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Median Nerve Entrapment Workup

  • Author: Bardia Amirlak, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Feb 24, 2016
 

Laboratory Studies

Some evidence suggests that there is a higher prevalence of concurrent conditions, such as diabetes mellitus and rheumatoid arthritis, in patients with carpal tunnel syndrome (CTS). At present, however, there is not enough evidence to warrant routine laboratory screening for such conditions in all patients with newly diagnosed CTS.[70]

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Imaging Studies

Both ultrasonography and magnetic resonance imaging (MRI) may be useful in the evaluation of patients with upper-extremity neuropathies.[71, 72] Atrophy can be appreciated in the involved muscles. Signal changes can also point to the affected muscles. Ultrasonography can similarly identify the affected muscles by looking at the muscle mass, perfusion on Doppler ultrasonography, and active contraction of affected muscles.[73, 74]  For diagnosis of CTS, peripheral nerve ultrasonography may be particularly useful in combination with electrodiagnostic studies (see Diagnostic Procedures).[75, 76]

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Diagnostic Procedures

Electrodiagnostic examination

Major limitations are associated with electrodiagnostic examination. False-positive and false-negative results are common. Patients with a positive clinical diagnosis of CTS and negative findings on electrodiagnostic studies improve with carpal tunnel release.[77]

Although electrodiagnostic studies provide quantifiable values, they are particularly dependent on the proficiency of the examiner.[78] These studies should only complement the clinical evaluation by helping to localize the level and severity of the injury and to monitor the progression of the disease when it is being managed conservatively. Electrodiagnostic studies are not generally helpful in confirming a diagnosis of more proximal lesions.

Needle electromyography

Needle electrodes are placed into muscle to record fibrillation potentials; sharp waves and increased insertional activity indicate advanced nerve compression. However, electromyography (EMG) cannot differentiate a median nerve lesion at the pronator teres from a more proximal lesion.[79] In addition, proximal median neuropathy is frequently normal preoperatively.[63]

Measurement of nerve conduction velocity

The velocity of motor and sensory nerve conduction is measured across definite landmarks. Latency greater than 3.5 ms or asymmetry of conduction velocity greater than 0.5 ms as compared with that of the opposite hand indicates possible entrapment neuropathy. Each segment of the upper extremity can be isolated for specific measurement.

Generally, an increase in sensory latency is observed first, and upon progression of the disease, an increase in the latency of motor fibers is seen. These studies assess only the large myelinated fibers, not the small ones that mediate pain. Nerve conduction studies may be less dependable when there is multiple levels of damage or when a systemic polyneuropathy is present.

Sensibility testing

Sensibility tests can be used to identify compressive neuropathies associated with sensory loss. These include two-point discrimination, Semmes-Weinstein monofilament (SWM) testing, and Strauch's ten test. The SWM test is more reliable, but it is time-consuming.[80]

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Contributor Information and Disclosures
Author

Bardia Amirlak, MD Assistant Professor of Plastic Surgery, Director of Residency Cosmetic Clinic, Director of Plastic Surgery Global Health Program, University of Texas Southwestern Medical Center at Dallas; Chief of Hand and Peripheral Nerve Surgery, Dallas Veterans Affairs Medical Center

Bardia Amirlak, MD is a member of the following medical societies: American College of Surgeons, American Society of Plastic Surgeons, American Society of Reconstructive Transplantation, Kleinert Society

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas W Wolff, MD Associate Clinical Professor of Hand Surgery, University of Louisville School of Medicine; Director, Christine M Kleinert Institute for Hand and Microsurgery

Thomas W Wolff, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Society for Surgery of the Hand, American Society for Reconstructive Microsurgery, Indiana State Medical Association, Kentucky Medical Association, American Association of Clinical Anatomists

Disclosure: Nothing to disclose.

Omar Ahmed, MD Senior Fellow in Hand and Microvascular Surgery, Department of Surgery, Kleinert Institute

Omar Ahmed, MD is a member of the following medical societies: American Association for Hand Surgery, American Medical Association, American Society for Surgery of the Hand, American Society for Reconstructive Microsurgery

Disclosure: Nothing to disclose.

K Prashant Upadhyaya, MBBS, MS Resident, Department of General Surgery, Creighton University Medical Center

Disclosure: Nothing to disclose.

Tsu-Min Tsai, MD Clinical Professor of Surgery, University of Louisville School of Medicine; Consulting Surgeon, Kleinert, Kutz and Associates Hand Care Center, PLLC

Tsu-Min Tsai, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, American Society for Reconstructive Microsurgery, Arthroscopy Association of North America, Kentucky Medical Association

Disclosure: Nothing to disclose.

Luis R Scheker, MD Assistant Clinical Professor, Division of Plastic and Reconstructive Surgery, University of Louisville School of Medicine; Assistant Consulting Professor, Department of Surgery, Duke University Medical Center; Consulting Staff, Kleinert, Kutz and Associates Hand Care Center, PLLC

Luis R Scheker, MD is a member of the following medical societies: American Medical Association, Kentucky Medical Association

Disclosure: Nothing to disclose.

Georges N Tabbal, MD Resident Physician, Department of Plastic and Reconstructive Surgery, University of Texas, Southwestern Medical Center at Dallas, Southwestern Medical School

Georges N Tabbal, MD is a member of the following medical societies: Texas Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, Missouri State Medical Association

Disclosure: Nothing to disclose.

References
  1. Tanzer RC. The carpal-tunnel syndrome; a clinical and anatomical study. J Bone Joint Surg Am. 1959 Jun. 41-A(4):626-34. [Medline].

  2. Phalen GS. The carpal-tunnel syndrome. Seventeen years' experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am. 1966 Mar. 48(2):211-28. [Medline].

  3. Danielsson LG. Iatrogenic pronator syndrome: case report. Scand J Plast Reconstr Surg. 1980. 14(2):201-3. [Medline].

  4. Hartz CR, Linscheid RL, Gramse RR, Daube JR. The pronator teres syndrome: compressive neuropathy of the median nerve. J Bone Joint Surg Am. 1981 Jul. 63(6):885-90. [Medline].

  5. Rask MR. Anterior interosseous nerve entrapment: (Kiloh-Nevin syndrome) report of seven cases. Clin Orthop Relat Res. 1979 Jul-Aug. 176-81. [Medline].

  6. Wertsch JJ, Melvin J. Median nerve anatomy and entrapment syndromes: a review. Arch Phys Med Rehabil. 1982 Dec. 63(12):623-7. [Medline].

  7. Patiala H, Rokkanen P, Kruuna O, et al. Carpal tunnel syndrome. Anatomical and clinical investigation. Arch Orthop Trauma Surg. 1985. 104(2):69-73. [Medline].

  8. Bilecenoglu B, Uz A, Karalezli N. Possible anatomic structures causing entrapment neuropathies of the median nerve: an anatomic study. Acta Orthop Belg. 2005 Apr. 71(2):169-76. [Medline].

  9. Varlam H, St Antohe D, Chistol RO. [Supracondylar process and supratrochlearforamen of the humerus: a case report and a review of the literature]. Morphologie. 2005 Sep. 89(286):121-5. [Medline].

  10. Siqueira MG, Martins RS. The controversial arcade of Struthers. Surg Neurol. 2005. 64 Suppl 1:S1:17-20; discussion S1:20-1. [Medline].

  11. Suranyi L. Median nerve compression by Struthers ligament. J Neurol Neurosurg Psychiatry. 1983 Nov. 46(11):1047-9. [Medline].

  12. Gessini L, Jandolo B, Pietrangeli A. Entrapment neuropathies of the median nerve at and above the elbow. Surg Neurol. 1983 Feb. 19(2):112-6. [Medline].

  13. Swiggett R, Ruby LK. Median nerve compression neuropathy by the lacertus fibrosus: report of three cases. J Hand Surg [Am]. 1986 Sep. 11(5):700-3. [Medline].

  14. Johnson RK, Spinner M, Shrewsbury MM. Median nerve entrapment syndrome in the proximal forearm. J Hand Surg [Am]. 1979 Jan. 4(1):48-51. [Medline].

  15. Nebot-Cegarra J, Perez-Berruezo J, Reina de la Torre F. Variations of the pronator teres muscle: predispositional role to median nerve entrapment. Arch Anat Histol Embryol. 1991-1992. 74:35-45. [Medline].

  16. Dellon AL, Mackinnon SE. Musculoaponeurotic variations along the course of the median nerve in the proximal forearm. J Hand Surg [Br]. 1987 Oct. 12(3):359-63. [Medline].

  17. Fuss FK, Wurzl GH. Median nerve entrapment. Pronator teres syndrome. Surgical anatomy and correlation with symptom patterns. Surg Radiol Anat. 1990. 12(4):267-71. [Medline].

  18. Degreef I, De Smet L. Anterior interosseous nerve paralysis due to Gantzer's muscle. Acta Orthop Belg. 2004 Oct. 70(5):482-4. [Medline].

  19. al-Qattan MM. Gantzer's muscle. An anatomical study of the accessory head of the flexor pollicis longus muscle. J Hand Surg [Br]. 1996 Apr. 21(2):269-70. [Medline].

  20. Gelberman RH, Hergenroeder PT, Hargens AR, et al. The carpal tunnel syndrome. A study of carpal canal pressures. J Bone Joint Surg Am. 1981 Mar. 63(3):380-3. [Medline].

  21. Dellon AL, Mackinnon SE, Seiler WA 4th. Susceptibility of the diabetic nerve to chronic compression. Ann Plast Surg. 1988 Feb. 20(2):117-9. [Medline].

  22. Thomas PK, Fullerton PM. Nerve fiber size in the carpal tunnel syndrome. J Neurol Neurosurg Psychiatry. 1963 Dec. 26:520-7. [Medline].

  23. Lundborg G, Dahlin LB. Anatomy, function, and pathophysiology of peripheral nerves and nerve compression. Hand Clin. 1996 May. 12(2):185-93. [Medline].

  24. Dahlin LB. Aspects on pathophysiology of nerve entrapments and nerve compression injuries. Neurosurg Clin N Am. 1991 Jan. 2(1):21-9. [Medline].

  25. Mackinnon SE. Pathophysiology of nerve compression. Hand Clin. 2002 May. 18(2):231-41. [Medline].

  26. Jinrok O, Zhao C, Amadio PC, et al. Vascular pathologic changes in the flexor tenosynovium (subsynovial connective tissue) in idiopathic carpal tunnel syndrome. J Orthop Res. 2004 Nov. 22(6):1310-5. [Medline].

  27. Lundborg G. Intraneural microcirculation. Orthop Clin North Am. 1988 Jan. 19(1):1-12. [Medline].

  28. LaBan MM, MacKenzie JR, Zemenick GA. Anatomic observations in carpal tunnel syndrome as they relate to the tethered median nerve stress test. Arch Phys Med Rehabil. 1989 Jan. 70(1):44-6. [Medline].

  29. Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973 Aug 18. 2(7825):359-62. [Medline].

  30. Lundborg G. Nerve Injury and Repair. New York, NY: Churchill Livingstone; 1988.

  31. Dellon AL, Mackinnon SE. Chronic nerve compression model for the double crush hypothesis. Ann Plast Surg. 1991 Mar. 26(3):259-64. [Medline].

  32. Nemoto K, Matsumoto N, Tazaki K, et al. An experimental study on the "double crush" hypothesis. J Hand Surg [Am]. 1987 Jul. 12(4):552-9. [Medline].

  33. Hirata H, Nagakura T, Tsujii M, et al. The relationship of VEGF and PGE2 expression to extracellular matrix remodelling of the tenosynovium in the carpal tunnel syndrome. J Pathol. 2004 Dec. 204(5):605-12. [Medline].

  34. Hirata H, Tsujii M, Yoshida T, et al. MMP-2 expression is associated with rapidly proliferative arteriosclerosis in the flexor tenosynovium and pain severity in carpal tunnel syndrome. J Pathol. 2005 Mar. 205(4):443-50. [Medline].

  35. Ettema AM, Amadio PC, Zhao C, et al. A histological and immunohistochemical study of the subsynovial connective tissue in idiopathic carpal tunnel syndrome. J Bone Joint Surg Am. 2004 Jul. 86-A(7):1458-66. [Medline].

  36. Mattioli S, Baldasseroni A, Bovenzi M, Curti S, Cooke RM, Campo G, et al. Risk factors for operated carpal tunnel syndrome: a multicenter population-based case-control study. BMC Public Health. 2009 Sep 16. 9(1):343. [Medline]. [Full Text].

  37. de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol. 1992 Apr. 45(4):373-6. [Medline].

  38. Stevens JC, Beard CM, O'Fallon WM, Kurland LT. Conditions associated with carpal tunnel syndrome. Mayo Clin Proc. 1992 Jun. 67(6):541-8. [Medline].

  39. Karpitskaya Y, Novak CB, Mackinnon SE. Prevalence of smoking, obesity, diabetes mellitus, and thyroid disease in patients with carpal tunnel syndrome. Ann Plast Surg. 2002 Mar. 48(3):269-73. [Medline].

  40. Geoghegan JM, Clark DI, Bainbridge LC, et al. Risk factors in carpal tunnel syndrome. J Hand Surg [Br]. 2004 Aug. 29(4):315-20. [Medline].

  41. Roquer J, Cano JF. Carpal tunnel syndrome and hyperthyroidism. A prospective study. Acta Neurol Scand. 1993 Aug. 88(2):149-52. [Medline].

  42. Papanicolaou GD, McCabe SJ, Firrell J. The prevalence and characteristics of nerve compression symptoms in the general population. J Hand Surg [Am]. 2001 May. 26(3):460-6. [Medline].

  43. Werner RA, Franzblau A, Gell N, et al. Incidence of carpal tunnel syndrome among automobile assembly workers and assessment of risk factors. J Occup Environ Med. 2005 Oct. 47(10):1044-50. [Medline].

  44. Kim JY, Kim JI, Son JE, Yun SK. Prevalence of carpal tunnel syndrome in meat and fish processing plants. J Occup Health. 2004 May. 46(3):230-4. [Medline].

  45. Ablove RH, Ablove TS. Prevalence of carpal tunnel syndrome in pregnant women. WMJ. 2009 Jul. 108(4):194-6. [Medline].

  46. Perkins BA, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care. 2002 Mar. 25(3):565-9. [Medline].

  47. Finsen V, Zeitlmann H. Carpal tunnel syndrome during pregnancy. Scand J Plast Reconstr Surg Hand Surg. 2006. 40(1):41-5. [Medline].

  48. Nigst H, Dick W. Syndromes of compression of the median nerve in the proximal forearm (pronator teres syndrome; anterior interosseous nerve syndrome). Arch Orthop Trauma Surg. 1979 Apr 30. 93(4):307-12. [Medline].

  49. Stal M, Hagert CG, Moritz U. Upper extremity nerve involvement in Swedish female machine milkers. Am J Ind Med. 1998 Jun. 33(6):551-9. [Medline].

  50. Cseuz KA, Thomas JE, Lambert EH, et al. Long-term results of operation for carpal tunnel syndrome. Mayo Clin Proc. 1966 Apr. 41(4):232-41. [Medline].

  51. Green DP. Diagnostic and therapeutic value of carpal tunnel injection. J Hand Surg [Am]. 1984 Nov. 9(6):850-4. [Medline].

  52. Kulick MI, Gordillo G, Javidi T, et al. Long-term analysis of patients having surgical treatment for carpal tunnel syndrome. J Hand Surg [Am]. 1986 Jan. 11(1):59-66. [Medline].

  53. Eversmann WW Jr, Ritsick JA. Intraoperative changes in motor nerve conduction latency in carpal tunnel syndrome. J Hand Surg [Am]. 1978 Jan. 3(1):77-81. [Medline].

  54. Yu GZ, Firrell JC, Tsai TM. Pre-operative factors and treatment outcome following carpal tunnel release. J Hand Surg [Br]. 1992 Dec. 17(6):646-50. [Medline].

  55. Lo SL, Raskin K, Lester H, Lester B. Carpal tunnel syndrome: a historical perspective. Hand Clin. 2002 May. 18(2):211-7, v. [Medline].

  56. Pfeffer GB, Gelberman RH, Boyes JH, Rydevik B. The history of carpal tunnel syndrome. J Hand Surg [Br]. 1988 Feb. 13(1):28-34. [Medline].

  57. Alfonso MI, Dzwierzynski W. Hoffman-Tinel sign. The realities. Phys Med Rehabil Clin N Am. 1998 Nov. 9(4):721-36, v. [Medline].

  58. Hoffmann P, Buck-Gramcko D, Lubahn JD. The Hoffmann-Tinel sign. 1915. J Hand Surg [Br]. 1993 Dec. 18(6):800-5. [Medline].

  59. Clark D. Jules Tinel and Tinel's sign. Clin Plast Surg. 1983 Oct. 10(4):627-8. [Medline].

  60. Montagna P, Liguori R. The motor tinel sign: a useful sign in entrapment neuropathy?. Muscle Nerve. 2000 Jun. 23(6):976-8. [Medline].

  61. Kuschner SH, Ebramzadeh E, Johnson D, et al. Tinel's sign and Phalen's test in carpal tunnel syndrome. Orthopedics. 1992 Nov. 15(11):1297-302. [Medline].

  62. Nora DB, Becker J, Ehlers JA, Gomes I. Clinical features of 1039 patients with neurophysiological diagnosis of carpal tunnel syndrome. Clin Neurol Neurosurg. 2004 Dec. 107(1):64-9. [Medline].

  63. Werner CO, Rosen I, Thorngren KG. Clinical and neurophysiologic characteristics of the pronator syndrome. Clin Orthop Relat Res. 1985 Jul-Aug. 231-6. [Medline].

  64. Gainor BJ. The pronator compression test revisited. A forgotten physical sign. Orthop Rev. 1990 Oct. 19(10):888-92. [Medline].

  65. Olehnik WK, Manske PR, Szerzinski J. Median nerve compression in the proximal forearm. J Hand Surg [Am]. 1994 Jan. 19(1):121-6. [Medline].

  66. Mackinnon SE, Dellon AL. Surgery of the Peripheral Nerve. New York, NY: Thieme Medical; 1988.

  67. Neundorfer B, Kroger M. The anterior interosseous nerve syndrome. J Neurol. 1976 Oct 4. 213(4):347-52. [Medline].

  68. Spinner M. The anterior interosseous-nerve syndrome, with special attention to its variations. J Bone Joint Surg Am. 1970 Jan. 52(1):84-94. [Medline].

  69. Mackinnon SE, Novak CB. Nerve transfers. New options for reconstruction following nerve injury. Hand Clin. 1999 Nov. 15(4):643-66, ix. [Medline].

  70. van Dijk MA, Reitsma JB, Fischer JC, Sanders GT. Indications for requesting laboratory tests for concurrent diseases in patients with carpal tunnel syndrome: a systematic review. Clin Chem. 2003 Sep. 49(9):1437-44. [Medline].

  71. Martinoli C, Bianchi S, Gandolfo N, et al. US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics. 2000 Oct. 20 Spec No:S199-213; discussion S213-7. [Medline].

  72. Mesgarzadeh M, Triolo J, Schneck CD. Carpal tunnel syndrome. MR imaging diagnosis. Magn Reson Imaging Clin N Am. 1995 May. 3(2):249-64. [Medline].

  73. Hide IG, Grainger AJ, Naisby GP, Campbell RS. Sonographic findings in the anterior interosseous nerve syndrome. J Clin Ultrasound. 1999 Oct. 27(8):459-64. [Medline].

  74. Yesildag A, Kutluhan S, Sengul N, et al. The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Clin Radiol. 2004 Oct. 59(10):910-5. [Medline].

  75. Goldberg G, Zeckser JM, Mummaneni R, Tucker JD. Electrosonodiagnosis in Carpal Tunnel Syndrome: A Proposed Diagnostic Algorithm Based on an Analytic Literature Review. PM R. 2016 Jan 19. [Medline].

  76. Kuo TT, Lee MR, Liao YY, Chen JP, Hsu YW, Yeh CK. Assessment of Median Nerve Mobility by Ultrasound Dynamic Imaging for Diagnosing Carpal Tunnel Syndrome. PLoS One. 2016. 11 (1):e0147051. [Medline]. [Full Text].

  77. Wilbourn AJ. The electrodiagnostic examination with peripheral nerve injuries. Clin Plast Surg. 2003 Apr. 30(2):139-54. [Medline].

  78. Dumas P. [Electrophysiological exploration of tunnel syndromes]. Neurochirurgie. 2009 Oct. 55(4-5):437-41. [Medline].

  79. Gross PT, Jones HR Jr. Proximal median neuropathies: electromyographic and clinical correlation. Muscle Nerve. 1992 Mar. 15(3):390-5. [Medline].

  80. Patel MR, Bassini L. A comparison of five tests for determining hand sensibility. J Reconstr Microsurg. 1999 Oct. 15(7):523-6. [Medline].

  81. Shores JT, Lee WP. An evidence-based approach to carpal tunnel syndrome. Plast Reconstr Surg. 2010 Dec. 126(6):2196-204. [Medline].

  82. Vasiliadis HS, Georgoulas P, Shrier I, Salanti G, Scholten RJ. Endoscopic release for carpal tunnel syndrome. Cochrane Database Syst Rev. 2014 Jan 31. 1:CD008265. [Medline].

  83. Weiss ND, Gordon L, Bloom T, et al. Position of the wrist associated with the lowest carpal-tunnel pressure: implications for splint design. J Bone Joint Surg Am. 1995 Nov. 77(11):1695-9. [Medline].

  84. Edgell SE, McCabe SJ, Breidenbach WC, et al. Predicting the outcome of carpal tunnel release. J Hand Surg [Am]. 2003 Mar. 28(2):255-61. [Medline].

  85. Aufiero E, Stitik TP, Foye PM, Chen B. Pyridoxine hydrochloride treatment of carpal tunnel syndrome: a review. Nutr Rev. 2004 Mar. 62(3):96-104. [Medline].

  86. Rozmaryn LM, Dovelle S, Rothman ER, et al. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther. 1998 Jul-Sep. 11(3):171-9. [Medline].

  87. Nathan PA, Wilcox A, Emerick PS, et al. Effects of an aerobic exercise program on median nerve conduction and symptoms associated with carpal tunnel syndrome. J Occup Environ Med. 2001 Oct. 43(10):840-3. [Medline].

  88. Kaplan SJ, Glickel SZ, Eaton RG. Predictive factors in the non-surgical treatment of carpal tunnel syndrome. J Hand Surg [Br]. 1990 Feb. 15(1):106-8. [Medline].

  89. Murphy RX Jr, Jennings JF, Wukich DK. Major neurovascular complications of endoscopic carpal tunnel release. J Hand Surg [Am]. 1994 Jan. 19(1):114-8. [Medline].

  90. Agee JM, McCarroll HR, Tortosa RD, et al. Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg [Am]. 1992 Nov. 17(6):987-95. [Medline].

  91. Tsai TM, Tsuruta T, Syed SA, Kimura H. A new technique for endoscopic carpal tunnel decompression. J Hand Surg [Br]. 1995 Aug. 20(4):465-9. [Medline].

  92. Kretschmer T, Antoniadis G, Borm W, Richter HP. Pitfalls of endoscopic carpal tunnel release [in German]. Chirurg. 2004 Dec. 75(12):1207-9. [Medline].

  93. Atroshi I, Larsson GU, Ornstein E, et al. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ. 2006 Jun 24. 332(7556):1473. [Medline].

  94. Tsai TM, Syed SA. A transverse skin incision approach for decompression of pronator teres syndrome. J Hand Surg [Br]. 1994 Feb. 19(1):40-2. [Medline].

  95. Cook AC, Szabo RM, Birkholz SW, King EF. Early mobilization following carpal tunnel release. A prospective randomized study. J Hand Surg [Br]. 1995 Apr. 20(2):228-30. [Medline].

  96. Campagna R, Pessis E, Feydy A, Guerini H, Le Viet D, Corlobé P, et al. MRI assessment of recurrent carpal tunnel syndrome after open surgical release of the median nerve. AJR Am J Roentgenol. 2009 Sep. 193(3):644-50. [Medline].

  97. MacDonald RI, Lichtman DM, Hanlon JJ, Wilson JN. Complications of surgical release for carpal tunnel syndrome. J Hand Surg [Am]. 1978 Jan. 3(1):70-6. [Medline].

  98. Hanssen AD, Amadio PC, DeSilva SP, Ilstrup DM. Deep postoperative wound infection after carpal tunnel release. J Hand Surg [Am]. 1989 Sep. 14(5):869-73. [Medline].

 
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Anatomy of median nerve along its course in upper extremity.
Ligament of Struthers.
Lacertus fibrosus (bicipital aponeurosis).
Pronator teres.
Fibrous arch of flexor digitorum superficialis.
Gantzer's muscle.
Traditional open carpal tunnel incision.
Lighted retractor allows direct visualization of transverse carpal ligament, which can be divided under direct vision with knife or scissors.
Blade (swivel knife) and blade guide (grooved Mickey Mouse director) are used to divide transverse carpal ligament when minimally invasive incision is made.
Two red lines show correct locations of incisions for endoscopic carpal tunnel surgery. FCR=flexor carpi radialis tendon; H=hook of hamate; P=pisiform; PL=palmaris longus tendon.
Cannula is inserted inside carpal space, with groove of instrument facing up.
Endoscope is inserted in cannula attached to endoscopic knife. Knife is pushed forward along cannula's groove, and carpal ligament is divided under direct vision.
Type of endoscopic knife used in carpal tunnel surgery.
Instruments used in endoscopic carpal tunnel surgery. From left to right: endoscopic camera, endoscopic knife, cannula, scraper, custom-made plastic tube, and elevator.
Incision for pronator teres syndrome (PTS) and anterior interosseous nerve syndrome (AINS) exposure.
Alternative incision for pronator teres syndrome (PTS) and anterior interosseous nerve syndrome (AINS) is marked by horizontal thickened lines. Relative locations of underlying pertinent structures are marked on skin. Bicep=biceps tendon; BR=ulnar border of brachioradialis; LABN=lateral antebrachial cutaneous nerve; MABN=medial antebrachial cutaneous nerve; PT=radial border of pronator teres.
 
 
 
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