[Carpal tunnel syndrome: clinical experience of 61 cases]

Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy. Appropriate diagnosis and therapy contribute to obtaining good results. We performed carpal tunnel release in 61 patients including 8 cases with chronic renal failure. They included 18 males and 43 females. Age distribution was from 28 to 76 years of age among the males, and from 29 to 82 years of age among the female patients. Bilateral operations were performed in 13 cases (male 5, female 8). Operations were carried out with local anesthesia in all cases except one. The skin incision was about 5 cm on the palmar skin. Hypertrophy of the transverse carpal ligament was found in all cases, with a thickness of 4 mm on the average. Usually, the ligament was as hard as gum in consistency. There were also hypertrophy of the subcutaneous connective tissue and palmar aponeurosis or aberrant muscle in some cases. In CTS following long-term hemodialysis for chronic renal failure, the ligament was very hard and appeared to be partly calcified. All patients improved clinically after the operation. We should understand the characteristic clinical symptoms and signs of CTS. Clinical worsening was prominent at night and/or early in the morning. Definite diagnosis was performed by electrophysiological means. Operative indications are 1) cases whose daily activities are disturbed due to severe symptoms with progressive aggravation, 2) cases with muscle weakness in the distribution of the median nerve, 3) cases with thenar atrophy, 4) cases which, electrophysiologically, are suspected of demyelination of the median nerve. As there were many unpredictable anomalies and variations among the lesions, correct decompression of the median nerve under direct vision is necessary during surgery.