Mejora y protocolización del proceso diagnóstico, terapéutico y seguimiento en el síndrome del túnel carpiano

Resumo

ABSTRACT: 1. Introduction: The CTS is the most frequent periferical entrapment neuropathy. After a clinical diagnosis, the ENG can contribute to the final differencial diagnosis and the degree of severity. The surgical liberation is the most effective treatment for moderate to severe cases. 2. Material and Method: 75 patients are analysed in a prospective, analitic, experimental, randomized and double blind study, in order to compare three surgical techniques. By order: Habitual Retinaculotomy, Retinaculotomy plus the application of “Medishield®”; and Retinaculotomy plus fat graft. In pre-operative and post-operative registers at 3 and 12 months, a follow-up is done of the clinical semiology, the Boston (BQ-SS, BQ-F) and DASH questionnaires, as well as the ENG. The data base is analyzed with SPSS© software. 3. Results: All the parameters have improved during the post-operative follow-up, finding significant changes: Early (0 to 3 months) as in nocturnal clinic, paresthesias, hypoaesthesia, BQ-SS and the majority of the sensitive ENG; Later (3 to 12 months) as in the handgrip strength, BQ- F and the majority of motor ENG; or during the entire follow-up (0 to 12 months), as in pain and weakness. Finally the three techniques are compared with each other. 4. Discussion: The personal background highlights arthrosis frequently. The first technique recovered more grip strength in the left hand. The second diminished more pain, the nocturnal clinic, the Phalen´s test, BQ-SS and BQ-F, the pinch strength and the majority of ENG. The third improved more the recuperation of tenar atrophy and the 4th finger test in ENG. 5. Conclusions: A high incidence of osteoarthritis was found in the sample studied. There is a relationship of the STC with both manual and domestic professions. The ENG continues to be the gold standard for final diagnosis. The three techniques have shown themselves to be excellent in their results. The second showed the most advantages, followed by the third and first techniques. Key words: “Carpal tunnel syndrome”; “carpal retinaculotomy”; “Medishield®”; “fat graft”.