Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Chamran Hospital, Shiraz, Iran.
Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran.
J Hand Surg Asian Pac Vol. 2022 Apr;27(2):256-260. doi: 10.1142/S2424835522500400. Epub 2022 Mar 31.
Some patients with a confirmed diagnosis of carpal tunnel syndrome (CTS) on clinical examination and electrodiagnostic testing (EDX) may also have one or more clinical features of pronator syndrome (PS). However, the EDX is negative for PS. We label these patients as suspected concurrent carpal tunnel and pronator syndrome (CCPS). We suspect that this is a presentation of reverse double crush syndrome that occurs when a symptomatic distal compression neuropathy converts an asymptomatic proximal compression into a symptomatic one. We believe both compressions can be relieved by decompressing the median nerve only at the wrist. The aim of our study is to determine whether carpal tunnel release (CTR) is an effective treatment for patients suffering from CCPS. This is a prospective, cohort study of the outcomes of CTR in two matched groups with 37 patients in each group. Group A included patients with suspected CCPS and group B included patients with isolated CTS. All patients were evaluated pre-operatively and 1 year after surgery using the Boston Carpal Tunnel Questionnaire (BCTQ). At one year, patients were also assessed for residual symptoms and positive provocative tests. A significant improvement in the symptom and functional severity scales (SSS and FSS) of the BCTQ was noted in both groups. The degree of improvement in SSS was similar in both groups; however, group A showed a greater improvement in FSS. This could be attributed to higher pre-operative values in some items of FSS in group A. No patients in either group had residual symptoms severe enough to necessitate further treatment. The outcomes of CTR are similar in patients with isolated CTS and suspected CCPS and a CTR may be sufficient to address symptoms of CTS and PS in patients with CCPS. Level II (Therapeutic).
一些在临床检查和电诊断测试（EDX）中确诊为腕管综合征（CTS）的患者可能还具有正中神经嵌压（PS）的一种或多种临床特征。然而，EDX 对 PS 呈阴性。我们将这些患者标记为疑似同时患有腕管综合征和正中神经嵌压（CCPS）。我们怀疑这是反向双重压迫综合征的表现，当症状性远端压迫性神经病将无症状性近端压迫转变为症状性时，就会发生这种情况。我们认为，仅通过腕部对正中神经进行减压，就可以缓解这两种压迫。我们的研究目的是确定腕管松解术（CTR）是否是治疗 CCPS 患者的有效方法。这是一项前瞻性、队列研究，比较了两组各 37 例患者接受 CTR 的结果。A 组包括疑似 CCPS 患者，B 组包括单纯 CTS 患者。所有患者在术前和术后 1 年均使用波士顿腕管问卷（BCTQ）进行评估。在 1 年时，还对患者进行了残留症状和阳性激发试验评估。两组患者的 BCTQ 症状和功能严重程度量表（SSS 和 FSS）均有显著改善。两组患者的 SSS 改善程度相似；然而，A 组的 FSS 改善程度更大。这可能归因于 A 组某些 FSS 项目的术前值较高。两组均无患者出现严重到需要进一步治疗的残留症状。单纯 CTS 患者和疑似 CCPS 患者的 CTR 结果相似，对 CCPS 患者进行 CTR 可能足以缓解 CTS 和 PS 的症状。2 级（治疗）。
