Variations in incisions and postoperative management in carpal tunnel surgery

2002 ◽  
Vol 10 (2) ◽  
pp. 63-67 ◽  
Author(s):  
Carolyn M Levis ◽  
Thomas H Tung ◽  
Susan E Mackinnon
Keyword(s):  
Carpal Tunnel ◽  
Postoperative Care ◽  
Carpal Tunnel Release ◽  
Vertical Axis ◽  
Postoperative Management ◽  
Anatomical Landmarks ◽  
The Third ◽  
Carpal Tunnel Surgery ◽  
Web Space ◽  
Open Carpal Tunnel Release

This study examines the variations in incisions and postoperative protocol of open carpal tunnel release. A questionnaire was distributed to 65 hand surgeons. Respondents were asked to draw their preferred incision on original photocopies of the same palm. The results were measured against standard anatomical landmarks (thenar crease, vertical axis of the third web space, proximal palmar crease and the distal wrist crease). The participants were also asked to answer questions concerning their postoperative protocols. Demographics of the cohort, as well as the variations in incisions and postoperative management, were analyzed. Significant variations existed in the length and location of the incision in the palm. The differences in postoperative care in this cohort of surgeons were less significant.

scholarly journals Endoscopic carpal tunnel release using the modified Chow's extrabursal dual portal technique: Clinical results of 640 patients

2007 ◽  
Vol 60 (1-2) ◽  
pp. 54-60 ◽  
Author(s):  
Poong-Taek Kim ◽  
Ivan Micic ◽  
Il-Hyng Park ◽  
In-Ho Jeon
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Clinical Results ◽  
The Third ◽  
Endoscopic Carpal Tunnel Release ◽  
Nocturnal Pain ◽  
Tunnel Syndrome ◽  
Web Space ◽  
Open Carpal Tunnel Release ◽  
Portal Technique

During a 4-year period, a total of 784 wrists of 640 patients were treated using a modified Chow's extrabursal dual portal endoscopic technique. All surgeries were performed under local anesthesia. A 1-cm incision was marked 1 - 2 cm proximal to the distal wrist crease, in the midline, ulnar to the palmaris longus. A distal portal was established along a line bisecting an angle created by the intersection of the ulnar border of the abducted thumb and the third web space. An obturator and cannula assembly were inserted under the portal, and three blades were used to cut under endoscopic vision. Subjective results showed that 706 hands (90%) had a reduction in the severity of pain after carpal tunnel release, 706 hands (90%) had a reduction in the severity of paresthesia and 729 hands (93%) had a reduction in the severity of numbness. Nocturnal pain and paresthesia were relieved in 745 cases (95%). Compared with the conventional open carpal tunnel release, less postoperative pain and faster recovery have been reported following endoscopic carpal tunnel release. This study suggests that extrabursal dual portal technique is a safe and reliable treatment option for carpal tunnel syndrome with a high success rate.

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 Patient Comprehension of Carpal Tunnel Surgery

Hand ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 175-180 ◽  
Author(s):  
Gregory R. Waryasz ◽  
Joseph A. Gil ◽  
Daniel Chiou ◽  
Paul Ramos ◽  
Jonathan R. Schiller ◽  
...  
Keyword(s):  
Health Literacy ◽  
Carpal Tunnel ◽  
Postoperative Care ◽  
Medical Condition ◽  
Carpal Tunnel Release ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Average Percentage ◽  
Patient Comprehension ◽  
Carpal Tunnel Surgery

Background: Health literacy is the ability of a patient to understand their medical condition. The purpose of this investigation is to determine whether patients are able to obtain an elementary understanding of the fundamental principles of carpal tunnel release and the postoperative instructions after going through the process of informed consent and being provided an additional standardized postoperative instruction document. Our hypothesis is that patients will lack an understanding of these principles and, therefore, will be at risk for being noncompliant in their postoperative care. Methods: Fifty patients with a diagnosis of carpal tunnel surgery who elected to undergo carpal tunnel release alone were enrolled. A standardized education process was performed. Patients completed the questionnaire at their postoperative visit. Results: The average percentage of correct answers was 75.8% (8.34 out of 11 correct). Fisher exact test analysis demonstrated that patients with a lower education level were less likely to know how long it takes for their preoperative symptoms to resolve ( P = .0071), and they were less likely to correctly choose all of the important elements of postoperative care during the first week after surgery ( P = .022). Conclusions: Although we made efforts to help patients achieve health literacy in carpal tunnel surgery, we found that patients continued to lack comprehension of pertinent components of carpal tunnel surgery, particularly understanding the involved anatomy.

Value of anatomic landmarks in carpal tunnel surgery

2013 ◽  
Vol 38 (6) ◽  
pp. 641-645 ◽  
Author(s):  
O. Y. Yavuz ◽  
I. Uras ◽  
B. Tasbas ◽  
M. Kaya ◽  
R. Ozay ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Transverse Carpal Ligament ◽  
Safe Distance ◽  
Kirschner Wires ◽  
Anatomic Landmarks ◽  
Motor Branch ◽  
The Third ◽  
Carpal Tunnel Surgery ◽  
Web Space ◽  
The Relationship

This study investigated which anatomic landmarks were most useful for correct and safe incision placement in carpal tunnel surgery. Kirschner wires were attached to the hands to mark previously defined landmarks. The bony attachments of the transverse carpal ligament, which were identified previously, were drawn on an anteroposterior digital x-ray of the hand, with the thumb in full abduction. The relationship between anatomic landmarks and these bony attachments were examined. In all hands, either the line along the third web space or the crease between the thenar and the hypothenar regions, or both, were on the ulnar half of the transverse carpal ligament. During incision placement, we recommend selecting the most ulnar choice between the line drawn along the third web space and the crease between the thenar and hypothenar regions in order to be at safe distance from the recurrent motor branch of the median nerve.

scholarly journals Does the Duration and Severity of Symptoms Have an Impact on Relief of Symptoms after Carpal Tunnel Release?

2019 ◽  
Vol 14 (01) ◽  
pp. e1-e8
Author(s):  
Mehreen Masud ◽  
Mamoon Rashid ◽  
Saleem Malik ◽  
Muhommad Ibrahim Khan ◽  
Saad-ur-Rehman Sarwar
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Hand Function ◽  
Normal Function ◽  
Duration Of Symptoms ◽  
Compressive Neuropathy ◽  
Carpal Tunnel Surgery ◽  
Short Period ◽  
Group 2 ◽  
Open Carpal Tunnel Release

Rationale Carpal tunnel syndrome (CTS) is the most frequently encountered compressive neuropathy of the upper limb. The treatment of CTS ranges from conservative management to carpal tunnel release. Many patients with misconception about the potential morbidity and with the hope of successful conservative treatment delay the surgical release of carpal tunnel. This delay results in reduced recovery of sensory and motor median nerve function. Objective The aim of this study was to evaluate the influence of preoperative duration and severity of symptom on the outcome of carpal tunnel surgery. Method It included 45 cases of CTS, all treated with limited access open carpal tunnel release. The duration of symptoms (i.e., pain, numbness, tingling, waking up at night because of pain/numbness, difficulty in grasping small objects, and their preoperative severity) was noted using Boston CTS questionnaire. To investigate the outcome, patients were divided into three groups based on their duration of symptoms. Result Group1: The severity of symptoms was reduced to normal in a short period of time in patients who presented with duration of symptoms less than 6 months. Group 2: Patients in whom symptoms lasted for 6 to 12 months had reduced or delayed recovery of hand function as compared with first group. Group 3: Patients who had symptoms for more than 12 months had incomplete recovery of grip strength. Return to normal function took the longest time (median: 16 weeks) in this group. Conclusion This study suggests that patients who present late have delayed/incomplete relief of symptoms after carpal tunnel release.

scholarly journals Trigger Fingers After Open Carpal Tunnel Release

2020 ◽  
Vol 28 (4) ◽  
pp. 192-195
Author(s):  
Duffield Ashmead ◽  
Haruko Okada ◽  
Jonathan Macknin ◽  
Steven Vander Naalt ◽  
Ilene Staff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Specific Treatment ◽  
Trigger Thumb ◽  
Carpal Tunnel Surgery ◽  
Tunnel Syndrome ◽  
Compensation Status ◽  
Open Carpal Tunnel Release

Trigger finger (TF) and carpal tunnel syndrome (CTS) are common conditions often occurring together with an unclear relationship. While some studies conclude that TFs occur as a result of carpal tunnel release (CTR), others have not established a causal relationship. Our purpose was to evaluate the prevalence and timing of TF development in the same hand after open CTR in our population. This was a retrospective review of 497 patients undergoing open CTR by a single surgeon. Two hundred twenty-nine charts were analysed for age, gender, handedness, BMI, workers’ compensation status, and background disease. We analysed the specific digit involved and timing to development of triggering after CTR. Thirty-one patients developed triggering after CTR (13.5%). Mean age was 52.5 (14.0) years. Follow-up ranged from 1 to 53 months with a median follow-up of 6 months (interquartile range = 2-13). The thumb was the most common to trigger (42.22%), followed by the ring 24.44%, middle 22.22%, little 8.89%, and index fingers 2.22%. Trigger thumb occurred at 3.5 months (3.6) post-operatively, while other digits triggered at 7.5 months (4-10.25) after surgery ( P = .022). No risk factors were associated with TF development. Our results suggest that a trigger thumb develops more frequently and earlier than other trigger digits after an open CTR. Further study is needed to clarify the mechanisms involved and may enable specific treatment such as local anti-inflammatory medication following CTR. We suggest educating prospective carpal tunnel surgery patients to high risk of triggering following CTR.

Neurophysiology not Required Before Surgery for Typical Carpal Tunnel Syndrome

2001 ◽  
Vol 26 (1) ◽  
pp. 61-64 ◽  
Author(s):  
V. FINSEN ◽  
H. RUSSWURM
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Diagnosis ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Neurophysiological Tests ◽  
Carpal Tunnel Surgery ◽  
Neurophysiological Studies ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release

Sixty-eight patients with typical carpal tunnel syndrome underwent neurophysiological investigations preoperatively, but these were not assessed until the end of the study. Open carpal tunnel release was performed and the clinical diagnosis of carpal tunnel syndrome was considered as confirmed when there was a prompt resolution of the preoperative symptoms. Sixty-three of the 68 patients responded well to surgery, three had equivocal outcomes and two did not improve, and thus were considered not to have carpal tunnel syndrome. The neurophysiological tests were normal in these two patients, but were also normal in 14 of the 63 patients who improved with carpal tunnel surgery. Preoperative neurophysiology might therefore have led to up to 14 of the 63 cases of carpal tunnel syndrome being turned down for surgery. We conclude that neurophysiological studies contribute little to the diagnosis in typical cases of carpal tunnel syndrome, and are more often confounding than of assistance.

Early Outcome and Cost-Effectiveness of Endoscopic Versus Open Carpal Tunnel Release: A Randomized Prospective Trial

2003 ◽  
Vol 28 (5) ◽  
pp. 444-449 ◽  
Author(s):  
N. L. B. SAW ◽  
S. JONES ◽  
L. SHEPSTONE ◽  
M. MEYER ◽  
P. G. CHAPMAN ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Prospective Trial ◽  
Cost Effective ◽  
Early Outcome ◽  
Endoscopic Carpal Tunnel Release ◽  
Carpal Tunnel Surgery ◽  
Significant Difference ◽  
Open Carpal Tunnel Release

Proponents of endoscopic carpal tunnel release have been advocating the technique for more than 10 years but there is still debate about its efficacy, safety and cost-effectiveness. We have performed a randomized, prospective, blind trial to compare early outcome after single portal endoscopic or open carpal tunnel surgery and to assess the cost-effectiveness of the procedures. There were no significant differences in symptom and functional activity scores, grip strength or anterior carpal pain in the first 3 months. For those in employment, we found a statistically significant difference between the two treatment groups with the endoscopic group returning to work, on average, 8 (95% CI, 2–13 days) days sooner than the open group. This translates into a cost saving to industry. There were no major neurovascular complications in either group. On the basis of these findings, we recommend that endoscopic carpal tunnel release should be considered in the employed as a cost-effective procedure, but perhaps not in the general population as a whole.

SHORT VERSUS LONG-ACTING LOCAL ANAESTHETIC IN OPEN CARPAL TUNNEL RELEASE: WHICH PROVIDES BETTER PREEMPTIVE ANALGESIA IN THE FIRST 24 HOURS?

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 45-47 ◽  
Author(s):  
Z. H. Chan ◽  
V. Balakrishnan ◽  
A. McDonald
Keyword(s):  
Carpal Tunnel ◽  
Local Anaesthetic ◽  
Carpal Tunnel Release ◽  
Local Anaesthetics ◽  
Pain Scores ◽  
Carpal Tunnel Surgery ◽  
Significant Difference ◽  
Long Acting ◽  
Open Carpal Tunnel Release

Open carpal tunnel release is commonly performed under local anaesthesia. No study has compared intra-operative short- versus long-acting local anaesthetics as preemptive analgesics in carpal tunnel surgery. In this single-blinded prospective study, 100 consecutive carpal tunnel releases were performed by a single surgeon at one institution with either lignocaine (n = 50) or ropivacaine (n = 50). Allocation was performed via the method of alternation. Subjects were given a questionnaire to answer the following: (1) time to first incidence of pain, (2) quality of first night's sleep, and (3) mean numerical pain scores in the first 24 hours. The time to the first postoperative pain was significantly shorter in the lignocaine group (5.58 vs. 9.17 hours, p < 0.035). There were no significant difference in the incidence of poor first night's sleep (16% vs. 26%, p = 0.28) or mean pain scores in the first day (3.6 vs. 2.9, p = 0.16). Existing evidence advocates for long-acting intraoperative local anaesthetic because it results in a longer duration of postoperative analgesia, however, our study suggests that it may also result in a poorer first night's sleep.

scholarly journals Open Carpal Tunnel Release Under WALANT – Suitable for All Ages?

2021 ◽  
Author(s):  
Laura Lech ◽  
Sebastian Leitsch ◽  
Christian Krug ◽  
Mario Bonaccio ◽  
Elisabeth Haas ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Open Carpal Tunnel Release
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