Abstract

This work is based on a series of 12 patients on hemodialysis who were operated on for a carpal tunnel syndrome, 66% of whom were seen with an average follow-up of 39 months (range 4 to 99 months). The operation was performed bilaterally on 5 occasions, which brings the number of hands operated to 17. Of the hemodialyzed patients 9.2% presented with median nerve compression. The main etiologies of renal insufficiency were chronic, interstitial nephropathies (5 cases) and chronic glomerular nephropathies (5 cases). All the patients were operated without a pneumatic tourniquet in order to preserve arteriovenous fistula permeability. In addition to division of the flexor retinaculum, 3 approaches to the Guyon canal, 3 anterior epineural membrane removals and 8 partial synovectomies of the flexors were performed. The postoperative evaluation included bilateral clinical and electromyographic analysis of both hands. In this study, the authors indicate the preferential appearance of certain sequelae specific to this type of syndrome for the hemodialyzed patient, and they propose therapies which could reduce their incidence. The use of electromyograms for systematic screening must be considered within the scope of earlier performance of surgery, this would help avoid irreversible neurological lesions.