Experience With Proximal Median Nerve Entrapment by the Lacertus Fibrosus.

IF 1.8 Q2 ORTHOPEDICS HAND Pub Date : 2024-09-01 Epub Date: 2023-03-01 DOI:10.1177/15589447231153233
Justin A Cline, Lisa M Frantz, Jessica M Adams, Bernard F Hearon
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Abstract

Background: Unconscious bias of the clinician favors the diagnosis of carpal tunnel syndrome (CTS) in patients with median paresthesia. We hypothesized that more patients in this cohort would be diagnosed with proximal median nerve entrapment (PMNE) by strengthening our cognitive awareness of this alternative diagnosis. We also hypothesized that patients with PMNE may be successfully treated with surgical release of the lacertus fibrosus (LF).

Methods: In this retrospective study, cases of median nerve decompression at the carpal tunnel and in the proximal forearm for the 2-year periods before and after adopting strategies to mitigate cognitive bias for CTS were enumerated. Patients diagnosed with PMNE and treated by LF release under local anesthesia were evaluated to determine surgical outcome at minimum 2-year follow-up. Primary outcome measures were changes in preoperative median paresthesia and proximal median-innervated muscle strength.

Results: There was a statistically significant increase in PMNE cases identified after our heightened surveillance was initiated (z = 3.433, P < .001). In 10 of 12 cases, the patient had previous ipsilateral open carpal tunnel release (CTR) but experienced recurrent median paresthesia. In 8 cases evaluated an average of 5 years after LF release, there was improvement in median paresthesia and resolution of median-innervated muscle weakness.

Conclusions: Owing to cognitive bias, some patients with PMNE may be misdiagnosed with CTS. All patients with median paresthesia, particularly those with persistent or recurrent symptoms after CTR, should be assessed for PMNE. Surgical release limited to the LF may be an effective treatment for PMNE.

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拉塞尔特斯肌纤维对正中神经近端卡压的经验。
背景:临床医生的无意识偏见倾向于将正中神经麻痹的患者诊断为腕管综合征(CTS)。我们假设,通过加强我们对正中神经近端卡压(PMNE)这一替代诊断的认知,将有更多患者被诊断为正中神经近端卡压。我们还假设,正中神经卡压患者可以通过手术松解纤维条索(LF)获得成功治疗:在这项回顾性研究中,我们列举了在腕管和前臂近端进行正中神经减压术的病例,这些病例是在采用减轻认知偏差的策略治疗 CTS 前后两年期间发生的。对确诊为 PMNE 并在局部麻醉下接受 LF 松解术治疗的患者进行评估,以确定至少 2 年随访的手术效果。主要结果指标为术前正中神经麻痹和近端正中神经支配肌力的变化:结果:在我们开始加强监控后,发现的 PMNE 病例明显增加(z = 3.433,P < .001)。在 12 例病例中,有 10 例患者曾接受过同侧开放性腕管松解术 (CTR),但再次出现正中麻痹。在 LF 术后平均 5 年进行评估的 8 个病例中,正中神经麻痹有所改善,正中神经支配的肌无力也得到缓解:结论:由于认知偏差,一些 PMNE 患者可能会被误诊为 CTS。所有正中神经麻痹患者,尤其是在 CTR 后症状持续或复发的患者,都应接受 PMNE 评估。仅限于低频的手术松解可能是治疗 PMNE 的有效方法。
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来源期刊
HAND
HAND Medicine-Surgery
CiteScore
3.30
自引率
0.00%
发文量
209
期刊介绍: HAND is the official journal of the American Association for Hand Surgery and is a peer-reviewed journal featuring articles written by clinicians worldwide presenting current research and clinical work in the field of hand surgery. It features articles related to all aspects of hand and upper extremity surgery and the post operative care and rehabilitation of the hand.
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