Electrophysiological and Clinical Assessment of Response to Surgery in Carpal Tunnel

The Influence of the Tissue Adhesive Material as a Surgical Wound-Closure Technique Following Carpal Tunnel Decompression on Neurological and Functional Outcomes: A Single-Center Randomized Controlled Trial

Background Carpal tunnel syndrome (CTS) is caused by compression of the median nerve in the carpal tunnel. The effect of tissue adhesives as a material for wound closure following CTS decompression has been insufficiently investigated. This study aimed to evaluate outcomes by comparing two modalities of wound closure following carpal surgery in patients randomly assigned to either tissue adhesives or sutures. Methodology This randomized, prospective study was conducted in April 2022 at the University Hospital of Split in Croatia. Patients aged 61.56 ± 12.03 years were randomized to either tissue adhesive Glubran Tiss 2®-based (n = 50) or suture-based (n = 50) wound-closure techniques. The following outcomes were assessed before surgery and six months postoperatively: hand strength, electroneurographic characteristics of the median nerve, and the Boston Carpal Tunnel Questionnaire. Results Significant differences between glue-based and suture-based wound-closure techniques were found in the six-month postoperative hand grip strength (25.06 ± 6.69 vs. 21.41 ± 5.62 kg; p = 0.002), postoperative sensory amplitude (10.08 ± 5.50 vs. 7.54 ± 5.41 mV; p = 0.012), and postoperative sensory velocity (42.22 ± 11.04 vs. 35.23 ± 16.40 m/s; p = 0.008). In the glue-based group, significantly more patients achieved a postoperative sensory velocity greater than 45 m/s (47.9% vs. 22.0%; p= 0.006), postoperative distal sensory latency less than 3.5 ms (89.6% vs. 84.0%; p = 0.304), and postoperative motor latency of less than 4.2 ms (60.42% vs. 38.00%; p = 0.022). Conclusions This trial demonstrated that cyanoacrylate-based adhesion material for wound closure after open CTS decompression compared with sutures showed a significant six-month postoperative increment in hand grip strength and median nerve sensory conduction.

Effect of Alpha-Lipoic Acid on Clinical and Neurophysiologic Recovery of Carpal Tunnel Syndrome: A Double-Blind, Randomized Clinical Trial

The objective of our study was to examine the effect of alpha-lipoic acid (ALA) on clinical and neurophysiologic outcomes after surgery for idiopathic carpal tunnel syndrome (CTS). We conducted a randomized, double-blind, placebo-controlled clinical trial in 20 adults diagnosed with idiopathic CTS after clinical and neurophysiologic assessment. Eligible participants took 600 mg ALA or placebo per day for 1 month before surgery, and for 2 months afterward. Further clinical and neurophysiologic assessments were undertaken immediately before surgical decompression, and at 12 weeks postoperatively with additional clinical assessments at the 4th and 8th week after surgery. Clinical outcome measures were taken by Boston Questionnaire score, the presence or absence of Tinel's sign, and Phalen's test findings. Median nerve conduction studies were also undertaken and interpreted according to Dumitru's reference values. Nineteen patients completed the study; one member of the placebo group was lost during follow-up. There were significant improvements in clinical and neurophysiologic variables in the ALA treatment group, present even before surgery. Boston Questionnaire scores had improved significantly in both groups. In the ALA group, none of the participants had positive Phalen's or Tinel's signs at 12 weeks, and motor and sensory fiber latency and amplitude had significantly improved; in the placebo group, only the sensory distal latency had improved significantly. In conclusion, ALA administered 1 month before open decompression and for 2 months afterward improves the clinical and neurophysiologic outcomes after surgery.

Median and common peroneal neuropathy in coir workers of Alappuzha district, Kerala

Introduction:

Coir work, in a large number of people involves mechanically rolling the coconut fibers into coir which is later subjected to various processes. The primary work is done as a cottage industry specially by women in the sitting posture for several hours. This study reports evidence of median and common peroneal neuropathy electrophysiologically in people who had been engaged in this job for several years. This study was initiated to establish the possible relationship between coir work and symptomatic neuropathies which was seen in that region with all investigations “for other causes not” contributing to the etiological diagnosis.

Subjects and Methods:

One hundred and forty-two upper limbs and 142 lower limbs in patients engaged in long years of coir work but having no symptoms were evaluated electrophysiologically with informed consent and financial compensation, appropriate inclusion and exclusion criteria were followed as described in the text.

Results:

There is electrophysiological evidence for median and common peroneal neuropathy in persons engaged in long years of coir work.

Conclusions:

Coir workers neuropathy appears to be a new occupational neuropathy which can be prevented by following simple preventive measures.