A STRUCTURED ALGORITHM FOR DECISION-MAKING IN TREATMENT OF CARPAL TUNNEL SYNDROME: Preliminary Report KARPAL TÜNEL SENDROMLARININ TEDAVİSİNDE YAPILANDIRILMIŞ TEDAVİ ALGORİTMASI: Ön Rapor

Göktekin Tenekeci, Kazım Onur Ünal, Metin Akinci

Özet


ABSTRACT
OBJECTIVE: Carpal Tunnel Syndrome (CTS) is a common entrapment syndrome which lowers quality of life and is a reason for high costs for health care systems. The algorithm presented in this study may be helpful for surgeons’ decision-making for treatment of Carpal Tunnel Syndrome in terms of correct timing and treatment option. Here, the treatment algorithm for carpal tunnel syndrome and its preliminary results are discussed.
MATERIALS & METHODS: Decision-making for treatment of all CTS patients enrolled in this study was performed according to the algorithm presented here, which is based on thenar trophy of patients and ability of median nerve innervated thenar muscles. 51 hands out of 88 were offered night splinting initially for three weeks while the rest 37 hands were operated as an emergent or urgent case without offering night splinting.
RESULTS: Quality of life of all the patients who were operated was improved except one and, awakening at night passed away in the postoperative period. 20 hands out 51 who were offered night splinting for three weeks were operated for carpal tunnel release since patients felt no improvement in their complaints after three weeks of night splinting.
CONCLUSION: We believe that, this algorithm will help surgeons in decision-making process, determining the correct timing for surgery, improve patient satisfaction and provide the opportunity for explanation of the need for whichever treatment option is required. The algorithmic approach we use in our cases is based on the examination of thenar trophy and ability of median nerve innervated thenar muscles (MNITM).
Keywords: Carpal tunnel syndrome, median nerve, thenar muscle.

ÖZET
AMAÇ: Karpal Tünel Sendromu (CTS) hayat kalitesini düşüren ve sağlık sigorta sistemleri için yüksek maliyetlere sebep olan sık rastlanan bir tuzakanma sendromudur. Bu çalışmada sunulan algoritma, CTS in tedavisinde doğru zamanlama ve tedavi yönteminin belirlenmesinde cerrahlara yardımcı olabilecek bir algoritmadır. Karpal tünel sendromlarının tedavi algoritması ve ön sonuçları tartışılmaktadır.
GEREÇ VE YÖNTEMLER: Bu çalışmaya dahil edilen tüm Karpal Tünel sendromlu olguların tedavisi, hastaların tenar trofisini ve median sinirin innerve ettiği tenar kasların becerisini temel alan bu algoritmaya göre yapılmıştır. 88 karpal tünel sendromlu elin 51'ine üç hafta gece atellemesi önerilmiş, geri kalan 37'si ise gece atellemesi önerilmeden acil veya acele olarak opere edilmiştir.
BULGULAR: Opere edilen hastaların hayat kalitesi postoperatif dönemde biri hariç dizeldi ve gece uyanmaları geçti. Gece atellemesi önerilen 51 elin 20si, üç hafta gece atellemesi sonrası şikayetlerinde gerileme olmaması sonucu opere edilerek karpal tünel serbestlemesi yapıldı.
SONUÇ: Bu algoritmanın cerrahların karar verme sürecinde, doğru operasyon zamanlaması kararının alınmasına, hasta memnuniyetinin artırılmasına ve hangi tedavi seçeneğinin açıklanabilmesine yardımcı olacağına inanmaktayız. Vakalarıımızda kullanılan bu algoritma tenar trofi muayenesini, ve median sinirin innerve ettiği tenar kasların (MNITM) becerisini esas almaktadır.
Anahtar Kelimeler: Karpal Tünel Sendromu, median sinir, tenar kas.

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Referanslar


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Online ISSN:2528-8644
Basılı ISSN:1300-6878 (önceki)

Türk Plastik Rekonstrüktif ve Estetik Cerrahi Dergisi (Turk J Plast Surg),
Türk Plastik Rekonstrüktif ve Estetik Cerrahi Derneği'nin, Estetik Plastik Cerrahi Derneği'nin, Türkiye Interplast Derneği'nin ve Çene Yüz Cerrahları Derneği'nin yayın organıdır.