Aim: To assess the implications of nerve conduction study for carpal tunnel syndrome. Methods and Materials: A retrospective audit of the patients who underwent carpal tunnel release at the district general hospital from July 2000 till June 2005. Due to the un-availability of facility for nerve conduction study at our district general hospital, the patients had to be referred to other hospitals in the region for the same. A total of 263 carpal tunnel releases were performed during the study period in 206 patients (57 were bilateral). 61 patients were males and 145 were females. Results: Of the classical presentation group, the nerve conduction study was requested in 76 of the 172 patients while in the atypical presentation group 53 of the 91 patients had a nerve conduction study prior to the operative treatment. The intra-operative findings of thickened flexor retinaculum and thinned median nerve were statistically similar in the 2 groups: Nerve conduction not performed and Nerve conduction study performed. Discussion: The average duration between the first consultation and the operative treatment was 72 days in the patients who did not undergo the nerve conduction study, whereas the average duration between the first clinic appointment and the operative treatment for the patients who had the nerve conduction study was 180.5 days. The request for nerve conduction study in cases with classical presentation leads to an average 108.5 days delay in the final management of the patient’s problem. It also causes a significant loss of time and finances

Introduction. Nerve conduction studies are considered to be the investigation of choice for the diagnosis of Carpal Tunnel Syndrome. However they are expensive and can be painful. We scored patients based on a ten point scoring system; four symptoms (Katz Hand Diagram – Classic and Probable pattern for tingling and numbness, nocturnal paresthesia, bilateral symptoms), four signs (weak thumb abduction test, Tinel sign, Phalen sign, Hypoalgesia in median nerve territory) and two risk factors (age more than 40 years and female sex). This was done in an effort to predict the severity of carpal tunnel syndrome and to correlate it with nerve conduction studies. Method. A prospective study of 59 patients was performed between May 2009 and March 2010. For every patient in the study we completed a scoring system based on ten points and correlated it with the severity (normal, mild, moderate and severe) result from the nerve conduction studies. Results. There were 61 completed data sets (59 patients, two patients had bilateral carpal tunnel release). The mean age of patients was 60 years (range: 37–91 years). The mean duration of symptoms was 17 months. The female to male ratio was 2.3:1. All scores greater than seven matched with nerve conduction study of moderate to severe intensity apart from three scores which were greater than seven that matched with a normal result. Conclusion. Based on this study, we believe that patients who score less than eight may require nerve conduction studies to confirm the diagnosis of carpal tunnel syndrome. However patients who score more than seven have a 93% chance of having moderate to severe carpal tunnel syndrome on nerve conduction studies

Carpal tunnel syndrome is the most frequent form of median nerve entrapment, accounting for 90% of all entrapment neuropathies. Routinely nerve conduction study (NCS) tests are ordered to confirm the diagnosis however; there are issues of long waiting periods and costs with it. We aimed to compare carpal tunnel questionnaire score (CTQS) by Kamath and Stothard (2003) to nerve conduction study result in the diagnosis of carpal tunnel syndrome. This prospective study involved analysis of data from all the patients referred to NHS Tayside (Dundee) hand clinic with signs and symptoms of Carpal tunnel syndrome (CTS) from September 2016 to February 2017. Statistical analysis was done using SPSS and sensitivity and specificity was calculated. The questionnaires were filled in by a team of specialist physiotherapists. Nerve conduction study tests were done by a team of consultant neurophysiologists. Both the groups were blinded to each other's assessment. We analysed 88 patients who filled in CTQS and also underwent NCS. We noted that CTQS of less than 3 correlated 100% to negative nerve conduction result. When the carpal tunnel questionnaire score was more than or equal to 5, 54 patients had positive NCS result and 6 patients had negative NCS result, giving a 90% predictability of a positive NCS result. Mean waiting period of carpal tunnel patients for NCS was 141 days. We noted from this prospective study that CTQS was sensitive enough to exclude carpal tunnel syndrome when the questionnaire score was less than 3. In addition, the questionnaire revealed a 90% probability of having carpal tunnel syndrome when CTQS was more than or equal to 5. Based on the present study, we would recommend that patients in grey zone of 3 to 4 on questionnaire should undergo NCS, resulting in only 20% of patients (based on the figures from the current study) being referred for NCS. The questionnaire can be used in primary health care or specialist physiotherapy screening clinic as a tool for diagnosing CTS with implications of cost saving and avoiding long waiting periods

The aim of this retrospective study was to investigate in patients with carpal tunnel syndrome the relationship between pre-operative symptoms, electrophysiological testing and outcome after surgery.

62 patients who had undergone carpal tunnel surgery were assessed in clinic, their case notes were reviewed and the electrophysiological results were analysed and graded according to severity.

The median duration of symptoms was 2 years. No relationship was found between the duration of pre-operative symptoms and the severity of electrophysio-logical impairment.

Furthermore, no relationship could be identified between electrophysiological impairment and either successful outcome after surgery (defined as complete symptom resolution) or time to resolution of symptoms after surgery

The aim of this study was to determine the outcome of carpal tunnel decompression in elderly patients and whether this can be predicted by the severity of pre-operative nerve conduction studies. A retrospective study was undertaken of all patients over 70 years who had carpal tunnel release (CTR) at Dunedin Hospital between April 1999 and April 2002 with a minimum one year follow up. A grading system for pre-operative nerve conduction studies (NCS) was formulated which scored patients from 1 to 6 according to severity. Patients were followed up by postal questionnaire (Boston Carpal Tunnel Score) with telephone follow up of non-responders. There were 105 CTR procedures performed in 96 patients. Median pre-operative NCS Score was 4 with 47% scoring 5 or 6. 4 Patients had died. Post-operative symptom severity scores were low and the majority of patients were very satisfied with the results of surgery. Despite nerve conduction studies consistent with severe median nerve compression, patients had low postoperative symptom severity scores and overall were very satisfied. Carpal tunnel release in patients over 70 years of age is justified and associated with good outcome

The aim of this study was to prospectively audit the results of carpal tunnel decompression using a subjective patient derived outcome score (modified Boston Symptom Severity Score) and to examine the relationship between symptom severity scores and nerve conduction studies. Prospective cohort study of all patients undergoing open carpal tunnel decompression at Dunedin Hospital over a 13-month period from December 2003 – January 2005. Demographic details collected included age, sex, duration of symptoms, diabetes, occupation and ACC status. Pre-operative investigations consisted of nerve conduction studies and a modified version of the Boston Symptom Severity Score developed for this study. Symptom severity scores were reassessed six months post-operatively. One hundred and ten patients participated in the study. Mean pre-operative Boston Symptom Severity Score was 3.35 (1= normal, 5=severe). Post-operatively this improved to mean 1.66, median 1.45. Ninety three percent of patients were “very satisfied” or “satisfied” with their results. Age and duration of symptoms were not significant predictors of poor outcome. The majority of patients undergoing carpal tunnel decompression were satisfied with the outcome and had excellent or good outcomes as determined by symptom severity score. The use of preoperative nerve conduction studies help in diagnosis and prognosis

Introduction and Aims: It has been suggested that elderly patients have poorer outcomes following carpal tunnel decompression than younger patients, especially if there is severe compression. The purpose of this study was to determine the outcomes of carpal tunnel decompression in the elderly patient and whether the outcome could be predicted from pre-operative nerve conduction studies. Method: A retrospective study of all patients over 70 years who had a carpal tunnel release over a three-year period at Dunedin Hospital, with a minimum one-year follow-up. Pre-operative nerve conduction studies were graded from one to six according to severity. Patients were followed up by postal questionnaire (Boston carpal tunnel symptom severity score) and telephone follow-up. Results: 109 procedures were performed in 96 patients. Eight patients had died, two excluded (one with Motor Neurone disease and one acute CTS following fracture) and five were demented and unable to fill out the questionnaire. Eighty-one patients with 92 wrists were available for review. Mean age was 78.6 years. Eighty percent had marked to severe neurophysiological changes (Grade 4–6). Post-operatively, the median Boston score was 1.27 with 84% having a Boston score of < 2.0. Patients were satisfied with the result in 94.6% of procedures. There was a positive correlation between nerve conduction grade and post-operative Boston Score (p=0.042). Conclusion: Despite nerve conduction studies consistent with marked to severe compression, elderly patients have low symptom severity scores following carpal tunnel decompression and a high rate of satisfaction. Carpal tunnel release in patients over 70 years of age is justified and usually associated with a good outcome

Introduction. Only a few studies have assessed the outcome of ulnar nerve decompression, most comparing various forms of decompression. A review of the case notes of patients undergone ulnar nerve decompressions was undertaken looking at the pre-op symptoms, nerve conduction studies, the co-morbidities, operative procedures and the post-operative outcomes. Material/methods. We reviewed the case notes of ulnar nerve decompressions surgery performed over a period of six year period. Outcome grading was recorded as completely relieved, improved, unchanged or worse. The significance level was set at 5%. Results. A total of 136 ulnar nerve decompressions formed the study group. Numbness and paraesthesia in ulnar distribution were the two most common presenting symptoms (96%). Majority (68%) had symptoms for over a year before surgery. Simple decompression was done in 110 extremities and rest of the cases required additional anterior subcutaneous transposition. The cause of compression was identified as idiopathic in 58.2%; flexor carpi ulnaris aponeurosis in 36.7% and Arcade of Struthers in 5.1% extremities. The outcome was satisfactory in 85.2% of patients. No obvious association was demonstrated between the outcome of surgery and duration of symptoms, presence of co-morbidities or the type of surgery performed. Interestingly out of 12 patients who got worse or had no improvement, nine (75%) had either normal nerve conduction studies or none done pre-operatively. Conclusions. This is the largest review of outcomes after ulnar nerve decompressions at elbow. The study showed that good results (85.2%) in majority of patients regardless of level of surgeon's experience or procedure undertaken

Introduction. Ulnar nerve entrapment is the second most common nerve entrapment syndrome of the upper extremity. Despite this, only a few studies have assessed the outcome of ulnar nerve decompression. The objectives of the study were to review the pre-operative symptoms, nerve conduction studies, the co-morbidities, operative procedures undertaken and the post-operative outcomes; and investigate and ascertain prognostic factors particularly in cases of persistence of symptoms after the surgery. Methods. We reviewed the case notes of ulnar nerve decompressions surgery performed over a period of six year period. A structured proforma was created to document the demographics, patient complaints, method of decompression, per-operative findings and symptom status at the last follow up. Outcome grading was recorded as completely relieved, improved, unchanged or worse. Analysis of data was carried out using the SPSS software (Version 16.0; Illinois). The significance level was set at 5%. Results. 136 ulnar nerve decompressions formed the study group. Minimum follow-up was three months. Numbness and paresthesia in ulnar distribution were the two most common presenting symptoms (96%). The cause of compression was identified as idiopathic in 58.2%; flexor carpi ulnaris aponeurosis in 36.7% and Arcade of Stuthers in 5.1% extremities. The outcome was satisfactory in 85.2% of patients. No obvious association was demonstrated between the outcome of surgery and duration of symptoms, presence of co-morbidities or the type of surgery performed. Interestingly out of 12 patients who got worse or had no improvement, nine (75%) had either normal nerve conduction studies or none done pre-operatively. Conclusion. This is the largest review of outcomes after ulnar nerve decompressions at elbow. The study showed that good results (85.2%) of ulnar nerve decompression at elbow in majority of patients regardless of level of surgeon's experience or procedure undertaken

A previously fit and well 58 year old male suffered from a bilateral psoas haematoma (PH) following 52 days of veno-venous extracorporeal membranous oxygenation (VV-ECMO) for severe Coronavirus disease (COVID-19), refractory to all non-invasive and medical therapies. He developed multiple complications, including inability to walk or weight-bear, due to lumbar plexopathy triggered by bilateral PH compression, compounded by COVID-19-related mononeuritis multiplex. The patient was referred to our institution with a known diagnosis of bilateral PH and after spinal multidisciplinary team (MDT) input, was deemed not for surgical or interventional radiology treatments. The patient received extensive neurorehabilitation, coordinated by multiple MDTs. Although PH has been correlated to COVID-19, to the best of our knowledge this is the first reported case of such a complex presentation resulting in a dramatic bilateral PH. Health records from 3 large UK teaching hospitals were collected regarding treatment and follow up appointments, following patient's written informed consent. Patient's comorbidities, duration in hospital units, MDT inputs, health assessments, mobilisation progress and neurologic assessments, were all recorded. Data was collected retrospectively then prospectively due to lengthy in-patient stay. The literature review was conducted via PubMed and open access sources, selecting all the relevant studies and the ECMO guidelines. Patient received treatment from 3 different units in 3 hospitals over 212 days including 103 days in neurorehabilitation. Involvement of physiotherapy, dietitians, speech and language teams, neurologist, neurophysiotherapists, occupational therapists was required. The patient progressed from a bed-bound coma and inability to walk, to standing with lower limb backslab at discharge. Additionally, he was referred for elective exploratory surgery of the psoas region for scar debridement and potential nerve graft repair of the lumbosacral plexus. The surgery outcome is cautiously optimistic, with some improvement in nerve conduction studies, however is currently unknown regarding recovery progress and return to premorbid functional baseline. The novelty of this presentation yields significant learning points regarding early recognition of PH, requirements for vast MDT input and specialist use of VV-ECMO in severe COVID-19 patients. It also highlights the broad pathophysiology of SARS-CoV-2 causing neuropathy and coagulopathy; understanding this will optimise robust anticoagulation guidelines, required in VV-ECMO

Simultaneous compression of the median and ulnar nerve at the elbow is rather uncommon. The aim of this study was to describe 10 such cases which have been treated in our unit. The patients presented with a combination of ulnar neuritis symptoms at the elbow with a pronator syndrome. Five patients were female and 5 male with an average age of 33 years. All patients were manual workers. Regarding the cubital tunnel syndrome, all patients complained for hypesthesia in the ulnar nerve’s distribution in the hand and 6 for additional night pain in the medial aspect of the elbow. Regarding the pronator syndrome, the patients complained for mild tenderness or pain at the proximal forearm as well as hypesthesia or paresthesias at the digits. Nerve conduction studies were positive only for the ulnar nerve compression neuropathy. Six patients were treated by decompressing both nerves at the same time through the same medial incision, creating large medial flaps. The ulnar nerve underwent a simple decompression. In one case that the symptoms were initailly attributed to ulnar nerve, a second operation for medial nerve decompression was required. In all patients symptoms subsided following surgical decompression. Four patients developed an ugly scar and 2 a hematoma. All returned to their previous occupation. Clinical tests and nerve conduction studies were performed postoperatively to evaluate the results; all of them turned out negative for ulnar and median nerve compression neuropathy. Simultaneous compression of the median and ulnar nerve at the elbow is rather rare. Careful evaluation of the patient’s symptoms as well as thorough clinical examination are the keystones for the correct diagnosis. Although decompression can be performed through the same medial incision, extensive dissection may be required

Nerve blocks are a common form of peri-operative analgesia that is administered for patients undergoing joint Replacement surgeries. The long term sequel following these peripheral nerve blocks used in total knee replacement not reported in the literature. Nerve blocks given under the guidance of nerve stimulators are in practice in most of the hospitals and are considered safe. We report a series of two cases with residual neurological deficit following these peripheral nerve blocks in total knee replacements. In both these cases the femoral, sciatic, obturator and lateral cutaneous nerve of thigh were blocked with 0.25% of Bupivacaine with the help of a nerve stimulator. First patient post operatively had residual numbness in the right lower leg after 4 weeks of surgery. Nerve conduction studies confirmed absent response in right Saphenous and superficial peroneal nerves. Patient has no improvement in her neurological deficit even after 16 months post operatively. Further to this she developed complex regional pain syndrome on the affected side. Second patient post operatively developed knee extensor weakness of grade II/V and loss of sensation in femoral nerve distribution. Nerve conduction studies confirmed severe femoral nerve damage around groin. She went through a turbulent phase, knee stiffness range of movements 0–20 degrees requiring Manipulation Under Anaesthesia, later Exploration and Release of adhesions which improved her range of movements to 0–95 degrees. At 12 months post operative the neurological status improved to grade 3/5 in knee extensors. Conclusion: Long term Complications of Peripheral nerve blocks in total knee replacements are not reported in the literature. These complications though uncommon, unfortunately for patients affect the surgical outcomes. The purpose of this case series is not only to report complications but also to share our experience of managing these complications, their outcomes and relevant literature review

Aim: Aim of this study is to determine if cubital tunnel view radiograph of the elbow is useful in the investigation and treatment of Ulnar nerve entrapment at the elbow. Patients and Methods: 28 patients presenting with symptoms suggestive of ulnar nerve entrapment at the elbow were prospectively studied. Detailed history and clinical examination was elicited in each patient and classified according to McGowan’s classification. Diagnosis of ulnar nerve entrapment at the elbow was confirmed by nerve conduction studies. Cubital tunnel view radiographs were taken and evaluated for any evidence of bony encroachment of the ulnar nerve bed in the cubital tunnel. Those patients with normal cubital tunnel view radiograph underwent simple ulnar nerve decompression where as those with significant bony encroachment of ulnar nerve bed underwent anterior transposition of the ulnar nerve. The results of surgery were assessed at follow up using the Wilson and Krout criteria. The difference in results in two groups was statistically analyzed by applying student ‘t’ test. Results: There were 20 patients (male=14, female 6) in the simple ulnar nerve decompression group with a mean age of 52 yrs (range 32 to 61 yrs) and 8 patients (male=6, female=2) in anterior transposition group with a mean age 59 yrs (range 45 to 69 yrs). Mean follow up was 25months (range 9 months to 32 months). According to McGowan’s classification there were 5 grade I, 9 grade II and 6 grade III patients in simple decompression group where as there were none grade I, 3 grade II and 5 grade III in anterior transposition group. All patients had neurophysiological evidence of ulnar nerve entrapment in pre-operative nerve conduction study. Wilson and Krout grading at final follow up showed 15 good, 4 fair and 1 poor result in simple decompression group and 5 good, 2 fair and 1 poor result anterior transposition group. There was no statistically significant difference between the two groups (p value < 0.001). Conclusion: Cubical tunnel view radiographs are valuable in the management of ulnar nerve entrapment at the elbow. Patients with normal radiograph can be treated by simple nerve decompression

Purpose: The purpose of this study is to investigate the relationships of traction force, traction time, and hip distraction to the development of nerve conduction abnormalities during hip arthroscopy. Method: Thirteen patients with hip pathology underwent hip arthroscopy. Traction forces applied to the operative leg were measured using a load-cell force transducer. Distraction of the hip joint was assessed using fluoroscopy. Nerve conduction studies of the tibial nerve was performed measuring the latency of the Hoffmann reflex (Hlat reflex). Measurements of the traction force, distraction of the hip, and nerve conduction studies were performed at routine intervals during the procedure, and compared to pre- and post-op values. Results: Nerve Conduction Studies- The mean baseline Hlat reflex was 30.4+/−2.2 milliseconds for all patients. Three patients lost the Hlat reflex immediately (t=0), and an additional three patients lost the Hlat reflex during the procedure (t=30, t=30, t=60). The remaining seven patients all had delayed conduction of the Hlat reflex over time. At one-hour post-op, the Hlat reflex was documented in all patients (mean 31.9+/−2.9 ms) and remained significantly different from baseline (p< 0.01). Clinically, one patient in the lost Hlat reflex group had an associated neuropraxia post-operatively. Traction Forces- The mean initial traction force at time of application for all patients was 97+/−28 lbs. The mean initial traction force of the lost Hlat reflex group and retained Hlat reflex group was 104+/−32.6 lbs and 91+/−24.1 lbs, respectively (p=0.44). Hip Distraction- The mean initial hip distraction at time of application of traction for all patients was 8.8+/−2 mm. The mean initial distraction of the lost Hlat reflex group and retained Hlat reflex group was 9.6+/−1.4 mm and 8+/−2.2 mm, respectively (p=0.15). Conclusion: Traction during hip arthroscopy is associated with significant nerve conduction abnormalities in the immediate post-operative period. Six of thirteen patients had complete loss of the Hlat reflex of the tibial nerve, one of these patients exhibiting clinical neuropraxia. Although length of time in traction may be a factor for the development of nerve conduction abnormalities, a more significant factor may be the change in length over time of the surrounding peripheral nerves

Background. We searched -in transverse ultrasound view- the value of the difference (Delta) between -proximal to the tunnel- CSA (a) and -in the tunnel's inlet- CSA (b) for separating normal from abnormal median nerves. Methods. 51 patients –suspicious for CTS- underwent Phalen and Tinnel tests. After that, we used a high frequency ultrasound to measure CSAa, CSAb and Delta CSA in both hands. 33 of our 51 patients did not experience any clinical symptoms at the contralateral hand, so that we could perform a comparative study of normal and pathological median nerves (on the same patients). Then, all of them completed a Q-DASH questionnaire and a visual analogue scale (VAS 100/100) and they carried through with a nerve conduction study (NCS). Results. We found that a CSAb more than 0,010 and a Delta CSA > 0,003 are both very sensitive findings for CTS, but only DeltaCSA has good specificity. Comparing to NCS the Delta CSA>0,003 had no statistical difference in sensitivity, specificity, true negative and true positive results. Furthermore, patients with Delta CSA>0,009 were suffering from heavy CTS according to NCS, Q-DASH and VAS. On the other way, a Delta CSA between 0,003 and 0,006 suggests a mild or moderate CTS. Conclusion. Delta CSA could be the golden standard for the detection of CTS in patients that feel uncomfortable to undergo NCS. We propose a grading scale that distinguish mild or moderate syndromes (where we could try a conservative treatment) from heavy syndromes and help as on decision-making

Background. To investigate the new theory of hydroneurolysis and hydrodissection in the treatment of carpal tunnel syndrome (CTS). Independently of the fluid hydrodissolution works due to mechanical forces and it may have some positive effects in patients with ischemic damage caused by scar tissue pressure at the nerve's surface. Methods. A prospective blind clinical study of 31 patients suffering from carpal tunnel syndrome, established by nerve conduction studies and clinical tests. 14 patients (out of 29), who refused to undergo an open operation as a treatment to their disease at this point of time, were treated with a simple ultrasound-guided injection at the proximal carpal tunnel. In order to exclude the biochemical influence of the fluid in the treating disease we choosed to infiltrate 3 cc. of normal saline 0,9%. In the follow-up period our group was asked to answer to a new Q-DASH score and visual analogue scale (VAS) 100/100 in 2, 4 and 8 weeks. Results. At the end of the second month we found only 2 out of 14 patients of the infiltration's group with clinical improvement. As far as the control group (17 patients), there was just one patient with recovery of the symptoms at the end of the second month who avoided operation. The rest 16 patients experienced insistence or worsening of CTS while they were waiting to be operated (mean time till operation in our department's waiting list: 2 months) and underwent a surgical decompression of the median nerve. Comparing the two groups in Q-DASH score, VAS 100/100 and ultrasound cross sectional area measurements we found no statistical difference between the two groups at the endpoint of our follow-up period. Conclusion. As far as nerve entrapment syndromes we proved that normal saline hydrodissolution appears to be non effective as a conservative treatment. The mechanical way of action seems to have only very short term effects. Level of Evidence. II

An 83-year-old woman presented with acute weakness in her right hand and wrist extensors and swelling in the proximal right forearm. Nerve conduction studies confirmed compression of posterior introsseous nerve at the level of proximal forearm. MR imaging demonstrated the characteristics of lipoma which extended on the atero-lateral aspect of the right radius neck. The lesion was parosteal lipoma of the proximal radius causing paralysis of the posterior interosseous nerve without sensory deficit. In this case report, posterior inretosseous nerve palsy due to compression of a parostel lipoma was recovered after excision of the lipoma followed by intensive rehabilitation for six month. Surgical excision should be promptly performed to ensure optimal recovery from the nerve paralysis

The objective was to compare vastus lateralis muscle splitting verses muscle sparing surgical approach to proximal femur for fixation of intertrochanteric fracture. Of the 16 patients in this prospective randomised double blind study 8 were randomised to vastus lateralis muscle splitting and rest to muscle sparing group. Main outcome measurement was assessment of status of vastus lateralis muscle at 2 and 6 weeks using nerve conduction study. Preoperative demographics were identical for both the groups. There was no statistically significant difference between the groups with regards to velocity, latency, and amplitude. The postoperative haemoglobin drop, heamatocrit, position of the dynamic hip screw and mobility status were identical. Both clinical and neurophysiological outcome suggest that damage done to vastus lateralis either by splitting or elevating appears to be identical

The postoperative course of median nerve decompression in the carpal tunnel syndrome may sometimes be complicated by postoperative pain, paresthesias, and other unpleasant symptoms, or be characterized by a slow recovery of nerve function due to prolonged preoperative injury causing extensive nerve damage. The aim of this study is to explore any possible effects of alpha lipoic acid (ALA) in the postoperative period after surgical decompression of the median nerve at the wrist. Patients were enrolled with proven carpal tunnel syndrome and randomly assigned into one of two groups: Group A: surgical decompression of the median nerve followed by ALA for 40 days. Group P: surgical decompression followed by placebo. The primary endpoint of the study was nerve conduction velocity at 3 months post surgery, Other endpoints were static 2 point discrimination, the Boston score for hand function, pillar pain and use of pain killers beyond the second postoperative day. ALA did not show to significantly improve nerve conduction velocity or Boston score. However, a statistically significant reduction in the postoperative incidence of pillar pain was noted in Group A. In addition, static 2 point discrimination showed to be significantly improved by ALA. Administration of ALA following decompression of the median nerve for carpal tunnel release is effective on nerve recovery, although this is not detectable through nerve conduction studies but in terms of accelerated and improved static two-point discrimination. The use of ALA as a supplementation for nerve recovery after surgical decompression may be extended to all types of compression syndromes or conditions where a nerve is freed from a mechanical insult. Furthermore, ALA limits post-decompression pain, including late pericicatricial pain at the base of the palm, the so called pillar pain, which seems to be associated with a reversible damage to the superfical sensitive small nerve fibers. In conclusion postoperative administration of ALA for 40 days post-median nerve decompression was positively associated with nerve recovery, induced a lower incidence of postoperative pillar pain and was associated with a more rapid improvement of static two-point discrimination. This treatment is well tolerated and associated with high levels of satisfaction and compliance, supporting its value as a standard postoperative supplementation after carpal tunnel decompression

Utilization of nerve conduction studies in the investigation and management of carpal tunnel syndrome varies according to their perceived usefulness and availability. The use of steroid injections and splinting also varies according to service availability and their perceived effectiveness. We present a three year follow up of 230 patients managed in an environment where nerve conduction testing was not readily available. The majority received splinting and a steroid injection in an effort to manage their symptoms conservatively in the first instance. Our results show that a clear majority of patients who were treated with initial splinting and steroid injections saw a recurrence of their symptoms (71.9% and 79.7% respectively) requiring eventual surgical decompression. These results would seem to suggest that conservative management of carpal tunnel does not produce the desired curative results and that there may be an argument for proceeding directly to surgery. We also showed that 55% of patients referred for Nerve Conduction Studies seem to progress to surgical decompression. This would seem to suggest that Nerve Conduction Studies could form a robust part of the standard investigation of carpal tunnel in order to identify those who would benefit from surgery