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Objectives: This study sought to evaluate pain severity and pain management methods of patients with carpal tunnel syndrome., Methods: This descriptive study was conducted with patients who were diagnosed with carpal tunnel syndrome (n=99) in the neurology clinic of the university hospital between August 2014 and December 2015. Patient data form, visual analog scale (VAS) and a pain management inventory were used to collect data., Results: Of the total, 64.6% of the patients experienced pain. Patients used prescription medication, massage, and exercise to control pain, and reported that the most useful method was exercise, followed by massage and, finally, prescription medication., Conclusion: Healthcare professionals may share the findings of relative benefit according to method of pain management and encourage patients to use non-pharmacological methods.

Objectives: We evaluated the early results of endoscopic carpal tunnel release with the use of local anesthesia., Methods: Endoscopic carpal tunnel release was performed in 14 hands of 10 patients (8 females, 2 males; mean age 43 years; range 35 to 58 years) using the two-portal Chow technique following local anesthesia described by Wood and Logan. Involvement was in the right hand in five patients, in the left in three, and in both hands in two patients. Electromyography showed moderate or severe compression of the median nerve in the carpal tunnel and the Tinel's and Phalen's signs were positive in all the patients. There was no previous history of metabolic diseases such as diabetes mellitus, gout, or hypothyroidism, nor a coexisting pregnancy. The decision for surgery was given at the end of an unsuccessful conservative treatment for a month. The mean follow-up period was 16 months (range 10 to 24 months)., Results: Two patients (14.3%) required further anesthesia with local anesthetic agents and sedation in the incision area. No complaints of paresthesia were seen during injections. Injection-associated problems such as increased thickness of the synovial layer or decreased endoscopic view did not occur. No instances of tendon or nerve injury, hematoma, or sympathetic dystrophy were seen. One patient developed neuropraxia in the third and forth fingers postoperatively. Early postoperative pain was observed in two wrists, appearing 10 days and two months after surgery, respectively. During the follow-up period, all the patients were free of preoperative complaints and no recurrences were encountered., Conclusion: Local anesthesia is a rapid and reliable technique in carpal tunnel surgery, enabling hospitalization confined to the same day.

Median nerve hemangiomas causing carpal tunnel syndrome are very rare. The number of reported cases is less than ten, all of which resulted in recurrences. We present a 35-year-old woman who developed median nerve hemangioma in her left wrist. The mass was removed by epineural resection and the patient's complaints disappeared after a while. During a six-year follow-up no recurrences were detected.

Objectives: We evaluated the clinical results of endoscopic carpal ligament release in patients with carpal tunnel syndrome., Methods: Twenty-six hands of 20 patients (16 females, 4 males; mean age 50 years; range 30 to 65 years) underwent endoscopic carpal ligament release according to the technique described by Chow. Clinical and electromyographic findings were compatible with carpal tunnel syndrome. The mean follow-up period was 13.2 months (range 3 to 28 months)., Results: Clinical and electromyographic improvement was obtained in all patients. Complications included superficial wound infection in one patient and neuropraxia of the digital nerve in three patients. The mean time to return to work was 22.5 days. No incision-site pain or localized scar sensitivity were noted. Excellent or good results were achieved in 24 hands (92%)., Conclusion: With a good knowledge of endoscopic anatomy and adequate experience, endoscopic carpal ligament release is an appropriate alternative in the treatment of carpal tunnel syndrome, resulting in lower complication rates, early return to daily activities and work, and a lower morbidity.

Objectives: A prospective, single-blind study was planned to investigate the role of magnetic resonance imaging (MRI) in the diagnosis, treatment, and staging of carpal tunnel syndrome (CTS)., Methods: The study group was comprised of 43 hands of 25 patients (21 women, 4 men; mean age 56 years) with a clinical diagnosis of CTS. Fifteen patients (12 women, 3 men; mean age 51 years) with ganglions on the dorsal side of the wrist constituted the control group. Comparisons were made between MRI findings, clinical findings, electrodiagnostic test results, and intraoperative findings., Results: Electrodiagnostic test results were positive in 36 (84%) and negative in seven hands (16%). Magnetic resonance imaging revealed positive findings for CTS in all patients. A significant difference was found between the study and control groups in the carpal tunnel measurements at the level of the hook of the hamate (p<0.005). In addition, MRI showed space occupying lesions within the carpal tunnel in three patients, and a bilateral anomaly of the median nerve in one patient., Conclusion: It was found that MRI offered objective findings for the diagnosis, treatment, and staging of CTS, which were in good correlation with clinical findings, electrodiagnostic test results, and intraoperative observations. Moreover, it was helpful in the diagnosis when there had been discrepancy between clinical findings and electrodiagnostic test results.

Lipofibromatous hamartoma of the nerve is a very uncommon, congenital, benign, peripheral nerve tumor. It is mostly encountered in the extremities of young adults, involving the median nerve in the majority of cases. The nerve tissue is infiltrated by diffuse fibroadipose tissue which dissociates the fasciculi without invasion. Patients with lipofibromatous hamartoma of the median nerve usually present with symptoms of carpal tunnel syndrome, usually accompanied by marked macrodactyly. Lipofibromatous hamartoma of the median nerve was encountered in an 18-year-old female patient, involving the wrist, causing macrodactyly of the index finger, and resulting in symptoms of carpal tunnel syndrome. Median nerve release and partial excision of the adipose tissue along the mass were performed. Fourteen months postoperatively, the patient had no complaints and the mass decreased in size without any motor or sensory functional losses.

Objectives: We investigated the causes of failure and ensuing problems and findings in patients with unrelieved or recurrent carpal tunnel syndrome (CTS) and evaluated the results of revision surgery., Methods: The study included 26 patients (21 women, 5 men; mean age 52 years; range 30 to 71 years) who underwent reoperation for unrelieved or recurrent symptoms following at least a year (range 1 to 4 years) after the initial surgery. A total of 34 operations had been carried out in 31 hands. All patients were investigated clinically and electrophysiologically. The mean follow-up after reoperation was 19 months (range 12 to 38 months)., Results: The diagnosis was confirmed in all patients by clinical and electrophysiologic studies. The primary operations had been performed using 11 transverse incisions, three incisions confined proximally to the wrist crease, 10 incisions without insufficient distal extension, and seven appropriate incisions. The transverse carpal ligament release was inadequate in 23 hands; it had not been released in three hands at all. Excessive fibrous tissue developed in one patient, leading to complete bilateral median nerve compression. Bilateral and unilateral tenosynovitis resulting from rheumatoid arthritis and tuberculosis was detected in two patients, respectively. All patients underwent repeat open carpal tunnel release. Neurolysis and tenosynovectomy were performed in both hands of one patient and in one hand of two patients, respectively. Clinical results were excellent in 24 hands, good in six hands, and fair in one hand., Conclusion: Selection of appropriate incision and achievement of complete carpal tunnel release without any injury to the median nerve or its branches are of great importance with regard to postoperative results. Careful imaging studies of the carpal tunnel should be carried out especially in patients with unilateral involvement, presenting with an atypical age or occupation.

Objectives: We evaluated the results of open surgical release in patients with carpal tunnel syndrome (CTS) and assessed the necessity of a clinical scoring system and electromyography (EMG) in the postoperative follow-up., Methods: The study included 24 wrists of 15 patients (9 females, 6 males; mean age 49.2 years; range 23 to 70 years) in whom a diagnosis of CTS was made by clinical examination and EMG. The patients underwent open surgical release and were followed-up for a mean of 21.5 months (range 7 to 40 months), during which they were evaluated by the Boston scale (BS) for clinical scoring and EMG. Postoperative findings of BS and EMG were compared in terms of their utility during follow-up., Results: Statistically significant differences were found between preoperative and follow-up EMG values of motor distal latency, sensorial latency, combined motor muscle potential amplitudes, and sensorial latency amplitudes (p<0.05). Of twenty-four wrists, 16 (66.6%) showed improvement, and eight (33.3%) showed marked improvement. Similarly, preoperative and follow-up BS scores showed significant differences in favor of treatment results (p<0.05). The Boston scale scores and EMG results were found consistent in showing treatment outcome., Conclusion: Open surgical release of CTS provides favorable results that can be sufficiently evaluated by the clinical scoring system alone. Electromyographic studies do not seem to add extra benefits to the postoperative evaluation of patients with CTS.