Endoscopic gastrocnemius recession: evaluation in a cadaver model

The purpose of this study was to describe a new method of gastrocnemius recession using an endoscopic approach and to determine the accuracy of incision placement during gastrocnemius recession. Fifteen fresh-frozen cadaveric limbs underwent an endoscopic gastrocnemius recession utilizing a two-portal technique. All limbs were anatomically dissected after the procedure and each was examined for injury to the sural nerve. The ability to visualize the sural nerve intraoperatively, improvement in ankle dorsiflexion, time requirement for the procedure, incision size, and appropriateness of placement to facilitate recession were recorded for each specimen. An average of 83% of the gastrocnemius aponeurosis was transected in all 15 cadavers. After modifications of the technique, the final eight cadavers were noted to have had the entire (100%) gastrocnemius aponeurosis transected. Sural nerve injury occurred in one specimen (7%) in which the aponeurosis and the sural nerve were not well visualized. The sural nerve was definitively visualized during the procedure in 5 of 15 specimens (33%). No Achilles tendon injury was noted in any specimen. There was a mean improvement in ankle dorsiflexion of 20 degrees (range, 10 degrees-30 degrees) during full knee extension. The average length of time to perform the procedure was 20 minutes (range, 10-35 minutes). The average medial and lateral incision lengths used in the two-portal technique were 18 mm (range, 14-22 mm) and 17 mm (range, 12-19 mm), respectively, and the average distance from the midpoint of the medial incision to the level of the gastrocnemius-soleus junction was 26 mm (range, 5-60 mm). These results indicate that a complete gastrocnemius aponeurosis transection may be obtained utilizing a modified endoscopic gastrocnemius recession, but visualization of the sural nerve is poor with possible risk of iatrogenic nerve injury.     

Surgical anatomy of the gastrocnemius recession (Strayer procedure)

BACKGROUND: The Strayer procedure (gastrocnemius recession) is a treatment option for patients with clinically relevant gastrocnemius equinus contracture. The purpose of this study was to review the surgical anatomy of the Strayer procedure with specific reference to 1) the location of the sural nerve, and 2) the gastrocnemius tendon release point. METHODS: Forty consecutive Strayer procedures in 33 patients (15 males, 18 females) served as the study group. Recorded measurements included: 1) the location of the sural nerve relative to the deep fascia, 2) the distance from the medial border of the gastrocnemius tendon to the sural nerve, and 3) the distance from the distal end of the gastrocnemius muscle belly (identified by surface landmarks) to the actual release site. RESULTS: At the point of the gastrocnemius release, the sural nerve was located superficial to the fascia in 17/40 legs (42.5%) and deep to the fascia in 23/40 legs (57.5%). In five legs (12.5%), the nerve was directly applied to the gastrocnemius tendon and needed to be gently dissected off the tendon. The gastrocnemius release point was located an average of 18 mm distal (range, 20 mm proximal to 57 mm distal) to the surface landmark created by the distal extent of the gastrocnemius muscle belly. CONCLUSION: Knowledge of the relevant anatomy associated with the gastrocnemius recession should allow surgeons to minimize the rate of sural nerve injuries and improve cosmesis by decreasing the length of the surgical incision. A posteromedial incision that begins 2 cm distal to the gastrocnemius indentation and extends proximally will minimize the length of the incision required.     

Isolated recession of the gastrocnemius muscle: the Baumann procedure

BACKGROUND: The Baumann procedure consists of intramuscular lengthening (recession) of the gastrocnemius muscle in the deep interval between the soleus and gastrocnemius muscles. The goal of the procedure is to increase ankle dorsiflexion when ankle movement is restricted by a contracted gastrocnemius muscle. Unlike the Vulpius procedure, the Baumann procedure truly isolates the lengthening site to the gastrocnemius muscle and does not lengthen the soleus muscle. The Baumann procedure has not previously been studied in cadaver specimens. METHODS: The gastrocnemius and soleus muscles of 15 normal cadaver specimens had four sequential releases: a single gastrocnemius recession, a second gastrocnemius recession, a single soleus recession, and an Achilles tenotomy. Ankle dorsiflexion was measured with a goniometer initially, after each muscle recession, and after the tenotomy. RESULTS: After the second gastrocnemius recession, the average increase in ankle dorsiflexion measured 14 degrees with the knee extended and 8 degrees with the knee flexed. CONCLUSIONS: The Baumann procedure treats equinus contracture of the gastrocnemius muscle by improving ankle joint dorsiflexion. The procedure is indicated when the results of the Silfverski?ld test are positive.     

Complications Associated with Uni-portal Endoscopic Gastrocnemius Recession in a Diabetic Patient Population: An Observational Case Series

The purpose of this article was to report the complications associated with uni-portal endoscopic gastrocnemius recession for surgical treatment of pathologic soft tissue ankle equinus contracture in diabetic patients. This is an observational case series involving a retrospective review of prospectively collected data of 23 uni-portal endoscopic gastrocnemius recessions used to treat pathologic soft tissue ankle equinus contracture in 18 consecutive diabetic patients between November 2006 and January 2009. Each patient underwent uni-portal endoscopic gastrocnemius recession under general or spinal anesthesia with thigh tourniquet control in combination with soft tissue and/or osseous reconstructive foot and/or ankle surgery. Patients were kept non–weight bearing based on the index procedure and followed until clinical healing occurred or failure was declared. There were 9 male and 9 female patients with a mean age ± SD of 69.0 ± 7.4-years (range: 47.0 to 71.0 years). There were 11 right and 12 left lower limbs involved, with 5 procedures performed bilateral. Complications included 3 conversions to an open incision secondary to difficulty dissecting through excessive adipose tissue, delayed healing of 3 incision sites in patients with uncontrolled diabetes mellitus at the time of surgery, and 3 undercorrections in patients with spastic contractures. The remainder of the procedures were deemed successful with no saphenous nerve, sural nerve, or lesser saphenous vein related injuries occurring. When properly performed, uni-portal endoscopic gastrocnemius recession represents a safe, reliable, and minimally invasive technique useful for correcting pathologic soft tissue ankle equinus contracture in patients with diabetes. A percutaneous tendo-Achilles lengthening should be performed in patients who have marginal arterial inflow that precludes tourniquet use or have a spastic contracture. An open rather than endoscopic gastrocnemius recession should be performed in patients with excessive adipose tissue. Before surgery, the risk of delayed wound healing should be discussed with patients who have uncontrolled diabetes mellitus and in-patient management with tight glycemic control considered.     

Endoscopic gastrocnemius recession: Preliminary report on 18 cases

A technique of endoscopic gastrocnemius recession was evaluated. Fifteen patients undergoing 18 procedures were prospectively studied with a minimum follow-up of 1 year. There were 9 women and 6 men (mean age, 44.1 +/- 22.6 years). One patient had an isolated recession; the others had various adjunctive flatfoot or reconstructive procedures. Pre- and postoperative ankle dorsiflexion was evaluated, as was the amount of time before patients could perform a single-leg heel raise postoperatively. The mean preoperative ankle dorsiflexion with the knee extended was -8.7 degrees +/- 3.5 degrees , which improved from a mean 14.9 degrees at 3 months postoperatively to a mean 6.2 degrees +/- 2.6 degrees . At 12 months postoperatively, this value was 3.6 degrees +/- 1.8 degrees , a net postoperative improvement of 12.6 degrees (P < .00001). Patients were able to perform a single-leg heel raise on an average of 13.0 +/- 6.0 weeks. Complications were mostly related to lateral foot dysesthesia in the distribution of the sural nerve (N = 3). Furrowing of the medial leg was noted in 1 patient. No hematomas or neuromas associated with the portal sites were found. These results show endoscopic gastrocnemius recession to be an acceptable method of lengthening the gastrocnemius complex.     

Comparative responsiveness of the disabilities of the arm,shoulder, and hand,the carpal tunnel questionnaire,and the SF-36 to clinical change after carpal tunnel release

PURPOSE: The objective of this study was to compare the responsiveness (ability to accurately detect change) of 3 self-administered questionnaires to changes produced by carpal tunnel release. METHOD: The Disabilities of the Arm, Shoulder and Hand (DASH), the Brigham and Women's Carpal Tunnel Questionnaire, and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were completed by 34 subjects before surgery and at 6 and 12 weeks after carpal tunnel release. RESULTS: The instrument most sensitive to clinical change at 12 weeks as judged by effect size and standardized response means was the Carpal Tunnel Questionnaire (effect size/standardized response means, 1.71/1.66) followed by the DASH (1.01/1.13) and the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain (0.57/0.52) and role physical (0.39/0.39) subscales. There was good correlation between DASH and Carpal Tunnel Questionnaire change scores (Spearman correlation coefficient 0.87). CONCLUSIONS: The Carpal Tunnel Questionnaire is the most sensitive to clinical change, but the DASH is sufficiently responsive for use in outcome studies of carpal tunnel syndrome done 12 or more weeks after surgery.     

Verletzung des N.?medianus nach minimal-invasiver Dekompression

A 72-year-old man suffering from carpal tunnel syndrome had undergone minimally invasive decompression by using a SafeGuard? Mini-Open Carpal Tunnel Release System. After the operation the patient presented with a paraesthesia in the median nerve distribution. Two months later an operative revision was performed in another hospital. A partial transection of the median nerve and an incomplete release was seen. The surgeon of the first operation stated that detailed informed consent including the risk of iatrogenic nerve injury had been obtained. Furthermore he referred to the operative report, which mentioned the accuracy of the procedure without any problems or complications during surgery. The Arbitration Board stated that the operative report could not exculpate the surgeon because the findings of the operative revision disagreed with the first operative report. The expert opinion declared that the lesion was a result of an inaccurate operative procedure as the surgeon was not able to demonstrate an anatomical variation of the median nerve.     

Evans calcaneal osteotomy for flexible pes valgus deformity. A preliminary study

This procedure was quite successful, particularly in patients with a transverse plane dominant flexible pes valgus deformity. The modifications that have proved to be successful include the use of the oblique skin incision following the relaxed skin tension lines, the use of allogeneic bone graft, and the use of ancillary procedures, including the gastrocnemius recession and medial arch tendosuspension. The procedure is less predictable in those patients whose deformity is primarily in the frontal or sagittal plane. It is most critical that preoperative analysis be used to discover the presence of the masked metatarsus adductus prior to performing this procedure.     

Mini-open blind procedure versus limited open technique for carpal tunnel release: a 30-month follow-up study

PURPOSE: To evaluate prospectively the safety and effectiveness of a mini-open blind technique for carpal tunnel release (group A) when compared with a limited open technique (group B). METHODS: From November 1999 to May 2001 (mean follow-up period, 30 mo) we performed 222 carpal tunnel release procedures on 185 consecutive patients. All patients were affected by mild to moderate median nerve compression. Patients in group A (82 patients, 99 procedures) had a short transverse incision at the wrist (length, 2 cm). We used a manual surgical instrument that helps in blindly dividing the flexor retinaculum because it has an integrated light source. The light makes it possible to locate precisely the tool blade by transillumination. Patients in group B (103 patients, 123 procedures) had a limited longitudinal incision (length, 3-4 cm). The preoperative and postoperative patient statuses were evaluated with an Italian modified version of the Boston Carpal Tunnel questionnaire with a mean of 30 months' follow-up after surgery (range, 24-39 mo). RESULTS: Group A patients showed better results than group B patients in all of the sections of the Italian modified version of the Boston Carpal Tunnel questionnaire at a mean follow-up period of 19 months, whereas after a mean of 30 months of follow-up evaluation the differences between groups A and B tended to decrease. Disease recurred in 7 group B patients, whereas only 1 patient in group A experienced symptom recurrence at the latest office evaluation. CONCLUSIONS: The blind mini-invasive technique has been shown to be as safe as traditional techniques but the recovery period is significantly shortened. With the technique we described a low recurrence rate was observed. All patients in group A reported great reduction in preoperative pain and numbness.     

腓肠肌前方腱膜松解治疗非痉挛性腓肠肌挛缩

目的介绍及评价腓肠肌前方腱膜松解治疗非痉挛性腓肠肌挛缩的手术方法及术后疗效。方法回顾性研究2006年7月至2013年7月期间,本组采用腓肠肌前方腱膜松解治疗非痉挛性腓肠肌挛缩的患者。患者术前体检Silfverskild试验（＋）,采用Baumann入路在腓肠肌与比目鱼肌间隙之间,松解腓肠肌前方腱膜,背伸踝关节至角度满意。术前和末次随访时测量踝关节的最大被动背伸角度（膝关节伸直位和屈曲90°时）,进行美国足踝医师协会后足-踝关节（AOFAS-AH）评分,并记录术后并发症情况。结果 29例（35足）患者获得随访,平均年龄36.5岁（8~69岁）,平均随访32.6个月（7~54个月）。其中成人扁平足11例13足,儿童扁平足4例5足,踇外翻6例8足,跖筋膜炎5例6足,创伤性马蹄足3例3足。术前和末次随访时伸膝位踝关节最大被动背伸角度分别为（-5.7°±3.2°）（-15°~3°）和（8.2°±3.7°）（-6°~17°）（P〈0.01）,背伸角度平均增加13.9°。AOFAS-AH评分由术前平均46.7分提高到末次随访的75.1分（P〈0.01）。术后马蹄足畸形复发2例（2足）,无过度延长、神经血管损伤及伤口并发症发生。结论腓肠肌前方腱膜松解操作方便,术后踝关节背伸角度恢复满意,跖屈肌力良好,未见明显并发症,是治疗非痉挛性腓肠肌挛缩安全、有效的手术方法。     

Comparison of the Complication Incidence in Open Versus Endoscopic Gastrocnemius Recession: A Retrospective Medical Record Review

Gastrocnemius recession is a practical and effective procedure to address gastrocnemius equinus. It has been shown that an equinus deformity can lead to the development of plantar fasciitis, osteoarthritis, and foot ulcerations. The 2 approaches to gastrocnemius recession are open and endoscopic. Both are viable options; however, both also have associated complications. We compared and evaluated the postoperative complications associated with these procedures. The electronic database of our orthopedics division at the University of Florida College of Medicine, Jacksonville, was retrospectively searched to identify all cases of gastrocnemius recession (Current Procedural Terminology [CPT] code 27687), and unlisted arthroscopy (CPT code 29999) from February 2006 to February 2016. The difference in the outcome variable, the incidence of postoperative complications, was assessed using Fisher's exact test. A total of 39 patients (41 procedures) were in the open gastrocnemius recession group and 35 (39 procedures) were in the endoscopic gastrocnemius recession group. The median follow-up time was shorter in the open gastrocnemius recession group than in the endoscopic gastrocnemius recession group (9 versus 12 months; p?<?.001). Postoperative complications developed after 12 of the 80 procedures (15%), with a greater incidence after open than endoscopic procedures (26.8% versus 2.6%; p?=?.003). The complications associated with the open technique included 1 case of scar pain (2.4%), 5 of dehiscence (12.2%), 1 of infection (2.4%), 2 of calf abscess (4.9%), and 2 cases of nerve injury (4.9%). A single complication occurred with the endoscopic technique—1 case of dehiscence (2.6%). To the best of our knowledge, ours is the first study to compare the postoperative complications between these 2 techniques. We found the incidence of postoperative complications was significantly lower in the endoscopic group, emphasizing the benefit of using the endoscopic approach. These findings could prove invaluable when addressing gastrocnemius equinus in those with a greater risk of postoperative complications.     

Proximal Ultrasound-Guided Gastrocnemius Recession: A New Ultra-Minimally Invasive Surgical Technique

Selective proximal recession of the medial gastrocnemius head has clear advantages over other approaches and can be performed as a single or combined open procedure for many indications. The purpose of this study was to evaluate the safety and efficacy of a new technique based on ultrasound-guided ultraminimally invasive proximal gastrocnemius recession. We performed a pilot study with 16 cadavers to ensure that the technique was effective and safe; we then prospectively performed gastrocnemius recession in 12 patients (23 cases) with gastrocnemius contracture associated with other indications. We evaluated pre- and postprocedure dorsiflexion, clinical outcomes (based on the visual analog scale and American Orthopedic Foot and Ankle Society scores), and potential complications. We achieved effective release of the proximal medial gastrocnemius tendon in all cases, with no damage to other tissue. Ankle dorsiflexion increased 12° (range 6° to 18°) (p = .05) and was maintained throughout follow-up. The mean preoperative visual analog scale score was 7 (range 5 to 9), which improved to 1 (range 0 to 2) (p = .01). The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score improved from a mean of 25 (range 20 to 40) to 85 (range 80 to 100) at 6 months and 90 at 12 months (p = .01). No major complications were observed. We considered the technique to be safe and effective for ultrasound-guided ultraminimally invasive proximal-medial gastrocnemius recession using a 1-mm incision in vivo. This novel technique is an alternative to open techniques, with encouraging results and with the potential advantages of reducing pain and obviating lower limb ischemia and deep anesthesia, thus decreasing complications and contraindications and accelerating recovery, although further studies are required.     

Gastrocnemius Recession Leads to Increased Ankle Motion and Improved Patient Satisfaction After 2 Years of Follow-Up

The isolated gastrocnemius contracture present in neurologic healthy patients results in a significant limitation of ankle dorsiflexion causing pathologic gait patterns and a greater risk of further foot disorders. Gastrocnemius recession is an established procedure to increase ankle dorsiflexion. However, little evidence is available of the use of gastrocnemius recession in these patients. Complication rates, recurrence of gastrocnemius contracture, and the prevalence of additional foot disorders needs further evaluation. A study group of 64 operated limbs undergoing gastrocnemius recession was evaluated to determine the prevalence of foot disorders, pre- and postoperative ankle dorsiflexion, and incidence of complications. A subgroup of 15 (23.4%) patients without additional operative procedures was examined regarding ankle dorsiflexion, strength (Janda method), sensitivity in the operated limb, and the pre- and postoperative Foot Function Index scores. The prevalence of foot disorders showed pes planus (41%), hallux valgus (38%), metatarsalgia (19%), hammertoe deformity (13%), and symptomatic Haglund exostosis (11%). At 31 months of follow-up, the patients had significantly benefited from increased ankle dorsiflexion of 13.3° ± 7.9° (p < .001). Postoperatively, 16% patients experienced complications. In the subgroup of 15 patients, the follow-up examination after 44 months showed ankle dorsiflexion of 14° ± 7.1°. The plantarflexion strength was 4 of 5 (Janda method). The Foot Function Index score had improved significantly from 65.4 ± 26.5 points to 33.4 ± 19.5 points (p < .001). Patients with isolated gastrocnemius contracture seem to have a high prevalence of symptomatic foot disorders. At a mid-term follow-up examination, gastrocnemius recession (Strayer) was shown to be an effective procedure to significantly improve ankle dorsiflexion, functionality, and pain symptoms. More attention should be given to the development of postoperative complications.     

Changes in grip strength in a randomized study of carpal tunnel release by three different techniques

Carpal tunnel release is frequently followed by weak grasp but recently, endoscopy has been claimed to avoid this pitfall. 277 patients representing 303 CT were enrolled in a prospective randomized study to assess changes in grasp after classical open CTR (Group I - 77 cases), ligamentoplasty (Group II - 133 cases) and an Agee endoscopic CTR (Group III - 99 cases). Grasp was measured pre-operatively and post-operatively every month for six months to analyse strength recovery according to technique, dominance, sex, motor conduction velocity, job, and leisure activity.There were no complications in the series except one RSD and six open conversions in the Agee group due to technical problems.Pre-operative CT was accompanied by an average loss of strength of 18%. In the postoperative period, the contralateral side had an increase in strength from 2% to 12.5%. These data plus the frequent bilaterality of CT explained the bias of any post-operative study without pre-operative measurement.Strength recovered faster and better in Group II and III. At three months, the percentage of patients having recovered was 38% in Group I, 54% in Group II, 58% in Group III. An explanation of similarity in the last two groups could be found in the modification of Agee procedure preserving an intermediate fascia, avoiding full separation of the two edges of the ligament, as in the ligamentoplasty.     

The Effect of Gastrocnemius Recession and Tendo-Achilles Lengthening on Adult Acquired Flatfoot Deformity Surgery: A Systematic Review

The purpose of this study was to evaluate the available clinical and radiographic evidence for incorporation of a gastrocnemius recession or tendo-Achilles lengthening into the surgical correction of adult acquired flatfoot deformity. A systematic review of the literature was performed using PubMed, Embase, Cochrane, CINAHL, and Google Scholar. Among the relevant articles, the level of evidence and quality was identified using the Methodological Index for Non-Randomized Studies tool. No study explicitly examined whether clinical or radiographic outcomes after adult acquired flatfoot deformity correction are improved when incorporating a gastrocnemius recession or tendo-Achilles lengthening compared with when no such procedure is performed, nor have they directly compared outcomes between 2 procedures. Studies demonstrated an overall improvement in postoperative range of motion and plantar flexion power after gastrocnemius recession, but such findings are hard to separate from the clinical contribution of concomitant corrective procedures to the foot itself. All studies that analyzed anteroposterior talo-calcaneal angle, anteroposterior lateral talo-first metatarsal angle and calcaneal inclination angle revealed improvement of each parameter postoperatively. There were no high-level evidence studies in the literature explicitly quantifying ankle range of motion, plantar flexion power, or radiographic impact of gastrocnemius recession or tendo-Achilles lengthening on adult acquired flatfoot deformity correction. Although gastrocnemius-soleus complex contractures have certainly been demonstrated to coexist with adult acquired flatfoot deformity, support for lengthening procedures is largely based on expert opinion or case series and is difficult to distinguish from the clinical contribution of associated corrective procedures.     

Gastrocnemius Recession as an Alternative to TendoAchillis Lengthening for Relief of Forefoot Pressure in a Patient with Peripheral Neuropathy: A Case Report and Description of a Technical Modification

The gastrocnemius recession is a popular surgical procedure for the treatment of equinus contracture. Lengthening the gastrocnemius tendon has been show to be an effective means of reducing pressure to the plantar forefoot by weakening the triceps surae complex. The more traditional method of weakening the triceps surae is a modification of Hoke's triple hemisection through the tendoAchillis. This technique unfortunately carries a serious risk of the development of a calcaneal gait. The purpose of this case report is to demonstrate that the gastrocnemius recession is an effective and safe alternative to the traditional tendoAchillis lengthening. The authors also describe a minimally invasive technique that uses a pediatric speculum for a self-retrained retractor and portal for instrumentation and visualization.     

踝关节骨折术后腓肠肌挛缩型马蹄足的手术治疗

背景：足踝部创伤可导致患者较长时间的踝部制动及术后软组织粘连,易造成腓肠肌挛缩,从而诱发创伤后马蹄足。若不及时进行合理有效的治疗,容易引发跖腱膜炎、外翻、获得性平足症、前跖痛等并发症。目的：探讨腓肠肌腱膜切断松解术治疗踝关节骨折术后腓肠肌挛缩型马蹄足的效果。方法：2011年1月至2013年1月,通过腓肠肌腱膜切断松解术治疗踝关节骨折术后腓肠肌挛缩患者26例,男17例,女9例,年龄24~55岁,平均44.3岁。术前对所有患者伸膝及屈膝90°时的踝关节背屈角度进行测量,确诊为踝关节骨折术后腓肠肌挛缩。采用改良的Strayer手术对腓肠肌松解。采用美国足踝外科协会（AOFAS）踝-后足评分评估患足功能。术后再次对伸膝及屈膝90°时的踝关节背屈角度进行测量并与术前比较。结果：21例患者获得随访,随访时间12~24个月,平均17个月。所有切口均一期愈合,无感染,无腓肠神经损伤,无明显疼痛不适。伸膝状态下踝关节背屈角度由术前的0.9°±3.4°恢复到术后的13.6°±2.4°（P＜0.01）。术后AOFAS踝-后足评分为（80.9±5.7）分,与术前（57.6±6.4）分,比较差异亦有统计学意义（P＜0.01）。结论：对于踝关节骨折后并发的腓肠肌型马蹄足,腓肠肌腱松解术操作简单,创伤小,可获得满意疗效。     

Endoscopic release in carpal tunnel syndrome: analysis of clinical results in 200 cases.

Carpal tunnel syndrome is the most common peripheral neuropathy. Conventional carpal tunnel surgery has been performed as a primary procedure for the decompression of the median nerve at the wrist in patients who have idiopathic carpal tunnel syndrome. While the results have been excellent, this surgical procedure has been reported to be related to high postoperative morbidity and extended length of recovery time. Over the past decade, endoscopic release of the transverse carpal ligament has been developed as a new, alternative method to the open procedures. Endoscopic carpal tunnel release has been reported to ensure less postoperative morbidity, more rapid recovery of strength, with earlier return to work, reduced disability time and a better cosmetic result. The authors present a surgical series of 200 hands in 164 patients (36 bilaterals) with idiopathic carpal tunnel syndrome, who underwent a single-portal endoscopic carpal tunnel release (Agee technique), with regards to the clinical outcome and complications occurred after 4-months follow-up.     

Uniportal Endoscopic Gastrocnemius Recession for Treatment of Gastrocnemius Equinus with a Dedicated EGR System with Retractable Blade

This study examined the effectiveness and safety of a uniportal endoscopic gastrocnemius recession with a specifically designed uniportal endoscopic system. Fifty-three patients underwent 60 endoscopic gastrocnemius recessions. Their mean range of ankle dorsiflexion changed from a preoperative value of –2.9° ± 1.9° to a postoperative value of 12.8° ± 1.7°, for a total increase of 15.7° ± 1.8° of ankle dorsiflexion (p < .001). The average time from skin incision to closure was 4 minutes and 19 ± 33.6 seconds. Overall, 4 (6.67%) cases (procedures) were associated with a complication, including 1 (1.67%) case of triceps surae weakness that resolved after physical therapy. Three (5%) cases developed nerve complications, with 2 (3.33%) cases of transient neuritis that spontaneously resolved at 5 and 8 weeks postoperatively, respectively, and 1 (1.67%) that experienced persistent cutaneous anesthesia in the distribution of the sural nerve along the lateral aspect of the foot up to 4 months postoperatively. There were no cases of wound dehiscence or delayed healing, painful scar formation, infection at the surgical site, hematoma, or deep venous thrombosis. Endoscopic gastrocnemius recession with a uniportal system appears to be safe and effective.     

A Randomized Controlled Study of Contrast Baths on Patients with Carpal Tunnel Syndrome

Study DesignRandomized clinical trial. Introduction: Contrast baths are a treatment modality commonly used in hand clinics. Yet the benefits of contrast baths have been poorly substantiated. Contrast baths have been suggested for the purposes of reducing hand volume, alleviating pain, and decreasing stiffness in affected extremities.Purpose of the StudyTo determine the effects of specific contrast bath protocols on hand volume in patients diagnosed with Carpal Tunnel Syndrome.MethodsStudy participants were randomly assigned to one of three treatment group protocols—contrast baths with exercise, contrast baths without exercise, and an exercise-only control treatment group. Study participants were evaluated with hand volumetry, before and after treatment at two different data collection periods—pre- and postoperatively.ResultsData were gathered on 58 participants before Carpal Tunnel Release surgery and on 56 participants after Carpal Tunnel Release surgery, for a total of 114 treatments. The changes in hand volume (the after treatment volume minus the before treatment volume) were analyzed using one-way and multi-way analysis of variance (ANOVA). Although all three treatments resulted in a slight increase in hand volume both pre- and postsurgery, the increase was not clinically significant with regard to hand volumes. Also no significant differences were noted among the three treatments. Specifically, the ANOVA for presurgery differences among treatments had F = 0.155 (2 and 55 df), p = 0.857. The ANOVA for postsurgery difference among treatments had F = 0.544 (2 and 53 df), p = 0.584.ConclusionsThe use of contrast bath treatment has no significant effect on increase or decrease of hand volume in Carpal Tunnel Syndrome patients, pre- and/or postoperatively.Level of evidence1B.