Carpal tunnel syndrome in pregnancy.

One thousand consecutive postpartum patients were interviewed by questionnaire to establish the incidence of carpal tunnel syndrome in pregnancy. Hand symptoms had been noted by 34%: 25% had had symptoms of carpal tunnel syndrome, 2% symptoms of ulnar nerve compression and 7% ill defined hand symptoms. Maternal and fetal age, parity and weight change did not correlate with the presence of symptoms. The rate of ring removal because of swelling was twice as great for the symptomatic women (73%) as for the asymptomatic women (36%), and the rates of pre-eclampsia, hypertension and edema were higher for the women with symptoms. Three quarters of the women had bilateral symptoms, and half of the multigravidas had had similar symptoms in previous pregnancies. Hand function and sleep were disturbed in 75% of the symptomatic women, yet only 46% of all those with symptoms mentioned their symptoms to their doctors; treatment was given to only 16% (35% of those who complained), and relief was obtained by only half of these.     

Carpal tunnel syndrome in hemodialysed patients]

A case of carpal tunnel syndrome in female patient treated with hemodialyses for 10 years is presented. Surgical management was applied with positive result. Histological examination of tissue collected during surgery has shown the deposits of amyloid-like substance in carpal tunnel. The authors discuss current concepts of carpal tunnel syndrome pathogenesis in hemodialysed patients.     

Carpal tunnel syndrome and routine blood chemistries

A total of 110 of the 175 patients examined had symptomatic carpal tunnel syndrome. We were able to isolate 10 patients with carpal tunnel syndrome and electrical evidence of an associated peripheral neuropathy from these 110 patients. We feel that patients with peripheral neuropathies probably warrant an extensive laboratory evaluation for primary and treatable disorders. In contrast, we feel patients with isolated carpal tunnel syndrome, normal ulnar latencies, and normal ankle jerk reflexes do not warrant initial erythrocyte sedimentation rates, thyroid profiles, or blood sugars unless there are other historical or physical factors that suggest a predisposition to diabetes mellitus, thyroid disease, or rheumatic disorders.     

Carpal tunnel syndrome and vitamin B6

We reviewed 1075 patients presenting over a 12-year period with symptoms of carpal tunnel syndrome. A total of 994 had a final diagnosis of carpal tunnel syndrome. There were 444 male and 550 female patients with a mean age of 42 years. Three-hundred and ninety-five related symptoms to their job. Surgery was performed in 27 percent of the total diagnosed cases with approximately 97 percent relief of symptoms. Satisfactory alleviation of symptoms was obtained in 14.3 percent of patients treated conservatively prior to 1980, with one or a combination of splinting anti-inflammatory agents, job or activity change, and steroid injections. In 1980, vitamin B6 (pyridoxine) was added as a method of conservative treatment. Satisfactory improvement was obtained in 68 percent of 494 patients treated with a controlled dosage (100 mg b.i.d.). While our findings were not the result of a controlled scientific study, we feel they suggest that regulated use of vitamin B6 may be helpful in treating many cases of carpal tunnel syndrome.     

Carpal tunnel syndrome caused by hand injuries.

Although carpal tunnel syndrome associated with injury to the wrist is common, it is possible to overlook symptoms of median nerve compression caused by an ascending tenosynovitis secondary to trauma distal to the wrist. One should look for these symptoms in such patients who complain of pain and weakness of the hand, and release the carpal tunnel if nerve compression is suspected.     

Repeat reduction mammaplasty

Repeat reduction mammaplasty is an uncommonly performed procedure. Currently, no clear operative guidelines of management exist. Sixteen patients (28 breasts) with a mean age of 29 years (range, 13 to 52 years) underwent repeat breast reduction over an 11-year period. Before the first reduction, the mean notch to nipple distance was 29.6 cm (range, 24 to 38 cm) and mean nipple to inframammary crease distance was 15.5 cm (range, 12 to 18 cm). The mean mass of tissue excised was 615 g per breast. A number of different pedicles were used (six inferior, five superior, four superomedial, one unknown). All patients subsequently developed pseudoptosis. The nipple to inframammary crease distance was a mean of 11.4 cm (having initially been set at 7 cm) before the second procedure. At the second operation, two patients (three breasts) had their initial pedicles transected and the nipple-areola complex moved, and both patients developed vascular compromise of the nipple-areola complex (two breasts). Where the same pedicle was used in the second operation (five patients, 10 breasts), one patient developed unilateral nipple-areola complex necrosis. In eight patients, because of the development of pseudoptosis, the nipple was in a satisfactory position, and therefore only an inferior wedge of tissue required excision. This was performed without nipple-areola complex compromise, irrespective of the initial pedicle. The mean mass of tissue excised in the second operation was 325 g per breast (range, 120 to 620 g). Fourteen patients were available for follow-up after a mean of 5.1 years (range, 3 months to 11.7 years) following the repeat reduction mammaplasty. In the repeat breast reduction, where nipple-areola complex transposition is planned, the initial pedicle should be reused to maintain nipple-areola complex perfusion. Where the initial pedicle is not known, a free nipple graft may be the safest option. In patients with pseudoptosis, in whom the nipple does not require transposition, an inferior wedge of tissue can be safely excised, irrespective of the initial pedicle.     

Periareolar reduction mammaplasty

This paper examines the technique of periareolar reduction mammaplasty. Periareolar reduction mammaplasty is a less aggressive procedure than traditional techniques. It preserves a greater number of central glandular lobules, as well as the papillary artery and nerve. It can be performed under local anesthesia, and the area to be anesthetized is smaller because the amount of breast tissue to be resected is reduced. The sutures required number less than a third of those used for conventional techniques, and operative time is shorter. The greatest advantage is the inconspicuous periareolar scar left, combined with an acceptable result for both surgeon and patient.     

Arch reduction mammaplasty

Arch mammaplasty is a breast reduction technique based on the inferior pedicle. It uses all the specific advantages of the inferior pedicle while avoiding the inframammary scars and dead space that occur with the inverted T technique. Arch mammaplasty has proven versatile and extremely safe, and it has a surprisingly good rate of acceptance by the patients. The scarring is aesthetically superior to that obtained with the well-accepted, inverted-T scar technique of the past.