Abstract
To reveal the long-term (ten or more years) postoperative course of hemodialysis-related carpal tunnel syndrome patients treated with the Universal Subcutaneous Endoscope (USE) system, we retrospectively compiled and analyzed pre- and postoperative clinical results (tingling, sensory disturbance, motor deficiency, electrophysiological testing) and when there were one or more surgeries for recurrence. This study included 264 hands of 194 patients who were followed up for ten or more years following initial endoscopic carpal tunnel release surgery. Preoperative clinical symptoms improved to normal following initial surgery using the USE system in 96% with tingling, 97% with abnormal pain sensation, 94% with abnormal touch sensation, 87% with preoperative manual muscle testing of the abductor pollicis brevis muscle from [0, 1, 2, 3] to [5], 80% with abnormal distal sensory latency, and 83% with abnormal distal motor latency. Surgery for recurrence at a mean of 12 postoperative years was needed in 97 out of 264 hands. In these cases, we performed endoscopic neurolysis using the USE system on 77 hands and flexor index to little digitorum superficialis (FDS) resection surgery on 20 hands. Three out of these 97 hands needed a third surgery because of re-recurrence and we performed FDS resection surgery and two endoscopic neurolysis surgeries at means of 12 and 13 postoperative years after the initial surgery, respectively. One hand needed a fourth surgery at 20 years postoperatively. Hemodialysis leads to continuous beta-2-microglobulin amyloid deposition inside the carpal canal structures and this leads to carpal tunnel syndrome. In recent years, the lifetimes of patients undergoing hemodialysis have lengthened and, as a result, these patients are more likely to suffer from multiple recurrences of carpal tunnel syndrome. At each recurrence, consideration of less invasive procedures for treatment over the course of the patients’ lifetime should be made.
