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L'échochirurgie est en plein essor grâce aux progrès des sondes linéaires à haute fréquence et des écrans d'échographie. Ainsi, la chirurgie du canal carpien est de plus en plus pratiquée sous contrôle échographique. La connaissance de l'échographie musculo-squelettique est un prérequis indispensable. Plusieurs types d'instrumentation et de voies d'abord existent : au poignet ou à la paume, avec couteaux, fil ou crochet... L'anesthésie walant (acronyme de wide awake and local anesthesia with no tourniquet) est particulièrement adaptée à cette technique dans le cadre d'un circuit patient hyper ambulatoire et dans un environnement sécurisé. L'opérateur doit bien sûr avoir une parfaite maîtrise de l'échographie et de la chirurgie avec ses complications per ou postopératoires. Nous allons étudier ici la technique chirurgicale avec ses précautions, contre-indications et complications, mais aussi les conséquences sur les nouveaux types de prise en charge organisationnelle, économique, logistique et environnemental pour la chirurgie du canal carpien. Ultrasound-guided surgery is a new trend stemming from the introduction of high-frequency linear probes and better quality screens. Surgical treatment of carpal tunnel syndrome is increasingly being performed under ultrasound guidance. Knowledge of musculoskeletal ultrasonography is obviously mandatory. Several types of cutting instruments (miniature knife, Gigli saw or hook) and surgical approaches (wrist or palm) have been described. Ultrasonography allows the wide-awake and local anesthesia with no tourniquet (Walant) technique to be used in the context of ambulatory patient care. The practitioner must be aware of all the possible intraoperative and postoperative complications and be able to treat them. The aim of this review is to analyze the surgical ultrasound guided techniques validated in literature. [ABSTRACT FROM AUTHOR]

Il existe aujourd'hui un engouement évident pour la libération du canal carpien sous échographie. Depuis 10 ans, de nouvelles techniques de section du rétinaculum des fléchisseurs sous contrôle échographique ont été mises au point et publiées. L'échographie permet de visualiser en temps réel l'instrument de coupe et les différentes structures anatomiques du canal carpien (paquet vasculo-nerveux, tendons, rétinaculum, limites osseuses). Les résultats de ces différentes études confirment l'intérêt de l'utilisation de l'échographie dans le traitement chirugical du syndrome du canal carpien (SCC). La sécurité du geste semble bien affirmée par les études scientifiques. Cette nouvelle technique et cette nouvelle entité ont, cependant, des difficultés à trouver sa place dans la pratique courante. Afin de confirmer l'intérêt clinique et l'intérêt économique de ces techniques écho-guidées, il est indispensable d'entreprendre une étude multicentrique prospective afin de comparer l'écho-chirurgie du canal carpien aux techniques chirurgicales à ciel ouvert (mini-open) et endoscopiques. There is now an obvious craze for the release of carpal tunnel under ultrasound. For 10 years, new ultrasound-controlled flexor retinaculum section techniques have been developed and published. Ultrasound allows visualization in real time of the cutting instrument and the various anatomical structures of the carpal tunnel (neurovascular bundle, tendons, retinaculum, bone boundaries). The results of these various studies confirm the interest of the use of ultrasound in the surgical treatment of carpal tunnel syndrome (SCC). The safety of the gesture seems well affirmed by scientific studies. This new technique and this new entity, however, has difficulties in finding its place in current practice. In order to confirm the clinical interest and the economic interest of these echo-guided techniques, it is essential to undertake a prospective multicenter study to compare the echo-surgery of the carpal tunnel with open surgical techniques (mini-open) and endoscopic. [ABSTRACT FROM AUTHOR]

Résumé Un syndrome du canal carpien a été diagnostiqué par son rhumatologue chez une femme âgée de 71 ans, présentant des fourmillements et picotements au niveau de la main droite ainsi qu’une douleur irradiante vers l’avant-bras. La patiente est, par ailleurs, suivie pour un diabète de type 2 stabilisé. Summary Carpal tunnel syndrome was diagnosed by a rheumatologist in a 71-year-old woman, presenting tingling and pins and needles in the right hand as well as a radiating pain in the forearm. The patient is also being monitored for controlled type 2 diabetes. [ABSTRACT FROM AUTHOR]

Summary Objectives To reappraise the respective involvement of small- and large-fiber damage in carpal tunnel syndrome (CTS) and to determine the diagnostic sensitivity of autonomic tests compared to conventional nerve conduction study (NCS). Methods Thirty-two manual workers complaining of at least unilateral CTS were enrolled. They underwent clinical interview and completed the symptom severity scale of the Boston CTS Questionnaire (sssBCTQ) and the Neuropathic Pain Symptom Inventory (NPSI). In addition, transcarpal NCS was performed to investigate large sensory and motor fibers of the median nerve, while small autonomic fibers were assessed by recording sympathetic skin reflexes (SSR) at the palm and by grading skin wrinkling in response to eutectic mixture of local anesthetic (EMLA) cream application at the pulp of the index finger. For each neurophysiological variable, sensitivity and specificity values for the diagnosis of CTS were calculated and clinical correlations were studied. Results Among 64 hands examined, 36 were clinically symptomatic, while 22 were clinically asymptomatic and served as controls. Among all the neurophysiological variables studied, only the values of transcarpal sensory nerve conduction velocity and the EMLA test grade were found to be more altered in clinically symptomatic hands, with also a trend towards prolonged distal motor latency. Overall, for the diagnosis of clinically symptomatic CTS, NCS, SSR, and the EMLA test had a sensitivity of 66.7%, 22.2%, and 69.4%, respectively, and a specificity of 72.7%, 90.9%, and 50%, respectively. Combining NCS and the EMLA test led to a sensitivity of 88.9% and a specificity of 45.4%. The sssBCTQ ( r = −0.34, P = 0.009) and the total NPSI score ( r = −0.41, P = 0.001) correlated to a more altered EMLA test grade, but not to any NCS or SSR variables. In symptomatic hands, burning sensation was associated with more severe small-fiber lesion, while other pain and sensory symptoms were rather found to be reduced in case of large-fiber damage, evidenced by NCS alteration. Conclusions This study confirms the discrepancy between conventional NCS results and clinical presentation of CTS, but still suggests a major involvement of Aβ fibers in the positive sensory symptoms of CTS, excepting burning sensation. On the other hand, the EMLA test was found to correlate with clinical data and to be able to improve sensitivity of neurophysiological investigation in diagnosing CTS. [ABSTRACT FROM AUTHOR]

Les auteurs rapportent le cas d'une patiente de 53 ans atteinte de cette pathologie qui s'est révélée par un syndrome de canal carpien. L'image montre du coté droit une vue opératoire après ouverture du canal carpien montrant le nerf médian écarté faisant apparaître la chondromatose, à gauche le plus gros chondrome après extraction.

Résumé Objectif Confirmer la faisabilité de la libération chirurgicale du canal carpien assistée par échographie en salle de radiologie interventionnelle. Méthodes Cette étude a inclus 39 patients atteints du syndrome du canal carpien, confirmé par électromyogramme, et ne répondant pas au traitement médical. Les patients ont été recrutés par le biais de consultations de chirurgie orthopédique et de rhumatologie, et opérés en salle de radiologie interventionnelle, sous anesthésie locale. Une voie d’abord unique, au pli de flexion du poignet, a été utilisée. Les patients ont été suivis sur une période de 90 j. Il s’agit d’une étude prospective ouverte non contrôlée. Résultats Quinze hommes et 24 femmes âgés de 21 à 86 ans, dont 23 exerçaient une activité professionnelle, ont été inclus. La durée moyenne de l’intervention chirurgicale était de 19,0 ± 4,6 min, le temps moyen d’occupation de la salle était de 38,0 ± 8,1 min et le volume moyen d’anesthésique local employé était de 14,7 ± 2,3 mL. Le score évaluant la douleur, les fourmillements et la gêne ressentis dans la main était considérablement réduit au jour 15 (49,1 ± 21,1 contre 23,5 ± 19,5 ; p < 0,001). Huit patients présentaient toujours une paresthésie au jour 15, et seulement 3 patients au jour 30. Quatre patients avaient repris le travail au jour 15, 10 patients considéraient qu’ils auraient pu reprendre le travail en moyenne 9,9 ± 4,9 j après l’intervention. Vingt-cinq patients ont estimé qu’ils auraient pu reprendre leurs activités quotidiennes dans un délai moyen de 7 ± 3,9 j. Aucune complication postopératoire liée à l’intervention n’a été observée. Conclusion D’après les résultats de cette étude, la procédure chirurgicale de libération du canal carpien assistée par échographie hors du bloc opératoire semble efficace et bien tolérée. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare a forearm-specific, sterile, single-use, non-pneumatic tourniquet to a conventional pneumatic tourniquet during carpal tunnel syndrome procedures. Patients with a systolic blood pressure exceeding 160 mmHg were excluded. The study included 76 patients. In 38 patients, surgery was performed with a pneumatic tourniquet on the forearm. In the remaining 38 patients, surgery was performed with a Hemaclear ® Model-F tourniquet. There were no significant differences between the two groups in terms of quality of the exsanguination or pain experienced by the patient. The duration of surgery was significantly faster by 30 seconds with the Hemaclear ® tourniquet but the procedure cost was about €30 more. The forearm-specific Hemaclear ® tourniquet has several theoretical advantages, but our clinical results do not support these advantages in terms of quality of the surgical exsanguination and pain experienced by the patient. The duration of surgery was significantly shorter, but at the price of a higher surgery cost. [ABSTRACT FROM AUTHOR]

Résumé: Avant une intervention pour syndrome du canal carpien, l’information orale aux patients est partiellement comprise puis retenue. L’objectif de cette étude était de réaliser une documentation destinée aux patients, conformément aux recommandations de la HAS, puis d’en comparer l’efficacité avec l’information orale. Notre série comprenait 37 patients ayant reçu la même information : douche préopératoire, physiopathologie, consignes postopératoires. Les 18 premiers (groupe 1) ont reçu une information exclusivement orale. Les 19 suivants (groupe 2) ont reçu l’information sous forme orale, écrite et visuelle. L’information au groupe 2 a suivi la méthodologie de McClune : promoteur (service de chirurgie de la main), comité d’organisation (deux enseignants de l’école supérieure des arts décoratifs, deux enseignants de la faculté de médecine), groupe de travail (cinq étudiants en art, cinq étudiants en médecine), groupe d’experts (trois chirurgiens, deux ergothérapeutes, un kinésithérapeute). Quatre documents ont été élaborés : un livret, un schéma, une animation, une affiche. La satisfaction était plus élevée dans le groupe 2. La compréhension et la mémorisation étaient meilleures dans le groupe 2. Cinquante-six pour cent des patients du groupe 1 auraient aimé un support papier, 12,5 % des vidéos, aucun n’est allé sur Internet. Douze et demi pour cent des patients du groupe 2 sont allés sur Internet, 18,8 % auraient aimé des vidéos. Nos résultats montrent qu’en matière de syndrome du canal carpien, les documents d’information écrits et visuels destinés aux patients améliorent significativement l’efficacité de l’information orale. Ces documents peuvent être étendus à d’autres pathologies en chirurgie de la main. [ABSTRACT FROM AUTHOR]

Résumé: Nous rapportons la découverte d’une rupture subtotale du nerf médian par usure « sur chevalet » de celui-ci sur une séquelle de fracture du poignet datant de l’enfance. Cette observation inédite a été faite lors d’une chirurgie de reprise du canal carpien chez un patient de 80ans, pour qui l’indication de neurolyse avait été posée devant la récidive d’un syndrome sévère du canal carpien à 30ans d’une première intervention de neurolyse. Si les ruptures par usure des tendons fléchisseurs sont largement relatées dans la littérature, de même que la survenue de plaies nerveuses aiguës dans le cadre de traumatismes à haute énergie, la survenue d’une rupture secondaire d’un nerf par usure de celui-ci sur un relief osseux n’a, à notre connaissance, jamais été décrite. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Several peripheral nerve block techniques (PNB) are performed for hand surgery. Their tolerance by patients or their efficacy are poorly described. We evaluated them for blocks at the wrist and at the brachial canal. Patients and methods: Cohort of outpatients undergoing open carpal tunnel release under PNB with arm tourniquet. Various anaesthetic protocols existed in our staff. The primary end points were a moderate to severe pain (greater than 3/10 on a numerical rating scale) felt during needle puncture, nerve stimulation, mepivacaine injection, at the surgical site (intraoperatively) or at the arm tourniquet, an intraoperative lidocaine supplementation, the occurrence of vasovagal events. For each primary end point, a logistic regression analyzed: the effects of gender, age, operated side, Emla® application, sedation before PNB (midazolam-sufentanil), wrist or brachial canal approach, musculocutaneous or radial block were using. Results: Between January 2007 and June 2010, 551 consecutive patients were analyzed. Puncture pain, mepivacaine injection pain, pain tourniquet and vasovagal events were associated with wrist block (P =0.003, relative risk=1.86; P <0.001, RR=4.22; P <0.001, RR=4.52; P =0.035, RR=6.40). An intraoperative pain greater than 3/10 at the surgical site, or a supplementation by the surgeon were associated with the absence of musculocutaneous block (P =0.013, RR=2.44; P =0.013, RR=2.51). Discussion: Wrist blocks are less tolerated than brachial canal blocks. The musculocutaneous nerve might often participate in the palm sensitive innervation. For open carpal tunnel release, median, ulnar and musculocutaneous nerves blocks at the brachial canal should be preferred. [Copyright &y& Elsevier]

Résumé: Objectif: Étude de la faisabilité du traitement chirurgicale du syndrome du canal carpien sous échographie. Méthode: Première étude réalisée sur 30 avant-bras afin de déterminer la voie d’abord et le plan de coupe du ligament annulaire antérieur du carpe en fonction des données écho-anatomiques. Seconde étude sur 104 avant-bras pour vérifier la faisabilité de la technique. L’intervention sous-contrôle échographique a été suivie d’une dissection anatomique étendue de la main afin de vérifier la section complète du ligament annulaire antérieur du carpe. La dissection a permis de s’assurer de l’absence de lésions vasculonerveuses et tendineuses. Résultats: Sur 104 avant-bras, la section du ligament annulaire antérieur du carpe a été complète, sans lésion apparente des structures anatomiques adjacentes. Cette section a nécessité un seul passage dans 61 cas, deux passages dans 27 cas et trois passages dans 16 cas. Conclusions: L’étude sur cadavre montre la faisabilité du traitement chirurgical du syndrome du canal carpien par voie percutanée sous-contrôle échographique. [Copyright &y& Elsevier]

Abstract: We report an uncommon case of heterotopic ossification affecting the median nerve at the level of the distal forearm and carpal tunnel with some unusual features: its length, the concomitant involvement of the ulnar nerve at Guyon''s canal and a positive family history of heterotopic ossification. [Copyright &y& Elsevier]

Abstract: This report describes a case of congenital synostosis between two bones of the wrist scaphoïd and trapezium in a nine-year-old girl who presented a severe tunnel carpal syndrome treated two years ago by open surgery. This association has not previously described. [Copyright &y& Elsevier]

Abstract: Objectives: We wished to evaluate the effectiveness of a free dermal fat graft for covering the median nerve in order to improve function after failure of carpal tunnel release. Methods: Eight patients with nine failures of carpal tunnel release were reviewed for this retrospective study. They all had significant perineural fibrosis. We performed a free dermal fat graft harvested from the inguinal region on the same side. The mean follow-up was 37 months (range 6 to 112). All patients had a clinical examination, a disability arm and shoulder scoring (DASH) and magnetic resonance imaging (MRI). Results: Five patients were satisfied or very satisfied with the procedure although only two patients returned to work. Mean grip strength was 13kg (43% of non-operated hand) and the two-point discrimination test was normal or subnormal six times on the eight wrists tested. The mean DASH score was 43 out of 100. MRI scans on eight wrists showed a fat signal in all patients and enhanced signal with gadolinium contrast in six cases. Conclusions: Free dermal fat graft offers a good covering for the median nerve over the carpal tunnel in cases of failure of carpal tunnel release. MRI showed viability of the graft. Clinical results show improvement but symptoms of median nerve irritation persisted. Permanent intraneural changes may explain these limited results. [Copyright &y& Elsevier]

Abstract: Objective: Wrist problems are common in grip sports. To better understand the entrapment symptomatology of the different neurovascular passages of the wrist, an anatomical revision seems necessary because confusion and error has increased lately. This study will focus on the ulnar canal. Comparison of the original description of the canal with definitions emanating from scientific papers, anatomical handbooks and Internet websites reveal various differences, which may create clinical confusion. Design: With the original paper of Guyon as a reference, comparison was made (i) with 37 cadavers (74 wrists); (ii) with an Internet search and; (iii) with a bibliographic survey. The dissections allowed for the verification of Guyon''s description and were used to illustrate the findings. Results: Dissection of 74 wrists confirmed Guyon''s original description. Out of the 2559 Internet hits, papers in English, French, German and Dutch were considered, only. The Internet websites and the published material presented an erroneous images and/or explanations. Conclusion: Dissection and bibliometry suggest that the canal has received multiple denominations including a confusion with the “canalis pisohamatum”. This confusion is situated on Internet sites, in scientific/clinical papers and in “classical anatomy literature”. A better understanding of this region will undoubtedly enhance our knowledge of entrapment pathologies. [Copyright &y& Elsevier]

Abstract: Patients must be informed of the benefits and risks before any surgical procedure. This information must be clear, honest, specific and complete in order that the patient can give his or her informed consent. This information has to be given face to face, however paper may be used to emphasize certain points and aid retention of information. We studied information sheets for carpal tunnel release given out in ten different hand surgery centres. Different points were identified to analyse each form. From this analysis, a literature review and recent law texts, we propose a new information sheet for carpal tunnel release. [Copyright &y& Elsevier]

Abstract: We present a new concept in outcome measurement namely “sifting”, which we demonstrate in a series of endoscopic carpal tunnel releases on 72 patients. Each patient is evaluated by considering three groups of criteria. The criteria in the first group are evaluated by the patients themselves (self-evaluation), those in the second group are evaluated by a medical observer (clinical examination) and those in the third group are evaluated by the community (socio-professional aspects). We consider that the global outcome result is good only if it is good at the same time from the point of view of the patient himself, from the point of view of the medical observer and from the point of view of the community. The originality of this “sifting” concept consists in sorting the global outcomes according to a principle of elimination. When the global outcome of each patient is passed through the sieve, this total result is considered as “poor” if only one of the three groups is noted as having a bad result. By applying this original principle to our series, we obtained 11 bad self-evaluated results (reduction in the preoperative DASH lower than 10), 6 bad clinical results (persistence of awkward paraesthesiae) and 1 bad socio-professional result (absence of return to work). After sifting all the patients the poor results represented 14 patients (19 %). It seems to us that this sifting principle represents an advance compared to existing evaluation forms, which do not independently consider these three points of view, and which provide a total score by means of arithmetic operations with arbitrary coefficients. [Copyright &y& Elsevier]

The goal of this anatomical study is to prove that reconstruction of the flexor retinaculum in carpal tunnel syndrome surgery is a reliable procedure and can improve the results of this procedure. In the first static study, we noted that when left to heal spontaneously, after 3 months the gap between the two edges of the cut retinaculum remained equal to or even larger than the gap created at the time of the surgery. A special Canaletto™® implant was created to achieve this reconstruction. It is technically possible to do this reconstruction by a 2 to 3 cm surgical approach in the palm. In another, dynamic study, we used a transducer to analyse the forces borne by the retinaculum during flexor tendon contraction. We compared these forces in a normal retinaculum, a reconstructed retinaculum with the Canaletto™® implant and a retinaculum opened endoscopically. This reconstruction conserves the anterior continuity of the retinaculum, allows excellent carpal tunnel decompression and immediately permits near-physiological forces. We discuss the advantages and the limits of this reconstruction. We think that this new surgical technique in the Carpal Tunnel Syndrome (CTS) will be able to improve the results, particularly in recurrences, in wrist malunion with CTS, in cases with severe electromyographic change with a sensory conduction speed of under 15 m.s–1 and in metabolic CTS. As always, his implant needs to be evaluated through a mid and long term clinical follow-up. By recovering better grip strength and reducing postoperative pain, this surgical technique can decrease the time needed to return to work and hence the economic costs of CTS surgery. [Copyright &y& Elsevier]

Anatomical variations may entail increased volume within the carpal tunnel and consequently the development of carpal tunnel syndrome (CTS) symptoms. The clinical importance of anomalous connection between the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) tendons was described by Linburg and Comstock. The objective of the present study was to compare postoperative outcomes of carpal tunnel release surgery in patients with and without Linburg-Comstock anomaly (LCA). Hands of CTS patients with and without LCA were evaluated for finger sensitivity, grip, tip, key and tripod pinch strength, pain intensity and Boston Carpal Tunnel Questionnaire score. Patients were evaluated preoperatively and 1, 3 and 6 months after surgery. Forty-six hands in 36 CTS patients with LCA and 50 hands in 38 patients without LCA were included. On all study parameters, no significant difference was found between CTS patients with versus without LCA. As outcomes are similar in both cases, LCA resection is not useful in patients with LCA and CTS. Preoperative diagnosis is unnecessary and screening for LCA is non-contributive for CTS evaluation., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

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Abstract: Giant cell tumour of tendon sheath is a benign proliferative lesion of synovial origin that may affect the joints, bursae and tendon sheaths. It is the second most common soft tissue tumor of the hand after ganglion cyst. The localised (nodular) form is the most common. However, the less-common diffuse-type giant cell tumour is usually located in the peri-articular soft tissue. The authors report the case of a giant cell tumor of the tendon sheath arising from the carpal tunnel of the wrist in a 42-year-old woman. The patient presented a mild carpal tunnel syndrome and a mid-palmar swelling. We present an unusual localization of giant cell tumor of the tendon sheath, causing carpal tunnel syndrome. [Copyright &y& Elsevier]

Résumé: Les infiltrations du canal carpien sont souvent pratiquées à des fins diagnostiques ou thérapeutiques. Le traumatisme direct du nerf par l''aiguille est une complication grave et assez fréquente. Le point d''injection le plus sûr n''est pas identifié de façon unanime dans la littérature. Le but de cette étude est de fournir des recommandations fondées sur des observations d''anatomie topographique pour éviter cette complication. Les distances entre le nerf médian, le grand palmaire, le petit palmaire et le cubital antérieur ont été mesurées, à un centimètre en amont du pli de flexion du poignet au cours de 124 libérations endoscopiques du nerf médian au canal carpien. Les résultats montrent qu''il y a un risque de ponction du nerf médian de part et d''autre du petit palmaire. Plus loin en dedans, il y aurait un risque pour le pédicule cubital. En conclusion, nous recommandons de réaliser l''infiltration du canal carpien en passant à travers le grand palmaire. [Copyright 2006 Elsevier]

Abstract: Carpal tunnel syndrome presenting as a trophic disorder in the hand is unusual. We report the case of a 66 year old man in whom nerve conduction tests confirmed compression of the median nerve in the carpal tunnel, and vasospasm in the corresponding area was demonstrated by arteriography for, we believe, the first time. Simple decompression of the carpal tunnel brought about total recovery. The mechanism of the autonomic disorders found in carpal tunnel syndrome remains controversial. The clinical case that we report objectively demonstrates the vasospasm caused by the compression of the autonomic fibres of the median nerve. [Copyright &y& Elsevier]

The aim of this study was to assess the value of using a Canaletto® implant in combination with a gel composed of carboxymethylcellulose and polyethylene oxide in the surgical treatment of recurrent carpal tunnel syndrome (CTS). The case series included 31 patients with 32 hands operated for the second time for recurrent (22 cases) or recalcitrant (9 cases) CTS by neurolysis. The average patient age was 62 years. Dynavisc® gel alone was applied around the median nerve in the first 16 cases (Group I). The Canaletto® implant combined with Dynavisc® gel was used in the last 16 cases (group II). With an average follow up of 8 months (for group I) and 11 months (for group II), the pre/postoperative variation in pain assessed with a visual analog scale was 1.38/10 (group I) and 2.04/10 (group II), the QuickDASH score was 20.1/100 (Group I) and 20.48/100 (Group II), grip strength was 8% (Group I) and 20% (Group II), sensory nerve conduction speed was 23.20 m/s (group I) and 15.51 m/s (group II) and distal motor latency was 1.55 m/s (group I) and 1.21 m/s (group II). Ten patients recovered from hypoesthesia in both groups, 6 patients in group I and 2 patients in group II regained good trophicity of their superficial thenar muscles. Two patients from group II had not improved clinically although their electromyography had become normal. One patient from group II suffered a postoperative infection that required removal of the Canaletto® implant. He subsequently improved slightly. Our study found that for recurrent or recalcitrant CTS, the combination of Dynavisc® anti-adhesion gel around the median nerve and a Canaletto implant® after neurolysis results in outcomes that are as good as Dynavisc® alone, with a significant improvement of the QuickDASH score without the Canaletto®. In conclusion, the use of Dynavisc® gel alone around the median nerve after neurolysis seems to be as effective as other techniques described in literature but less invasive or time-consuming, and not associated with donor site morbidity such as the flexor tendon sheath., (Copyright © 2020 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Lipofibromatous hamartoma (LFH) is a rare benign tumor affecting the peripheral nerves, particularly the median nerve. It is characterized by fatty tissue infiltrating the nerve. We report the case of a patient with LFH of the median nerve, recurrent branch and ulnar proper palmar digital nerve of the thumb associated with macrodactyly. It was responsible for hypoesthesia of the thumb's hemi-pulp and secondary carpal tunnel syndrome confirmed by electroneuromyography (ENMG). Diagnosis was suspected based on the MRI findings. The patient underwent surgical treatment consisting of open carpal tunnel release combined with neurolysis of the ulnar proper palmar digital nerve of the thumb. The extraneural LFH tissue was excised also. Forty-five days after surgery, the patient no longer had nocturnal paresthesia. Ninety days after surgery, sensitivity of the thumb pulp was satisfactory. Symptoms of LFH are related to the increased volume of the affected nerve. In the absence of symptoms, abstention seems to be the best option. In case of neurological clinical signs or ENMG abnormality, surgical treatment is indicated to perform neurolysis and excision of extraneural LFH tissue. The diagnosis is based on histological examination of tissue samples., (Copyright © 2020 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

L'IMAX est une nouvelle technique permettant d'évaluer l'excitabilité des axones moteurs des nerfs périphériques. Rapide, simple et réalisable facilement en routine, elle constitue un paramètre supplémentaire intéressant dans la pratique ENMG. Nous avons voulu tester la pertinence de cette technique dans le syndrome du canal carpien en la comparant aux autres mesures utilisées en routine. Nous avons ainsi mesuré l'IMAX et l'IUP chez des patients adressés en ENMG pour un syndrome du canal carpien. Les patients inclus étaient ceux souffrant uniquement d'un canal carpien, les patients avec une neuropathie sous-jacente ou autre pathologie étaient exclus de l'étude. La détermination de l'IMAX se déroulait en 3 étapes. L'intensité du stimulus était d'abord augmentée graduellement de 1 mA jusqu'à atteindre l'amplitude maximale du PGAM (IUP). L'intensité maximale était vérifiée en appliquant un stimulus supramaximal. L'intensité du stimulus était ensuite progressivement diminuée par décréments de 0,2 mA jusqu'à obtenir la première diminution d'amplitude du PGAM. Enfin l'intensité du stimulus était augmentée de nouveau à intervalle de 0,2 mA pour confirmer notre valeur de l'IMAX. Notre étude a reposé sur l'évaluation de l'IMAX et de l'IUP chez 40 canaux carpiens, en confrontant ces valeurs aux paramètres classiques de l'ENMG réalisés en pratique courante. L'IMAX est un paramètre rapide à mesurer et peut être réalisé facilement en pratique courante. Son utilisation dans l'évaluation de la sévérité du canal carpien et de son pronostic semble ainsi un paramètre intéressant et prometteur. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome (CTS) is the most frequent among entrapment neuropathies. The usual etiology is idiopathic, but can be caused by space-occupying lesions, a relatively rare condition. This condition becomes exceptional when the space-occupying lesion corresponds to a rare tumor whose location is atypical. The authors report the case of a 36-year-old woman with CTS due to hibernoma of the wrist., (Copyright © 2018 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

The aim of our study was to demonstrate the benefits of combining the Canaletto® implant with carboxymethylcellulose/polyethylene oxide gel in the surgical treatment of carpal tunnel syndrome (CTS) recurrences. Our case series included 39 patients (40 hands, one bilateral case) who underwent revision surgery for recurrent CTS (28 cases) or resistant CTS (12 cases). The mean age of the patients was 56 years. The Canaletto ® only was implanted in the first 21 cases (group I). In the following 19 cases (group II), Dynavisc ® gel was added to the protocol and applied around the median nerve when the Canaletto ® was implanted. At 12 months' follow-up (group I) and 11 months' follow-up (group II), the pre-versus post-operative difference between the average values of the DN4 neuropathic Pain Score was 0.55/10 in group I and 2.25/10 in group II; the Pain Score was 2.23/10 (in group I) and 2.52/10 (in group II); the Quick DASH Score was 18.98/100 (group I) and 19.06/100 (in group II); the hand grip strength was 19.55% (group I) and 28.53% (group II); the sensory nerve conduction velocity was 8.67 m/s (group I) and 10.27 m/s (group II); the distal motor latency was 1.05 m/s (group I) and 1.75 m/s (group II). Nine patients recovered from hypoesthesia in both groups, 5 patients regained satisfactory trophism of the thenar muscles in group I and 3 patients in group II. No improvement whatsoever was noted in 2 patients in group II, despite the electromyogram being normal. One patient from group II suffered an infection that required revision surgery to remove the Canaletto ® ; this led to a moderate improvement. Our results show that when resistant or recurrent CTS is diagnosed, the combined treatment of an anti-adhesion gel such as Dynavics ® around the median nerve with the Canaletto ® implant after performing secondary neurolysis leads to satisfactory post-operative outcomes. Compared to other techniques described in the current literature, our technique is less invasive, quicker and associated with minimal morbidity of the surgical site., (Copyright © 2018 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Introduction La physiopathologie des paresthésies en territoire extramédian au cours du syndrome du canal carpien (SCC) reste un sujet de controverse [1–3] . Si une sensibilisation centrale est fort probable, une atteinte périphérique ulnaire est également envisageable. Le but de ce travail est d’étudier l’implication ulnaire au cours du SCC indépendamment de la distribution topographique des symptômes. Méthodes Étude menée sur 109 mains symptomatiques présentant un SCC confirmé électriquement et 35 mains asymptomatiques témoins. Une étude des vitesses de conduction nerveuse du nerf médian, ulnaire et de la branche cutanée dorsale (BCD) du nerf ulnaire a été effectuée. Les mains étaient réparties en 3 groupes en fonction de la sévérité électrique du SCC et comparé par le test de Kruskall–Wallis ( p < 0,05 était significatif). Les coefficients de corrélation de Spearman étaient calculés entre les données neurophysiologiques. Selon la correction de Bonferroni, p était significatif à 0,007. Résultats La latence distale motrice (LDM) du nerf ulnaire était significativement augmentée chez les patients par rapport au groupe témoin. Les paramètres de conduction ulnaire étaient corrélés à la sévérité électrique du SCC. La recherche de corrélation a montré que l’amplitude du potentiel d’action sensitif (PAS) du nerf ulnaire était corrélée positivement à l’amplitude du PAS du nerf médian ( p < 0,001, r = 0,556) et à la vitesse de conduction sensitive du nerf médian ( p < 0,001, r = 0,466). La LDM du nerf ulnaire était corrélée négativement à la vitesse de conduction motrice du nerf médian ( p = 0,004, r = −0,379). Cependant, les paramètres de conduction du nerf médian n’étaient pas corrélés à l’amplitude du PAS de la BCD. Conclusion Certains paramètres de la neurographie ulnaire sont corrélés à la sévérité électrique du SCC et à certains paramètres de conduction du nerf médian. Ceci laisse à penser qu’il existe une atteinte latente ulnaire corrélée à la sévérité électrique du SCC. [ABSTRACT FROM AUTHOR]

Objectifs Le syndrome du canal carpien (SCC) est confirmé par ENMG dans 85 % des cas. Le but de cette étude est de déterminer l’apport du SUDOSCAN, évaluant les petites fibres de type C, dans le diagnostic du SCC. Méthodes Les patients de l’étude avec un SCC, bénéficiaient d’un ENMG, d’une échographie du nerf médian et d’un SUDOSCAN (évaluation des conductances cutanées électrochimiques CCE en μSiemens) ; les témoins avaient un SUDOSCAN et une échographie. Résultats Vingt-six patients (7 hommes, 19 femmes) avec 12 SCC unilatéral et 14 SCC bilatéral, dont 4 mains sans confirmation ENMG ; et 26 témoins, appariés sur l’âge (âge moyen 54,5 ans) étaient inclus. Les CCE des pieds étaient similaires (81,2 μS et 81,1 μS). La CCE des mains avec SCC est plus basse que la CCE des mains des témoins (70,2 μS et 75,9 μS, p < 0,005). Chez les patients avec SCC unilatéral, la CCE est plus basse dans la main symptomatique que dans la main saine (73,8 μS et 76,4 μS, p < 0,05). La CCE des 4 mains sans confirmation ENMG est plus basse que celle des 36 mains avec confirmation ENMG (59 μS et 71,4 μS, p < 0,05). Conclusion Notre étude confirme l’atteinte des petites fibres de la main, lors d’un entrappement du nerf médian au canal carpien. Lors de symptômes unilatéraux, les valeurs du SUDOSCAN sont plus basses dans la main symptomatique. L’atteinte au SUDOSCAN est plus marquée dans les SCC sans confirmation ENMG, que dans les formes plus évoluées ; dans ces dernières nous supposons une réinnervation des glandes sudorales du territoire médian, par les nerfs adjacents, ulnaire et radial, sous évaluant la baisse des CCE. À l’échelle individuelle, le SUDOSCAN n’est pas sensible pour être un test de dépistage du syndrome du canal carpien ; il peut être une aide diagnostique lorsque l’ENMG est négatif. [ABSTRACT FROM AUTHOR]

Devant un syndrome du canal carpien, la présence d’un nerf médian bifide est souvent méconnue. Les corrélations électrocliniques ont été peu décrites dans la littérature. Nous rapportons le cas d’un patient de 36 ans adressé pour des paresthésies des 3 premiers doigts de la main gauche de survenue soudaine. Le testing moteur mettait uniquement en évidence un déficit du muscle court abducteur du pouce, qui était par ailleurs amyotrophique. Il n’existait pas de signe de tinel au poignet. L’examen sensitif révélait une hypoesthésie tactile de la pulpe des 3 premiers doigts. À l’ENMG, les paramètres moteurs et sensitifs des nerfs médians, ulnaires et radiaux étaient normaux. Les techniques électriques comparatives des nerfs médian et ulnaire étaient négatives. L’électromyogramme de détection mettait en évidence un tracé d’aspect neurogène chronique au niveau du muscle court abducteur du pouce gauche. Devant ce tableau électro-clinique discordant, une échographie du poignet était réalisée montrant un nerf médian d’aspect bifide dès la partie distale de l’avant-bras gauche sans muscle accessoire décelable ni artère anormale. L’IRM confirmait l’aspect du nerf et l’absence de variation musculaire locale. La symptomatologie clinique a régressé spontanément en quelques semaines. Les variations anatomiques musculaires, tendineuses ou vasculaires à l’origine d’un syndrome du canal carpien sont nombreuses [2,3] . La présence d’un nerf médian bifide, souvent de découverte chirurgicale, est plus rare. Sa fréquence, identique en absence ou en présence d’un syndrome du canal carpien, est évaluée à environ 9 % [2,3] . En cas de syndrome du canal carpien, il semble exister une prédominance de l’atteinte motrice du muscle opposant du pouce. À l’ENMG, le potentiel sensitif du nerf médian au 4 e doigt serait plus fréquemment conservé et la latence distale motrice du nerf médian plus souvent normale [1] . [ABSTRACT FROM AUTHOR]

Ultrasound-guided surgery is a new trend stemming from the introduction of high-frequency linear probes and better quality screens. Surgical treatment of carpal tunnel syndrome is increasingly being performed under ultrasound guidance. Knowledge of musculoskeletal ultrasonography is obviously mandatory. Several types of cutting instruments (miniature knife, Gigli saw or hook) and surgical approaches (wrist or palm) have been described. Ultrasonography allows the wide-awake and local anesthesia with no tourniquet (WALANT) technique to be used in the context of ambulatory patient care. The practitioner must be aware of all the possible intraoperative and postoperative complications, and be able to treat them. The aim of this review is to analyze the literature on the feasibility and outcomes of surgical ultrasound-guided carpal tunnel release, and to compare it to the other validated techniques., (Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Several techniques are available for revision surgery of carpal tunnel syndrome (CTS) to preserve a gliding layer and protect the median nerve, including Strickland's pedicled hypothenar fat pad flap. The objective of this single-center, prospective study was to report the results of this flap after a minimum follow-up of two years. Between March 2006 and April 2014, 34 patients were enrolled (mean age 67 years) who had postoperative complications after the primary surgical release of CTS with nighttime paresthesia and/or neuropathic pain and abnormal electromyography findings. All patients were operated on using the same technique: neurolysis of the median nerve in the carpal tunnel with the nerve protected by a Strickland flap. The preoperative and postoperative evaluations consisted of questionnaires (paresthesia, neuropathic pain using the VAS and DN4 score, QuickDASH) and a clinical examination (grip strength, Weber two-point discrimination, atrophy of thenar muscles). Eighteen patients were reviewed in person and sixteen over the telephone. The outcomes were analyzed after at least 24 months' follow-up for all patients and 60 months for 13 patients. At 24 months postoperative, nighttime paresthesia was present in 3 of 34 patients and neuropathic pain in 2 of 24 patients. There was a significant reduction in pain on the VAS in all 34 patients (1.4 versus 6.4), the DN4 score (1.3 versus 5.7) and QuickDASH (60.7 versus 19.8). Of the 18 patients examined, grip strength improved from 72% to 86% of the opposite side (P<0.05), the mean static Weber was 6.4mm (versus 7.1mm preoperatively); nine patients had atrophy of the thenar muscles (versus eight preoperatively). The results observed at two years were maintained at five years' follow-up. This flap appears to improve the subjective neurological signs of CTS., (Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Some very poor results after carpal tunnel syndrome (CTS) surgery are difficult to explain. The main hypothesis of this study was that a relationship exists between self-efficiency toward pain and the difference between pre-operative and post-operative pain. The secondary hypothesis was that a relationship exists between self-efficiency toward pain and the pre-operative and post-operative QuickDASH score. The records of 64 patients operated for purely subjective CTS were reviewed. The evaluation consisted in determining self-efficacy beliefs from two PSEQ2 questions (1: I can still accomplish most of my goals in life, despite the pain; 2: I can live a normal lifestyle, despite the pain), pain levels and the QuickDASH score. There was an inversely proportional relationship between the pre-operative PSEQ2 and pain on one hand, and post-operative pain and the pre-operative QuickDASH score on the other hand. We found no correlation between the pre-operative PSEQ2 and post-operative QuickDASH score. Self-efficiency beliefs as measured by PSEQ2 help to predict pain levels after surgical CTS treatment in the absence of sensory and/or motor deficits and/or associated morbidity., (Copyright © 2016 SFCM. Published by Elsevier Masson SAS. All rights reserved.)