title: Results of endoscopic management of primary versus recurrent carpal tunnel syndrome in long-term haemodialysis patients.
abstract: In long-term haemodialysis patients, carpal tunnel syndrome (CTS) frequently occurs as a result of amyloid deposition, originating from beta-2 microglobulin, to the flexor retinaculum, paratenons and tendons themselves, which leads to an increase in carpal canal pressure and compression of the median nerve. Surgical procedures can rectify the condition, but continuing maintenance haemodialysis sometimes causes recurrence. We endoscopically operated 1848 hands primarily, 104 recurrent post-endoscopic procedure hands and 130 recurrent post-open procedure hands using the Universal Subcutaneous Endoscope (USE) system, then analysed clinical symptoms and electrophysiological recovery for more than six months post-operatively. The patients were satisfied with the clinical results. Optimal electrophysiological improvements were reported. There were no statistical differences between three groups, except in recovery of touch sensation, which was better in the post-endoscopic group than in the post-open group. There were no complications in this series. Our minimally invasive endoscopic procedure, using the USE system, is safe and effective for primary and recurrent CTS in haemodialysis patients.
authors.affiliation: Department of Orthopaedic Surgery, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo 150-8935, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Yoshida
authors.forename: Ichiro
authors.initials: I
authors.lastname: Okutsu
authors.forename: Ikki
authors.initials: I
authors.lastname: Hamanaka
authors.forename: Tomohide
authors.initials: T
authors.lastname: Motomura
mesh_terms: D002349:Carpal Tunnel Syndrome / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D004594:Electrophysiology; D004724:Endoscopy; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects*; D012677:Sensation / Q000502:physiology; D016896:Treatment Outcome