Innervation pattern at the undersurface of the extensor carpi radialis brevis tendon in recalcitrant tennis elbow

Purpose

We investigated the general, sensory, and sympathetic innervation patterns at the undersurface of the extensor carpi radialis brevis (ECRB) origin in patients with recalcitrant tennis elbow.

Methods

Eight elbows in eight consecutive patients (6 females and 2 males) with tennis elbow who underwent arthroscopic surgery were included in this study. The mean age was 45 years (38–66 years), and the mean duration of symptoms before surgery was 23 months (13–52 months). Operative treatment consisted of an arthroscopic inspection and debridement of the ECRB origin. Control tissues were obtained from biopsy of the ECRB capsule in two patients with osteochondritis dissecance of the capitellum who underwent arthroscopic resection of loose bodies. The tissue specimens were investigated immunohistochemically with antibodies delineating general (PGP9.5), sensory (SP/CGRP), and sympathetic (NPY) nerve patterns.

Results

In the non-tendinosis control tissue, SP/CGRP and NPY immunoreactions were heterogeneously distributed in association with blood vessels. Pathologic evaluation of the biopsy tissue showed atypical fibrous granulation containing numerous vessels and nerve structures in all eight patients. Marked reactions to PGP 9.5 took the form of nerve fibers associated with arteries and arterioles in the atypical granulation. Most of the perivascular innervation was found to express NPY. The immunoreactions for SP and CGRP were invariably weak.

Conclusion

Increased perivascular sympathetic innervation accompanied with loss of sensory innervation at the undersurface of the ECRB tendon may play a role in chronic pain generation in recalcitrant tennis elbow.

Level of evidence

Diagnostic, Level IV.     

Systematic diagnosis and therapy of lateral elbow pain with emphasis on elbow instability

Purpose

In recalcitrant epicondylitis innumerable operative techniques have been published, nevertheless a certain percentage of patients remains symptomatic after operative treatment. We developed an individual, systematic diagnostic pathway including arthroscopic assessment of elbow stability to identify the optimal and respectively less invasive therapy.

Methods

We so far included 40 patients with recalcitrant lateral epicondylitis (mean age 46 ± 11). 5 patients had previous surgery. In all patients, we did an elbow arthroscopy and a systematic arthroscopic stability testing. 25 patients were treated exclusively arthroscopically once instability was excluded. In 13 patients with slight instability, we did an open debridement of the lateral tendon complex and local refixation. Two patients with severe instability were treated with open debridement and additional stabilization of the LUCL with a trizeps graft. With a minimum follow-up of 1 year, we assessed the DASH score and subjective patient satisfaction.

Results

Mean follow-up was 24 ± 12 months, mean duration of symptoms before surgery was 19 ± 18 months. The mean DASH score at follow-up was 22 ± 19.36 patients reported symptoms improvement, 34 patients would repeat surgery given the same situation; in 30 cases, patients expectations had been fulfilled. We did not observe any intraoperative complications or infections. One patient developed joint stiffness requiring reoperation.

Conclusion

Using a systematic diagnostic pathway including assessment of elbow stability and consecutive individualized, respectively, less invasive surgical procedure we acquired high patients satisfaction and good clinical outcome with a low complication rate.

Level of evidence

Level III.     

Arthroskopische Revisionsstabilisierung der Schulter mit Fadenankern

Aim

Is arthroscopic revision of shoulder instabilities using suture anchors a viable alternative treatment to open revision surgery? Successful surgical stabilization of the shoulder is still a challenging problem. Many, mostly arthroscopic treatments using suture anchors are established for the initial surgery. In the literature, recurrence rates up to 49% are reported. Until now, the gold standard for these difficult recurrence cases was open revision surgery.

Materials and methods

From 2001 to 2007, 21 patients were retrospectively examined after arthroscopic revision surgery of the shoulder using suture anchors. The mean follow-up was 2.8 years (6 months to 6.2 years). Mean age at surgery was 27.8 years (17 to 34 years). An MRI of the shoulder was used preoperatively for diagnosis in all patients. All patients were clinically followed up, including a physical examination and MRI. Furthermore, the Diabilities oft the Arm, Shoulder and Hand (DASH), American Shoulder and Elbow Surgeons Standardized Assessment Form (ASES), and modified Constant Murley Score (CMS) were obtained. The MRI results were evaluated by an independent radiologist.

Results

A statistically significant difference between pre- and postoperative stability was found. There was no statistically significant correlation between the number of dislocations, the time interval between dislocation and stabilization surgery, and clinical outcome. The MRI showed good reconstruction of the labrum. The CMS rose from 72 preoperatively to 90 postoperatively, the ASES score from 59 to 88. The DASH score decreased from 42 to 9. There were no further dislocations until follow-up in this group. In a questionnaire, all patients would have surgery again.

Conclusion

The clinical outcome of the selected group at follow-up after arthroscopic revision surgery of the shoulder is equal to results published in the literature after open revision surgery. The procedure is in our view a viable alternative to open surgery by using an appropriate arthroscopic technique.     

Percutaneous Release,Open Surgery,or Corticosteroid Injection,Which Is the Best Treatment Method for Trigger Digits?

Background

Percutaneous A1 pulley release surgery for trigger digit (finger or thumb) has gained popularity in recent decades. Although many studies have reported the failure rate and complications of percutaneous release for trigger digit, the best treatment for trigger digit remains unclear.

Questions/purposes

Our aim was to identify the relative risk of treatment failure, level of satisfaction, and frequency of complications, comparing percutaneous release with open surgery or corticosteroid injections for adult patients with trigger digits.

Methods

We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs), comparing percutaneous release with open surgery or corticosteroid injections. Seven RCTs involving 676 patients were identified. Methodologic quality was assessed by the Detsky quality scale. After data extraction, we compared results using a fixed meta-analysis model.

Results

There were no differences in the failure rate (risk ratio [RR] = 0.93; 95% CI, 0.14–6.25) and complication frequency (RR = 0.83; 95% CI, 0.15–4.72) between patients undergoing percutaneous release and open surgery. Patients treated with percutaneous release had fewer failures (RR = 0.07; 95% CI, 0.02–0.21) and a greater level of satisfaction (RR = 2.01; 95% CI, 1.62–2.48) compared with the patients treated with corticosteroid injections. We found no difference in complication frequency between percutaneous release and corticosteroid injection (RR = 3.19; 95% CI, 0.51–19.91).

Conclusions

The frequencies of treatment failure and complications were no different between percutaneous release surgery and open surgery for trigger digit in adults. Patients treated with percutaneous releases were less likely to have treatment failure than patients treated with corticosteroid injections.     

Percutaneous versus open repair of acute Achilles tendon ruptures

Background

Controversy exists regarding the optimal treatment for acute Achilles tendon ruptures. Conservative and surgical treatments have been reported with variable results and complications rates. The purpose of this study is to compare the postoperative clinical and functional results of percutaneous versus open repair of acute Achilles tendon ruptures.

Materials and methods

We present 34 patients with acute Achilles tendon ruptures treated with open and percutaneous surgical repair. There were 15 patients who had open surgical repair and 19 patients who had percutaneous repair. The mean follow-up was 22 months (range 10–24 months) for the open repair group and 20 months (range 9–24 months) for the percutaneous repair group; no patient was lost to follow-up. Postoperative rehabilitation was the same for both groups. Wound healing, complications, ankle range of motion, and patients’ return to work, activity level, weight-bearing, and subjective assessment of their treatment were recorded.

Results

No significant difference was observed with respect to any of the examined variables between the open and percutaneous repair groups. Tendon healing was observed in all patients of both groups by 7–9 weeks. The mean time of patients’ return to work was 7 weeks for the open repair group and 9 weeks for the percutaneous repair group. All patients were capable of full weight bearing by the 8th postoperative week time; the time to return to previous activities including non-contact sports was 5 months for both groups. All patients expressed satisfaction and graded their treatment as good. As expected, cosmetic appearance was significantly better in the percutaneous repair group. One patient who had open repair experienced skin incision pain and dysesthesia and graded his operation as fair. No patient experienced other complications such as re-rupture, infection, sural neuroma, or Achilles tendinitis within the period of this study.

Conclusions

The present study showed similarly successful clinical and functional results after both open and percutaneous repair of acute Achilles tendon ruptures are similar. Cosmetic appearance is superior in the group of patients who had a percutaneous treatment.     

Arthroskopischer Korakoidtransfer

Background

The standard operative treatment of anterior shoulder instability is refixation of the capsule and labrum to the anterior glenoid (Bankart repair). In cases of larger bony defects or complex soft-tissue lesions coracoid transfer (Latarjet procedure) provides a more stable treatment option. The arthroscopic coracoid transfer is not frequently performed because of the high technical demands and possible neurovascular complications. Compared to the open Latarjet procedure the risk of long-term arthritic consequences cannot yet be rated but mid-term results are promising.

Objectives

Based on a clinical case series of patients treated by an arthroscopic Latarjet operation the results concerning stability, function, complication rate and patient satisfaction were assessed.

Methods

Since 2007 a total of 221 patients were treated with an arthroscopic coracoid transfer and any complications needing revision surgery were recorded. Clinical and radiological follow-up were assessed for 50 patients (surgery between 2007 and 2010) after a mean of 4.5 years.

Results

On the visual analogue scale the patients were very satisfied with the operation (8.8 out of 10) and the stability was rated with 7.6 out of 10. The mean Walch Duplay score increased from 48 to 86. The Oxford shoulder score was very good or good in 94?% of the patients at follow-up. The radiological evaluation generally showed a remodeling of the coracoid graft which did not affect the clinical result and so far11 out of 221 (5?%) patients needed further revision surgery.

Conclusion

Patients with anterior shoulder instability and glenoid bone loss or irreparable soft tissue lesions can be successfully treated with a minimally invasive arthroscopic coracoid transfer according to Latarjet with a high degree of patient satisfaction. The risk of complications is relatively low although the follow-up period included the learning curve of this technically very demanding procedure and given the high number of patients with failed previous surgery included in the study.     

Efficacy and complications of open and minimally invasive surgery in acute Achilles tendon rupture: a prospective randomised clinical study—preliminary report

Purpose

Surgical treatment of an acute Achilles tendon rupture can effectively reduce the risk of re-rupture, but it increases the probability of surgical complications. We postulated that a minimally invasive surgical treatment might reduce the number of complications related to open surgery and improve the functional results.

Method

We enrolled 47 patients with acute Achilles tendon ruptures in a prospective, randomised trial to compare clinical results and complications between a minimally invasive procedure with the Achillon® device and traditional open surgery with Krackow-type sutures. The average patient age was 46 years. The follow up time was 24 months.

Results

No Achilles tendon re-rupture or nerve injury occurred in treated patients. There were two cases of wound infections in the open surgery group, and one superficial wound infection occurred in the minimally invasive group. The groups were not significantly different in the amount of pain, range of ankle movements, the single heel-rise test, calf circumference, or time to return to work and sports.

Conclusion

After a two year follow-up period, we found no significant differences in clinical outcomes between groups treated with traditional open surgery or minimally invasive surgery.     

Anatomische Ersatzplastik des vorderen Kreuzbandes mit der autologen Quadrizepssehne

Objective

Restore function of the anterior cruciate ligament (ACL).

Indications

Chronic functional instability with rupture of the ACL, giving way phenomena, acute rupture of the ACL with concomitant meniscus repair, rerupture of ACL graft with anatomical tunnels.

Contraindications

Local infection of the skin at the knee joint, local soft tissue damage, after rupture of the quadriceps tendon, enthesopathia of the quadriceps tendon, lack of patient compliance.

Surgical technique

Harvest quadriceps tendon graft with a bone block via a 4–5 cm long incision, starting from the middle third of the proximal patella pole without damaging the tendon fibers. Drill the femoral tunnel via a deep anteromedial portal with the knee flexed of more than 110° (tunnel diameter 0.5–1 mm smaller in diameter than bone block). Gentle tunnel preparation using dilators. In absence of an ACL stump the lateral meniscus anterior horn serves as tibial landmark. In case of revision surgery, remove graft material and implants from the tunnel. Graft fixation using press fit method in the femoral tunnel. Tibial graft fixation archieved with a resorbable interference screw and a button.

Postoperative management

Goal of the inflammatory phase (weeks 1–2) is pain and inflammation control (20 kg partial weight bearing). During the proliferative phase (weeks 2–6), load and mobility slowly increased (closed-chain exercises). During the remodeling phase (>?6 weeks), strength and coordination exercises are performed. In revision cases and in case of concomitant injuries, longer partial weight-bearing period might be necessary. Athletes should not return to competitive sports before 6–8 months.

Results

In a prospective study, 33 patients (age 16–48 years) were examined after replacement of the ACL with a quadriceps tendon graft after a minimum follow-up (FU) of 2 years (12 revision; 21 primary surgery). No post- or perioperative complications. Postoperative radiographs showed an anatomical tunnel location and no dislocation of the bone block. After 2 years the difference of a-p translation compared to the other leg was assessed by the use of KT 1000. The revision group improved from an average of 7.2 mm (pre-op) to 2.2 mm (FU). The group with primary surgery improved from 6.4 mm (pre-op) to 1.7 mm (FU). A sliding pivot shift phenomenon was detected in 2 patients in the revision group and 1 patient in the primary surgery group.     

Die suprapektorale arthroskopische Tenodese der langen Bizepssehne

Background

A lack of clinical data regarding suprapectoral arthroscopic tenodesis of the long head of the biceps tendon (LHB) is evident. This study was performed to analyze the clinical results of this technique based on scores and force measurements. The affected arm was evaluated over time and compared to the ipsilateral arm. It was hypothesized that this would result in 1) improved elbow flexion force and clinical scores up to the level of the healthy ipsilateral side and 2) avoidance of a Popeye sign deformity of the upper arm.

Methods

Tenodesis of the LHB was performed by arthroscopic tendon fixation using a 6.25 mm Bio-SwiveLock screw at the sulcus entrance. Out of 27 consecutive patients who were treated by this technique for isolated LHB lesions, a total of 17 patients were included in this study. Clinical scores, force and upper arm circumference measurements were performed before surgery and 3, 6 and 12 months after the intervention.

Results

A significant improvement in clinical scores and force was found 6–12 months after surgery.

Conclusion

Arthroscopic suprapectoral intraosseous LHB tenodesis results in a significant improvement of clinical scores and elbow flexion force with no significant differences compared to the healthy ipsilateral side within 6–12 months. A Popeye sign deformity of the biceps muscle cannot be avoided in all cases.     

Anterosuperiore Rotatorenmanschettenrupturen

Background

Subscapularis (SSC) tendon tears seem to regularly occur combined with lesions of the supraspinatus (SSP) and long biceps (LBS) tendons. The aim of this study was to evaluate the rupture configurations and results after arthroscopic treatment of anterosuperior rotator cuff tears.

Patients and methods

A total of 65 consecutively treated patients [20 female, 45 male, median age 59 (23–80) years] with anterior and anterosuperior rotator cuff tears were examined prospectively. Rupture configurations were evaluated intraoperatively and subjective parameters, clinical function and Constant-Murley score (CMS) were assessed 12 months postoperatively.

Results

The SSC tears were isolated in 34 % and combined lesions of SSC and SSP were found in 66 % of patients. Additionally, LBS participation was observed in 65 % of patients and 12 (18%) patients had further concomitant lesions. Clinical function improved significantly and the age and gender-related CMS averaged 89.3 % 12 months postoperatively. Reconstructive treatment of concomitant lesions had a negative influence on outcome. Tenotomy of LBS led to better results than tenodesis. All patients would choose arthroscopic treatment again having knowledge of the postoperative result.

Conclusion

Due to convincing short-term clinical results and advantages of minimally invasive surgery, arthroscopic treatment of anterior and anterosuperior rotator cuff tears has become prevalent. Treatment of concomitant LBS tendon pathology seems to play an important role in most patients. Further development of refixation techniques and better means of visualization will increase the trend towards arthroscopic treatment of anterosuperior rotator cuff tears in the future.     

Arthroscopic management of occult greater tuberosity fracture of the shoulder

Purpose

The purpose of this retrospective study was to evaluate the early results of arthroscopic treatment in patients with missed occult greater tuberosity (GT) fracture of the humerus using the arthroscopic suture–bridge fixation technique.

Methods

Between January 2007 and August 2010, we used arthroscopic suture–bridge fixation in 15 cases of missed occult GT fractures, which were referred to our department with persistent symptoms following trauma, despite physical therapy. Occult GT fracture was diagnosed with bone marrow edema seen on magnetic resonance imaging in all patients. There were 13 male and 2 female patients with a mean age of 45 years (range 31–67 years). Mean time period until the surgery following the initial trauma was 4 months (1.5–12 months). For the measurement of clinical outcomes, we assessed the range of motion and evaluated the University of California, Los Angeles (UCLA) American Shoulder and Elbow Surgeons (ASES) scores and simple shoulder test (SST).

Results

The early clinical results were evaluated in these patients at a mean of 24 months (range 14–36 months) after surgery. All the patients were satisfied with the surgery. The mean UCLA, ASES, and SST scores improved from preoperative 15, 39, and 2 to postoperative 33, 91, and 11, respectively (P < .05). Mean forward flexion, abduction, external rotation at the neutral position, and internal rotation were improved to 159°, 155°, 24°, and L1, respectively, at the final follow-up.

Conclusion

In the occult GT fracture with persistent shoulder symptoms, arthroscopic suture–bridge fixation and early rehabilitation showed excellent clinical outcomes on a short-term follow-up study.

Level of evidence

Retrospective review, Level IV.     

Arthroscopic treatment of iliopsoas impingement (IPI) after total hip replacement

Purpose

The purpose of the study was to present our arthroscopic surgical technique and the results in patient with an iliopsoas impingement (IPI) syndrome after a hip replacement.

Materials and methods

Between 1999 and 2011, 35 patients with the clinical picture of an IPI after total hip replacement were diagnosed and treated arthroscopically. The age was ranged from 58 to 82 years. All patients underwent conservative treatment for at least 6 months without success. The indication for the arthroscopic procedure was the failure of the conservative therapy as well as typical clinical signs as painful hip flexion, a positive local anesthesia test and radiological evidence of the presence of a prominent anterior acetabular component. The arthroscopic treatment was performed in all patients with anterior capsulotomy and partial capsulectomy of the hip joint. After identification of the pathology an arthroscopic release of the iliopsoas tendon in the region of the proved lesion was performed. The average follow-up period was 3.6 years (6 months to 12 years).

Results

In all patients osseous integrated acetabular components were found. In six cases there was a surface replacement, in three cases it was a cementless screw-in cup and in the other three cases it was a cementless modular press-fit cup. 8 out of 12 patients suffered from a hip dysplasia with a secondary osteoarthritis. After establishing an anterior capsular window arthroscopically, the iliopsoas tendon could be visualized in all cases. In addition to multiple local tendinitis all patients already showed mechanical limitation with partial rupture of variable extent in the iliopsoas tendon. During the arthroscopy the lesion was detected at the level of the anterior prominent acetabular component as well as distal to it. 10 out of 12 patients reported immediately after postoperative mobilization that the typical preoperative complaints have disappeared. Two patients still had residual pain. In one of those patients this was relieved by the time of the follow-up examination. Clinically a temporary weakness of hip flexion in the first days of the postoperative period was detected. In the first follow-up 6 weeks later there was no evidence of weakness in any of the patients.

Conclusion and clinical relevance

An arthroscopic release of the iliopsoas tendon with evidence of iliopsoas impingement after total hip replacement gives predictably good results. A clinically relevant weakness of hip flexion is not expected after the procedure.     

Arthroskopische Materialentfernung nach winkelstabiler Plattenosteosynthese am proximalen Humerus

Background

Implant removal is necessary in up to 25% of patients with plate osteosynthesis after proximal humeral fracture. Our new technique of arthroscopic implant removal offers all the advantages of minimally invasive surgery. This study outlines the first results after arthroscopic implant removal in comparison with those of open implant removal.

Material and methods

Twenty patients [median age 64 (30-82) years] had arthroscopic and nine patients [median age 53 (34-76) years] had open implant removal. Median 9.5 months after implant removal subjective patient satisfaction, Constant-Murley Score (CMS) and Simple Shoulder Test (SST) were determined.

Results

Arthroscopic implant removal showed first results comparable to open implant removal. The SST outlined advantages for the arthroscopic technique. In 85% of arthroscopically treated patients concomitant intra-articular lesions were observed.

Conclusion

Arthroscopic implant removal offers all the advantages of minimally invasive surgery and first results comparable to open implant removal. The subjective and objective satisfaction of the patients is high. The technique can be applied and established by all skilled arthroscopic shoulder surgeons.     

Die arthroskopische Arthrolyse des Ellenbogengelenks

Objective

Arthroscopic assisted improvement of range of motion in elbow stiffness. Detailed diagnostic evaluation including medical history and preoperative radiographs, CT and MRI scans are necessary for planning the operative treatment.

Indications

Restricted range of motion <?30° in extension and/or more than 100° in flexion related to intraarticular causes (loose bodies, osteophytes or contracture of the capsule).

Contraindications

Extension deficit >?30°, extraarticular causes (e.g., heterotopic ossifications), nerve irritation, incongruity of joint surfaces, acute joint infection.

Surgical technique

Prone position, filling of the joint with irrigation fluid, arthroscopic examination of the anterior and posterior compartment. Partial synovectomy, debridement and capsular release, removal of loose bodies and resection of osteophytes.

Postoperative management

Intensive physiotherapy, continuous passive motion. Plexus anesthesia and nonsteroidal antiphlogistic medication.

Results

A total of 29 patients who underwent arthroscopic arthrolysis of the elbow joint were evaluated after a mean follow up of 15.4 months after surgery. Average preoperative extension deficit improved from 23° to 5°. Mean preoperative flexion improved from 115° to 131°. Improvement of range of motion was 34° on average. No vascular or neurologic complications were noted. Infection was not observed. In one case, stiffness persisted and early arthroscopic revision was needed. Postoperative patient satisfaction on the VAS Scale was 8.9. The Mayo Elbow Performance Index was 92.9 points on average.     

Influence of arthroscopic lateral release on functional recovery in adolescents with recurrent patellar dislocation

Introduction

The aim of this study is to prove the influence of the arthroscopic lateral release on functional recovery in adolescents with recurrent lateral dislocation of patella.

Materials and methods

From 2006 to 2009, arthroscopic release of the lateral retinaculum was done on 27 adolescent patients (24 women, 3 men) and 33 knees (in 6 patients on both knees). All of them were active in different sports. The severity of patellar subluxation and dislocation was analysed on X-ray; the Q angle, congruence angle, sulcus angle, patellofemoral angle and height ratio were measured. Functional scores (Lysholm, Kujala, Tegner) were measured preoperatively and postoperatively. The average duration of clinical and X-ray follow-up was 4.5 years (range 3–6 years).

Results

The mean age of the patients was 14.56 years (range 11–18 years). There was an average of 4.16 dislocations (range 2–28 dislocations) before surgery. The mean Lysholm score improved from 64 to 95 (p = 0.0002), and the mean Kujala score improved from 66 to 94 (p < 0.0001). Congruence angle and lateral patellofemoral angle improved but without any significant differences.

Conclusion

Arthroscopic lateral release successfully treats recurrent patellar dislocations in adolescents, influences functional recovery and improves knee function.     

Revisional Bariatric Surgery for Unsuccessful Weight Loss and Complications

Background

There are growing numbers of patients who require revisional bariatric surgery due to the undesirable results of their primary procedures. The aim of this study was to review our experience with bariatric patients undergoing revisional surgery.

Methods

We conducted a retrospective analysis to review the indications for revisional bariatric procedures and assess their postoperative outcomes.

Results

From 04/04 to 01/11, 2,918 patients underwent bariatric surgery at our institution. A total of 154 patients (5.3 %) of these cases were coded as revisional procedures. The mean age at revision was 49.1?±?11.3 and the mean BMI was 44.0?±?13.7 kg/m². Revisional surgery was performed laparoscopically in 121 patients (78.6 %). Laparoscopic revisions had less blood loss, shorter length of hospital stay, and fewer complications compared to open revisions. Two groups (A and B) were defined by the indication for revision: patients with unsuccessful weight loss (group A, n?=?106) and patients with complications of their primary procedures (group B, n?=?48). In group A, 74.5 % of the patients were revised to a bypass procedure and 25.5 % to a restrictive procedure. Mean excess weight loss was 53.7?±?29.3 % after revision of primary restrictive procedures and 37.6?±?35.1 % after revision of bypass procedures at >1-year follow-up (p?<?0.05). In group B, the complications prompting revision were effectively treated by revisional surgery.

Conclusions

Revisional bariatric surgery effectively treated the undesirable results from primary bariatric surgery. Laparoscopic revisional surgery can be performed after both failed open and laparoscopic bariatric procedures without a prohibitive complication rate. Carefully selected patients undergoing revision for weight regain have satisfactory additional weight loss.     

One portal simultaneous bilateral endoscopic carpal tunnel release under local anaesthesia. Do the results justify the effort?

Purpose

The purpose of this study was to evaluate whether simultaneous bilateral endoscopic carpal tunnel release could be effectively and safely performed under local anaesthesia.

Methods

We prospectively evaluated 85 consecutive patients (62 females) who underwent simultaneous one portal endoscopic bilateral carpal tunnel release with subcutaneous injection of 2 mL 2 % lidocaine. In case of pain after discharge, all patients were advised to take paracetamol (i.e., acetaminophen) and to record the dose of drug taken. Patients were reviewed at regular intervals until one year postoperatively.

Results

The mean operative time was 31.2 min. Postoperatively, only nine patients (10.6 %) received on average 611 mg of paracetamol. Significant improvement was noticed in the parameters of numbness, pain, positive Phalen and Tinel tests, pinch strength, grip strength, tip pinch strength and Quick DASH Score. Patients returned fully to work after surgery in average 2.2 weeks. Conversion to open release took place in four wrists (2.4 %). Discomfort and pain from tourniquet pressure was reported from two patients (2.4 %). Two wrists (1.2 %) required revision surgery. One patient (1.2 %) reported temporary thenar numbness and another (1.2 %) had slight scar hypersensitivity.

Conclusions

Simultaneous bilateral endoscopic carpal tunnel release under local anaesthesia is well tolerated by patients. The technique may be of benefit in young, active, high-demand patients who require fast recovery, early return to work and less disability time.