Control por ecografia de alta definición de los cambios morfológicos del nervio mediano tras su liberación quirúrgica en el sindrome del túnel cardiaco

Identificador:  TDX:652

Handle: https://hdl.handle.net/20.500.11797/TDX652

Autors:  Aldecoa Llauradò, Javier

Resum:
Introduction: Surgical decompression of carpal tunnel syndrome (CTS) is the intervention most commonly performed by hand surgeons. Local changes caused by the procedure are still not well known. High definition ultrasonography (HDU) is being increasingly used to diagnose various musculoskeletal pathologies. Objective: To use HDU to study whether there are morphological changes in the median nerve and their chronology, after surgical decompression in CTS. Patients and methods: A prospective observational study was made of cases and controls. Clinical and ultrasound controls were carried out on the median nerve in patients with idiopathic CTS (n = 44). The median nerve was studied along the wrist at three different levels, with an 11 MHz linear array transducer. The studies were performed preoperatively, and one, three and six months postoperatively. The crosssectional areas, the oedema ratio and the flattening ratio of the nerve were calculated. The ultrasonographic results were correlated with the symptomatolgy, the initial scan and the scans obtained in the two control groups, one of which consisted of patients with similar characteristics but who had not undergone surgery (n = 26) and the other of the wrists of asymptomatic volunteers (n = 40). Results: We describe the evolution of the symptoms and the scans in the three study groups being examined. There were significant changes in the morphology of the median nerve in the three groups studied. The evolution of the decompressed nerves was different from that of the nondecompressed nerves. Six months after surgery their ultrasound parameters had not normalized. Conclusions: Our results indicate that there are no sonographic criteria for predicting a successful outcome of surgical decompression of the median nerve in CTS. Keywords: Carpal tunnel syndrome, median nerve, ultrasonography, postoperative period.