High Bifurcation of Median Nerve at the Wrist Causing Common Digital Nerve Injury in Endoscopic Carpal Tunnel Release

2002 ◽  
Vol 27 (6) ◽  
pp. 580-582 ◽  
Author(s):  
I. H. JEON ◽  
P. T. KIM ◽  
I. H. PARK ◽  
B. C. PARK ◽  
J. C. IHN
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Electric Shock ◽  
Local Anaesthetic ◽  
Carpal Tunnel Release ◽  
Digital Nerve ◽  
Proximal Half ◽  
Endoscopic Carpal Tunnel Release ◽  
Middle Ring ◽  
High Level

A 45-year-old right-handed woman was treated by endoscopic carpal tunnel release under local anaesthetic. When cutting the proximal half of the flexor retinaculum with the retrograde blade, she complained of an electric shock-like pain in her middle and ring fingers. Open exploration of the carpal tunnel was performed and a laceration of the middle/ring common digital nerve, which bifurcated at the unusually high level of the wrist crease, was found.

scholarly journals Supraretinacular endoscopic carpal tunnel release: A safe alternative method for treatment of carpal tunnel syndrome

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199340
Author(s):  
Kotaro Sato ◽  
Kenya Murakami ◽  
Yoshikuni Mimata ◽  
Gaku Takahashi ◽  
Minoru Doita
Keyword(s):  
Learning Curve ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Open Surgery ◽  
Carpal Tunnel Release ◽  
Safe Alternative ◽  
Endoscopic Carpal Tunnel Release ◽  
Flexor Retinaculum ◽  
Carpal Tunnel Surgery ◽  
Conversion Rates

Purpose: Supraretinacular endoscopic carpal tunnel release (SRECTR) is a technique in which an endoscope is inserted superficial to the flexor retinaculum through a subcutaneous tunnel. The benefits of this method include a clear view for the surgeon and absence of median nerve compression. Surgeons can operate with a familiar view of the flexor retinaculum and median nerve downward, similar to open surgery. This study aimed to investigate the learning curve for SRECTR, an alternate method for carpal tunnel release, and evaluate its complications and the functional outcomes using a disposable commercial kit. Methods: We examined the open conversion rates and complications associated with SRECTR in 200 consecutive patients performed by two surgeons. We compared the operative time operated by a single surgeon. We evaluated outcomes in 191 patients according to Kelly’s grading system. Patients’ mean follow-up period was 12.7 months. Results: Nine patients required conversion to open surgery. There were no injuries to the nerves and tendons and no hematoma or incomplete dissection of the flexor retinaculum. The operative times varied between 11 and 34 minutes. We obtained the following results based on Kelly’s grading of outcomes: excellent in 116, good in 59, fair in 13, and poor in 3 patients. Conclusions: We found no patients with neurapraxia, major nerve injury, flexor tendon injury, superficial palmar arch injury, and hematoma. Although there was a learning curve associated with SRECTR, we performed 200 consecutive cases without neurovascular complications. This method may be a safe alternative to minimally invasive carpal tunnel surgery.

ENDOSCOPIC CARPAL TUNNEL RELEASE FOR RECURRENT CARPAL TUNNEL SYNDROME AFTER PREVIOUS OPEN RELEASE

Hand Surgery ◽  
2004 ◽  
Vol 09 (02) ◽  
pp. 235-239 ◽  
Author(s):  
Lam Chuan Teoh ◽  
Puay Ling Tan
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Open Release ◽  
Endoscopic Carpal Tunnel Release ◽  
Endoscopic Release ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release ◽  
Surgical Release

Recurrent carpal tunnel syndrome from various causes has been shown to occur in up to 19% of patients. Endoscopic carpal tunnel release has been used to decompress the median nerve in carpal tunnel syndrome for many years. However, endoscopic release for recurrent carpal tunnel syndrome after previous surgical release has not been reported. Nine hands in six patients had recurrent carpal tunnel syndrome five to 20 years after previous open carpal tunnel release. All the cases were successfully treated with endoscopic release.

Morphologic Analysis of the Carpal Tunnel and Median Nerve Following Open and Endoscopic Carpal Tunnel Release

Hand ◽  
2019 ◽  
pp. 155894471986171 ◽  
Author(s):  
Blair R. Peters ◽  
Amanda M. Martin ◽  
Brett F. Memauri ◽  
Hardy W. Bock ◽  
Robert B. Turner ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Resonance Imaging ◽  
Open Release ◽  
Endoscopic Carpal Tunnel Release ◽  
Endoscopic Release ◽  
Significant Difference

Background: Endoscopic carpal tunnel release (ECTR) has purported advantages over open release such as reduced intraoperative dissection and trauma and more rapid recovery. Endoscopic carpal tunnel release has been shown to have comparable outcomes to open release, but open release is considered easier and safer to perform. Previous studies have demonstrated an increase in carpal tunnel volume, regardless of the technique used. However, the mechanism by which this volumetric increase occurs has been debated. Our study will determine through magnetic resonance imaging (MRI) analysis the morphologic changes that occur in both open carpal tunnel release (OCTR) and ECTR, thereby clarifying any morphologic differences that occur as a result of the 2 operative techniques. We hypothesize that there will be no morphologic differences between the 2 techniques. Methods: This was a prospective study to compare the postoperative anatomy of both techniques with MRI. Nineteen patients with clinical and nerve conduction study–confirmed carpal tunnel syndrome underwent either open or endoscopic release. Magnetic resonance imaging was performed preoperatively and 6 months postoperatively in all patients to examine the volume of the carpal tunnel, transverse distance, anteroposterior (AP) distance, divergence of tendons, and Guyon’s canal transverse and AP distance. Results: There was no significant difference in the postoperative morphology of the carpal tunnel and median nerve between OCTR and ECTR at 6-month follow-up on MRI. Conclusion: We conclude that there are no morphologic differences in OCTR and ECTR. It is an increase in the AP dimension that appears to be responsible for the increase in the volume of the carpal tunnel.

ENDOSCOPIC CARPAL TUNNEL RELEASE AND CONGENITAL ANOMALIES OF THE MEDIAN NERVE

Hand Surgery ◽  
2003 ◽  
Vol 08 (02) ◽  
pp. 265-270 ◽  
Author(s):  
Andrew V. Cavallo ◽  
Philip G. Slattery ◽  
Richard J. Barton
Keyword(s):  
Median Nerve ◽  
Nerve Injury ◽  
Carpal Tunnel ◽  
Congenital Anomalies ◽  
Carpal Tunnel Release ◽  
Effective Means ◽  
Open Release ◽  
Endoscopic Carpal Tunnel Release ◽  
Endoscopic Release

Endoscopic release has been shown to be a safe and effective means of carpal tunnel decompression. The surgeon needs to be aware of the variations in the anatomy of the median nerve in order to minimise the risk of nerve injury. In this series of 748 endoscopic carpal tunnel releases, six were found to have variations in the median nerve anatomy, in two patients conversion to open release was necessary.

Is Complete Release of all Volar Carpal Canal Structures Necessary for Complete Decompression in Endoscopic Carpal Tunnel Release?

2007 ◽  
Vol 32 (5) ◽  
pp. 537-542 ◽  
Author(s):  
A. YOSHIDA ◽  
I. OKUTSU ◽  
I. HAMANAKA
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Active Power ◽  
Full Length ◽  
Hand Position ◽  
Pressure Measurements ◽  
Proximal Margin ◽  
Endoscopic Carpal Tunnel Release ◽  
Flexor Retinaculum

This study investigated the need to completely divide the flexor retinaculum to achieve full decompression of the median nerve in the carpal canal, using carpal canal pressure measurements at the mid-point and/or the proximal one-third of the flexor retinaculum to analyse the degree of decompression after release of successive lengths of the flexor retinaculum from the distal holdfast fibres to its proximal margin. Pressure measurements were taken at each operative step in the resting hand position and during active power gripping. The pressure measurements indicated that decompression of the carpal canal was achieved both at rest and on active gripping after complete division of the flexor retinaculum. However, pressure measurements indicated that complete decompression had not been achieved during active power gripping with the proximal one-third of the flexor retinaculum intact. These results demonstrate the need for complete release of the full length of the flexor retinaculum, including the distal holdfast fibres.

Median Nerve Excursion during Endoscopic Carpal Tunnel Release

Neurosurgery ◽  
2004 ◽  
Vol 54 (5) ◽  
pp. 1155-1161 ◽  
Author(s):  
Serdar Tuzuner ◽  
Sibel Özkaynak ◽  
Cem Acikbas ◽  
Aydin Yildirim
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Endoscopic Carpal Tunnel Release

Surgical Release of the Median Nerve under Local Anaesthesia for Carpal Tunnel Syndrome

1988 ◽  
Vol 13 (4) ◽  
pp. 395-396
Author(s):  
M. ALTISSIMI ◽  
G. B. MANCINI
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Local Anaesthetic ◽  
Local Anaesthesia ◽  
Subcutaneous Tissue ◽  
Carpal Tunnel Release ◽  
Skin Incision ◽  
Tunnel Syndrome ◽  
Surgical Release

Carpal tunnel release was performed under local anaesthesia in 124 wrists of 108 patients. The local anaesthetic was injected into the carpal tunnel and into the subcutaneous tissue under the line of the skin incision. A tourniquet was used in all cases. Analgesia was complete in all but six patients. Only one patient had real difficulty in tolerating the tourniquet. In 18 cases the median nerve, when exposed at operation, showed evidence of some damage caused by the needle or by injection of local anaesthetic but, at follow-up, no symptoms or signs related to this damage were found.

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