Comparison of Clinical and Electromyographic Outcomes of Amnion–Methylcobalamin in Carpal Tunnel Release
DOI:
https://doi.org/10.59784/glosains.v7i2.747Keywords:
Amniotic Membrane, Carpal Tunnel Release, Carpal Tunnel Syndrome, Electromyography, MethylcobalaminAbstract
Background: Carpal tunnel syndrome (CTS) commonly requires carpal tunnel release (CTR); however, residual symptoms and incomplete nerve recovery remain unresolved. Amniotic membrane and methylcobalamin have individually demonstrated anti-inflammatory, neuroregenerative, and remyelinating effects, but their combined use as an adjuvant during CTR has not been evaluated.
Objective: To compare clinical and electromyographic (EMG) outcomes between standard carpal tunnel release (CTR) alone and CTR combined with amniotic membrane and methylcobalamin in patients with CTS.
Methods: A nonrandomized controlled trial conducted at Prof. Dr. I.G.N.G. Ngoerah General Hospital (January–March 2025) involving 24 CTS patients allocated to CTR alone (control, n = 12) or CTR with amniotic membrane impregnated with a methylcobalamin solution (treatment, n = 12). EMG parameters (distal motor latency, amplitude, and conduction velocity) and the Liverpool Carpal Tunnel Scoring System (LCTSS) were measured preoperatively and 4 weeks postoperatively. Paired t-tests and Wilcoxon signed-rank tests were applied (α = 0.05).
Results: Both groups showed significant postoperative EMG improvement (p < 0.001). The treatment group achieved greater gains in conduction velocity (Δ = +6.48 m/s vs +4.58 m/s) and SNAP amplitude (Δ = +7.44 µV vs +4.55 µV). LCTSS improved in both groups; however, the within-group difference for the treatment arm did not reach statistical significance at 4 weeks (p = 0.083). No complications were observed.
Conclusion: Combining amniotic membrane and methylcobalamin with CTR accelerates electrophysiologic recovery, although the 4-week clinical advantage was not statistically significant. This combination may benefit patients with severe or recurrent CTS; however, larger randomized controlled trials with 6–12-month follow-up are warranted.
References
Alanazy, M. H. (2017). Clinical and electrophysiological evaluation of carpal tunnel syndrome: approach and pitfalls. Neurosciences Journal, 22(3), 169–180.
Buentello‐Volante, B., Molina‐Medinilla, M., Aguayo‐Flores, E., Magaña‐Guerrero, F. S., & Garfias, Y. (2020). Comparison of amniotic membrane transplantation and carpal tunnel syndrome release surgery (CTRS) and CTRS alone: clinical outcomes at 1‐year follow‐up. Journal of Tissue Engineering and Regenerative Medicine, 14(5), 714–722. https://doi.org/10.1002/term.3033
Burton, C., Chesterton, L. S., & Davenport, G. (2014). Diagnosing and managing carpal tunnel syndrome in primary care. The British Journal of General Practice, 64(622), 262. https://doi.org/10.3399/bjgp14X679903
Chan, Y., Selvaratnam, V., Manickavasagar, T., Shetty, V., & Sahni, V. (2022). Liverpool carpal tunnel scoring system to predict nerve conduction study results: A prospective correlation study. World Journal of Orthopedics, 13(2), 171. https://doi.org/10.5312/wjo.v13.i2.171
Chang, M. C. (2020). Conservative treatments frequently used for chronic pain patients in clinical practice: a literature review. Cureus, 12(8). https://doi.org/10.2147/OPTH.S208008
Chen, X., Zhang, B., & Yuan, Y. (2024). Study of ultrasound and nerve electromyogram in diagnosis of carpal tunnel syndrome and its severity in the elderly. Biotechnology and Genetic Engineering Reviews, 40(4), 4495–4511. https://doi.org/10.1080/02648725.2023.2213079.
Duncan, S. F. M., Bhate, O., & Mustaly, H. (2017). Pathophysiology of carpal tunnel syndrome. In Carpal Tunnel Syndrome and Related Median Neuropathies: Challenges and Complications (pp. 13–29). Springer. https://doi.org/10.1007/978-3-319-57010-5_3.
Emril, D. R., Zakaria, I., & Amrya, M. (2019). Agreement between high-resolution ultrasound and electro-physiological examinations for diagnosis of carpal tunnel syndrome in the Indonesian population. Frontiers in Neurology, 10, 888. https://doi.org/10.3389/fneur.2019.00888
Gaspar, M. P., Abdelfattah, H. M., Welch, I. W., Vosbikian, M. M., Kane, P. M., & Rekant, M. S. (2016). Recurrent cubital tunnel syndrome treated with revision neurolysis and amniotic membrane nerve wrapping. Journal of Shoulder and Elbow Surgery, 25(12), 2057–2065. https://doi.org/10.1016/j.jse.2016.09.013
Joshi, A., Patel, K., Mohamed, A., Oak, S., Zhang, M. H., Hsiung, H., Zhang, A., & Patel, U. K. (2022). Carpal tunnel syndrome: pathophysiology and comprehensive guidelines for clinical evaluation and treatment. Cureus, 14(7). https://doi.org/10.7759/cureus.27053
Kilinc, F., Behmanesh, B., Seifert, V., & Marquardt, G. (2021). Does recurrence of carpal tunnel syndrome (CTS) after complete division of the transverse ligament really exist? Journal of Clinical Medicine, 10(18), 4208. https://doi.org/10.3390/jcm10184208
Liu, C., Liu, D., Zhang, X., Hui, L., & Zhao, L. (2023). Nanofibrous polycaprolactone/amniotic membrane facilitates peripheral nerve regeneration by promoting macrophage polarization and regulating inflammatory microenvironment. International Immunopharmacology, 121, 110507. https://doi.org/10.1016/j.intimp.2023.110507
Newcomb, N. L., Nammour, M., Desai, B., Vaughan, L., & Sisco-Wise, L. E. (2023). Revision Carpal Tunnel Release With Umbilical Cord Allograft: A Four-Year Retrospective Cohort Study. Ochsner Journal, 23(1), 16–20. https://doi.org/10.31486/toj.22.0079
Nishimoto. (2015). Methylcobalamin promotes the differentiation of Schwann cells and remyelination in lysophosphatidylcholine-induced demyelination of the rat sciatic nerve. (No Title). https://doi.org/10.3389/fncel.2015.00298
Okada, K., Tanaka, H., Temporin, K., Okamoto, M., Kuroda, Y., Moritomo, H., Murase, T., & Yoshikawa, H. (2010). Methylcobalamin increases Erk1/2 and Akt activities through the methylation cycle and promotes nerve regeneration in a rat sciatic nerve injury model. Experimental Neurology, 222(2), 191–203. https://doi.org/10.1016/j.expneurol.2009.12.017
Osiak, K., Elnazir, P., Walocha, J. A., & Pasternak, A. (2022). Carpal tunnel syndrome: state-of-the-art review. Folia Morphologica, 81(4), 851–862.
Padua, L., Cuccagna, C., Giovannini, S., Coraci, D., Pelosi, L., Loreti, C., Bernabei, R., & Hobson-Webb, L. D. (2023). Carpal tunnel syndrome: updated evidence and new questions. The Lancet Neurology, 22(3), 255–267.
Shurr, D. G., Blair, W. F., & Bassett, G. (1986). Electromyographic changes after carpal tunnel release. The Journal of Hand Surgery, 11(6), 876–880.
Song C, Lee SJ, K. (2022). Electrophysiological Changes in Patients with Carpal Tunnel Syndrome after Open Carpal Tunnel Release. https://doi.org/10.18214/jend.2022.00122
Suzuki, K., Tanaka, H., Ebara, M., Uto, K., Matsuoka, H., Nishimoto, S., Okada, K., Murase, T., & Yoshikawa, H. (2017). Electrospun nanofiber sheets incorporating methylcobalamin promote nerve regeneration and functional recovery in a rat sciatic nerve crush injury model. Acta Biomaterialia, 53, 250–259.
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