6 months postoperatively when compared with preoperative ones (P<0.05). There was no relapse. ConclusionArthroscopic "two-portal" technique is an effective surgical procedure for relieving the compression symptoms on the median nerve from carpal canal, so it is helpful to functional recovery of the median nerve. The long-term effectiveness is definite.
Objective To investigate the effectiveness of wrist tube inside and outside releasing for treating median nerve double entrapment at wrist. Methods Thirty-one patients of median nerve double entrapment at wrist were treated between April 2011 and May 2014. There were 8 males and 23 females with an age of 33-69 years (mean, 56.4 years). In palm lateral three and a half finger, the two-point discrimination was 7-14 mm (mean, 9.5 mm), in which 24 cases were 4-10 mm and 7 cases were more than 10 mm. Carpal tunnel median nerve Tinel sign was positive; there was weak and acid swollen felling when press big thenar muscle on median nerve return branch palm surface projection points. Electromyography examination showed that median nerve endings movement incubation period was 4.5-10 ms in 22 cases, more than 10 ms in 9 cases; fibrillation potentials and positive phase voltage happened in 6 cases; the median nerve sensory conduction velocity of all patients was slow, and the motor conduction velocity also slowed down; the motor amplitude was 5-10 mV in 19 cases, less than 5 mV in 12 cases. The disease duration was 3-8 months (mean, 5.5 months). Surgical exploration of wrist median nerve in carpal tunnel and median nerve return branch outside carpal tunnel were performed in patients, especially completely released the variety entrapment factors such as thickening bow at starting point of short hallux flexor tendon, fiber bundles at ulnar side of short hallux flexor tendon, deep layer fiber of the palmar aponeurosis, and variant shallow head of short hallux flexor. Results All the wounds healed by first intention without wound scar pain. The patients were followed up 24-59 months (mean, 33 months). Night numbness and pain disappeared, and weak and acid swollen feeling in big thenar muscle on median nerve return branch points also disappeared. The sensation recovered to S4 in 28 patients in palm lateral three and a half finger, the index and middle fingertip sensation recovered to \begin{document}$ \small{{\rm{S}}_{{{ 3}^ + }}} $\end{document} in 3 cases. In the median nerve innervation area, the two points discrimination was 4-6 mm (mean, 4.8 mm). The thumb opposition function returned to normal in 29 cases and mild confinement in 2 cases. The grip strength of all the 31 cases recovered, and 1 of them increased significantly. In preoperative big thenar muscle atrophy cases, muscle strength recovered to S5 in 4 cases, S4 in 2 cases. At 2 years after operation, according to the functional assessment of carpal tunnel syndrome recommend by GU Yudong, the results were excellent in 29 cases and good in 2 cases, with an excellent and good rate of 100%. Conclusion When treating the nerve double entrapment in wrist using wrist tube inside and outside releasing method, the variety entrapment factors of return branch of median nerve should be completely released, so the effectiveness can be improved.
Platelet-rich plasma (PRP) is a platelet-rich plasma protein concentrate extracted from autologous peripheral blood, which contains a variety of blood-derived growth factors and cytokines. As an autologous blood product, PRP is widely used in many fields such as tissue repair and regeneration because of its minimally invasive process, simple preparation process and good biological properties. The acquisition of PRP is mainly achieved by collecting peripheral blood through density gradient centrifugation. Various growth factors and cytokines in PRP can repair various tissues. With the deepening of PRP research, it is now gradually applied to rotator cuff injury, lateral epicondylitis of humerus, carpal tunnel syndrome, knee joint injury, gluteal muscle tendinopathy, achilles tendinopathy, plantar fasciitis, and other soft tissue injuries, and some progress has been made. This article reviews the progress on clinical applications of PRP in chronic soft tissue injuries to provide a theoretical basis.