scholarly journals The Effect of an Open Carpal Tunnel Release on Thumb CMC Biomechanics

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Marc A. Tanner ◽  
Bryan P. Conrad ◽  
Paul C. Dell ◽  
Thomas W. Wright
Keyword(s):  
Carpal Tunnel ◽  
Soft Tissues ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Before And After ◽  
Fresh Frozen ◽  
Rigid Body Mechanics ◽  
Thumb Carpometacarpal ◽  
Open Carpal Tunnel Release ◽  
Cmc Joint

Purpose. We have observed worsening thumb pain following carpal tunnel release (CTR) in some patients. Our purpose was to determine the effect of open CTR on thumb carpometacarpal (CMC) biomechanics.Methods. Five fresh-frozen cadaver arms with intact soft tissues were used. Each specimen was secured to a jig which fixed the forearm at 45° supination, and the wrist at 20° dorsiflexion, with thumb pointing up. The thumb was axially loaded with a force of 130 N. We measured 3D translation and rotation of the trapezium, radius, and first metacarpal, before and after open CTR. Motion between radius and first metacarpal, radius and trapezium, and first metacarpal and trapezium during loading was calculated using rigid body mechanics. Overall stiffness of each specimen was determined.Results. Total construct stiffness following CTR was reduced in all specimens but not significantly. No significant changes were found in adduction, pronation, or dorsiflexion of the trapezium with respect to radius after open CTR. Motion between radius and first metacarpal, between radius and trapezium, or between first metacarpal and trapezium after open CTR was not decreased significantly.Conclusion. From this data, we cannot determine if releasing the transverse carpal ligament alters kinematics of the CMC joint.

Endoscopic Carpal Tunnel Release

2019 ◽  
pp. 989-994
Author(s):  
Antony Hazel ◽  
Neil F. Jones
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Hand Surgery ◽  
Anatomical Landmarks ◽  
Transverse Carpal Ligament ◽  
Palmar Arch ◽  
Endoscopic Carpal Tunnel Release ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery ◽  
Open Carpal Tunnel Release

Conventional open carpal tunnel release surgery is one of most successful procedures in hand surgery and has been demonstrated to be an effective treatment for carpal tunnel syndrome. However, a known sequelae in some individuals who undergo the procedure is “pillar” pain. In an effort to avoid this condition and help people return to work more quickly, the endoscopic technique was developed. Endoscopic carpal tunnel release offers a minimally invasive alternative to other traditional techniques with similar outcomes. By placing the incision proximal to the transverse carpal ligament there is potential for decreased scar sensitivity and pillar pain. The technique is technically demanding. The superficial palmar arch and common digital nerve to the ring and middle fingers are at risk for injury during the procedure. With adherence to anatomical landmarks and the proper visualization, the surgery may be safely performed.

scholarly journals The Accuracy of Common Hand Injections With and Without Ultrasound: An Anatomical Study

Hand ◽  
2017 ◽  
Vol 12 (6) ◽  
pp. 591-596 ◽  
Author(s):  
Philip To ◽  
Kaylan N. McClary ◽  
Micah K. Sinclair ◽  
Brittany A. Stout ◽  
Mohab Foad ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Anatomical Study ◽  
Blue Dye ◽  
Success Rates ◽  
Additional Information ◽  
Lower Accuracy ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Thumb Carpometacarpal ◽  
Cmc Joint

Background: The aim of the study is to determine the accuracy of hand injections with and without the aid of ultrasound (U/S) into the carpal tunnel, thumb carpometacarpal (CMC) joint, first dorsal compartment (DC) and the radiocarpal (RC) joint. Methods: Four participants of various level of experience injected the carpal tunnel, thumb CMC, first DC, and RC joint into 40 fresh frozen cadaver specimens with blue dye and radiographic contrast. Participants 1 and 2 were injected without U/S guidance, and participants 3 and 4 were injected with U/S guidance. A successful injection was determined by both fluoroscopy and dissection/direct observation. Additional information was recorded for each injection such as median nerve infiltration and evidence of thumb CMC arthrosis. Results: The overall accuracy for carpal tunnel, thumb CMC, first DC, and RC injections were 95%, 63%, 90%, and 90%, respectively. Success was compared with and without U/S guidance. Success rates were similar for each injection site, except the thumb CMC joint, where U/S participants had 25% higher accuracy. In the setting of thumb CMC arthrosis, the incidence of success was 38% for participants with no U/S aid and 72% for participants with U/S aid. There was a significant difference between participants who used U/S with the participant with more U/S experience being more successful. Conclusion: Carpal tunnel, first DC, and RC injections had an accuracy of greater than 90%. Thumb CMC injections have a lower accuracy (63%) and one can improve accuracy with U/S. The accuracy of U/S-guided injections is dependent on the user and their experience.

Technical Tip for Proximal Release During Open Carpal Tunnel Release Using a Subcutaneous Pocket

2016 ◽  
Vol 21 (02) ◽  
pp. 280-282
Author(s):  
Dariush Nikkhah ◽  
Amir H. Sadr ◽  
Mohammed Ali Akhavani
Keyword(s):  
Carpal Tunnel ◽  
Local Anaesthesia ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Blunt Dissection ◽  
Collective Experience ◽  
Subcutaneous Tissues ◽  
Open Carpal Tunnel Release ◽  
Subcutaneous Plane ◽  
Optimal Visualization

Technical steps to avoid incomplete proximal release of the carpal tunnel are described. Local anaesthesia is infiltrated as a subcutaneous bleb over the distal wrist crease and extending 2–3 cm over the forearm fascia. Tumescence of local anaesthesia into the subcutaneous plane helps create a pocket between the forearm fascia and subcutaneous tissues. Intraoperatively a subcutaneous pocket is made above the transverse carpal ligament and antebrachial fascia with blunt dissection. A retractor is placed under the pocket, which facilitates optimal visualization to allow reliable complete proximal release of compression.The authors have found that this technique is reproducible and reliable across their collective experience.

scholarly journals Functional Outcome Of Mini-Open Carpal Tunnel Release In Carpal Tunnel Syndrome

2019 ◽  
Vol 2 (1) ◽  
pp. 8-14
Author(s):  
Sagun Pradhan ◽  
Rishi Bista ◽  
Laxman Sharma ◽  
Nabin Poudel ◽  
Bhawana Amatya
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Functional Outcome ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release ◽  
Mini Open ◽  
Boston Questionnaire

Introduction: Carpal tunnel syndrome is the most common compression neuropathy in clinical practice and is also the most extensively studied. In Mini-open carpal tunnel release, the transverse carpal ligament is transected using a small open cut at the volar aspect of the proximal palm. The objectives of this study were to determine the functional outcome of mini-open carpal tunnel release procedure, to use the Boston Questionnaire to determine the functional outcome following mini open carpal tunnel release which includes pain, numbness, weakness and fine hand activities. Methods: This descriptive cross-sectional was conducted in National After informed consent, the cases who meet the informed criteria were examined and relevant details were filled up in the proforma preoperatively and two weeks post-operatively. Assessment of the patient’s symptom severity and functional status was done with the Boston questionnaire. Results: CTS was most common in the age group of 25-29 years (36.36%) and was predominant in housewives (18.20%). Mean symptom severity scores per person improved from 3.11 pre-operatively to 1.12 post-operatively. Mean functional status scores per person improved from 2.65 pre-operatively to 1.03 post-operatively. There was a statistically significant improvement in postoperative outcomes in our population. Conclusions: The findings in this study indicate that mini-open carpal tunnel release has a good functional outcome. Keywords: carpal tunnel syndrome; compression neuropathy; transverse carpal ligament.

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