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Noel Eboh and Donald H. Wilson

T he carpal tunnel syndrome is an entrapment neuropathy of the median nerve within the hand, beneath the flexor retinaculum. Like the similar condition of the ulnar nerve at the elbow, 4 it is probably caused by mild hypertrophy of the retinaculum and overgrowth of epineurium within a congenitally narrow tunnel. Occasionally, a synovitis will compromise the tunnel and press on the nerve, but this occurred in only 4% of Phalen's large series of 212 hands; 2 and he strongly advised against routine synovectomy. The syndrome is characterized by painful

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Gayle Randall, Philip W. Smith, Bernard Korbitz and Donald R. Owen

T he carpal tunnel syndrome (CTS) can be caused by any space-occupying lesion in the carpal tunnel. 5 Systemic diseases, trauma, tumors, endocrine disorders, and infectious diseases have all been reported to manifest as CTS. 5, 7, 9, 11, 12 Infectious causes include mycobacteria, Histoplasma capsulatum, Coccidioides immitis , pyogenic infections, Sporothrix schenkii , and rubella. The purpose of this report is to record two unusual cases of CTS caused by Histoplasma capsulatum and Mycobacterium fortuitum , respectively. Case Reports Case 1

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David F. Jimenez, Scott R. Gibbs and Adam T. Clapper

F ollowing the introduction of endoscopic techniques for treatment of carpal tunnel syndrome (CTS) in the late 1980s, significant controversy ensued regarding the efficacy, safety, and success of these procedures. Numerous reports have been published, mostly in the orthopedic and plastic surgery literature, describing modifications to the original procedure as well as results and complications. To date, no such publication has appeared in the neurosurgical literature. The goal of this paper is to present neurosurgeons with a comprehensive and critical review

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Carpal tunnel syndrome

Decompression using the Paine retinaculotome

Kenneth W. E. Paine and Konstantinos S. Polyzoidis

P rior to the late 1940's, median nerve compression in the carpal tunnel was diagnosed only when weakness, wasting, and numbness in the median nerve distribution occurred. There were very few patients who had their flexor retinaculum divided in an attempt to reverse these symptoms and signs. 1 In 1951, McArdle, in a presentation to the Association of British Neurologists, first related acroparesthesias to median nerve compression in the carpal tunnel and recommended division of the flexor retinaculum for relief. 3 At about this time, electromyography, nerve

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Allan H. Friedman

The author describes and details the anatomy of the carpal tunnel and surrounding structures pertinent to the surgical treatment of carpal tunnel syndrome. Potential complications of both open and endoscopic carpal tunnel release are discussed as well as techniques to avoid or minimize poor patient outcomes.

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Dean S. Louis, Thomas L. Greene and Raymond C. Noellert

T he carpal tunnel syndrome (CTS) is a clinical problem of frequent occurrence. It was first postulated as a clinical problem by Marie and Foix in 1913. 11 They observed the postmortem enlargement of the median nerve proximal to the transverse carpal ligament in a patient who had bilateral thenar atrophy. Learmonth 8 is credited with the first surgical decompression of the carpal tunnel in 1933. He believed that the increased content of the carpal tunnel caused by proliferative tenosynovitis was responsible for the compression of the median nerve. Now, more

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David F. Jimenez, Scott R. Gibbs and Adam T. Clapper

An extensive review of published articles on the subject of endoscopic carpal tunnel release surgery is presented, encompassing six endoscopic techniques used to treat carpal tunnel syndrome. Since the first report in 1987, 7091 patients have undergone 8068 operations. The overall success rate has been 96.52%, with a complication rate of 2.67% and a failure rate of 2.61%. The mean time to return to work in patients not receiving Workers' Compensation was 17.8 days, ranging between 10.8 and 22.3 days. The most common complications were transient paresthesias of the ulnar and median nerves. Other complications included superficial palmar arch injuries, reflex sympathetic dystrophy, flexor tendon lacerations, and incomplete transverse carpal ligament division. All studies in which open and endoscopic techniques were compared reported that patients in the latter group experienced significantly less pain and returned to work and activities of daily living earlier. The reported success and complication rates of endoscopic carpal tunnel release surgery are similar to those for standard open procedures. Endoscopic techniques and outcomes are discussed.

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Michael E. Miner and R. Neil Schimke

associated with normal or near normal intelligence and have a better prognosis. Unfortunately, while some of these patients survive longer, they are still prone to many of the irreversible complications of these diseases, for instance, patients must learn to adapt to the claw hand deformity. Loss of thumb function in a hand with already restricted mobility can have significant consequences. We are reporting the presence of the carpal tunnel syndrome with median nerve compression in four children with mild mucopolysaccharidoses. Case Reports Cases 1 and 2 These

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Russell Payne, Zeinab Nasralah, Emily Sieg, Elias B. Rizk, Michael Glantz and Kimberly Harbaugh

A thorough understanding of the anatomy of the distal forearm, wrist, and hand is critical to maximize success and minimize complications during carpal tunnel release. This is particularly important in light of the currently used endoscopic and open techniques that emphasize a minimally invasive approach. 3 , 11 , 25 , 33 While there are many reports on anatomical variations around the carpal tunnel, 12 , 23 , 26 , 41 there is little mention of the median nerve (MN) in the distal forearm as it approaches the wrist. Most figures depict the MN as taking a

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Angelo Franzini, Giovanni Broggi, Domenico Servello, Ivano Dones and Maria Grazia Pluchino

I n the last decade, minimally invasive surgery for carpal tunnel syndrome has gained increasing popularity among neurosurgeons and orthopedic surgeons. 1, 3, 5, 12–15, 17 The aim of the various procedures is the early use of the operated hand and the decrease of side effects caused by palmar incision and scar. 9 Nevertheless, some problems and controversies still surround the available minimally invasive procedures. 3, 6 Incomplete section of the ligament may occur distally when blind procedures are performed. Endoscopic procedures may cause a certain rate