Mini-Open Carpal Tunnel Decompression

Neurosurgery ◽  
2004 ◽  
Vol 54 (2) ◽  
pp. 397-400 ◽  
Author(s):  
Jason H. Huang ◽  
Eric L. Zager
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Entrapment Neuropathy ◽  
Transverse Carpal Ligament ◽  
Motor Branch ◽  
Tunnel Technique ◽  
Tunnel Syndrome ◽  
Mini Open ◽  
Surgical Release

Abstract CARPAL TUNNEL SYNDROME is the most common entrapment neuropathy, and it is caused by compression of the median nerve at the wrist. The authors describe the mini-open carpal tunnel technique for surgical release of the transverse carpal ligament. The success of the procedure depends on meticulous technique with attention to certain important anatomic details and careful avoidance of injury to the palmar cutaneous nerve and the recurrent motor branch.

The History of Carpal Tunnel Syndrome

1988 ◽  
Vol 13 (1) ◽  
pp. 28-34
Author(s):  
G. B. PFEFFER ◽  
R. H. GELBERMAN ◽  
J. H. BOYES ◽  
B. RYDEVIK
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Transverse Carpal Ligament ◽  
Motor Branch ◽  
Compressive Neuropathy ◽  
Anatomical Localization ◽  
History Of ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome

Carpal tunnel syndrome is the most frequently diagnosed, best understood and most easily treated entrapment neuropathy. During the first half of the 20th century, however, most patients with carpal tunnel syndrome were diagnosed as having compression of either the brachial plexus or thenar nerve motor branch of the median nerve. As late as 1950, only twelve patients with operative release of the transverse carpal ligament for idiopathic carpal tunnel syndrome had been reported. The delay in accurate anatomical localization of this compressive neuropathy can be attributed both to the confusion caused by the diverse manifestations of median nerve compression in the carpal tunnel, and to some interesting developments that altered early investigations in this area.

scholarly journals The Palmar Cutaneous Branch Mimicking the Recurrent Motor Branch of the Median Nerve

2018 ◽  
Vol 10 (01) ◽  
pp. 052-053
Author(s):  
Feiran Wu ◽  
Chye Ng
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Transverse Carpal Ligament ◽  
Proximal Margin ◽  
Anatomical Variant ◽  
Motor Branch ◽  
Iatrogenic Nerve Injury ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch ◽  
Tunnel Syndrome

AbstractWe report an unusual anatomical variant of the palmar cutaneous branch (PCB) of the median nerve in a 46-year-old man presenting with recurrent carpal tunnel syndrome. At surgery, after neurolysis, the PCB was visualized arising at the level of the proximal margin of the transverse carpal ligament, mimicking the appearance of the recurrent motor branch. To date, there has been no description of this branch arising at this level. We aim to remind surgeons of this variation and highlight the importance of maintaining vigilance to avoid iatrogenic nerve injury.

scholarly journals Median Nerve Variation: A Complete Spin before Terminal Branching

2020 ◽  
Vol 15 (01) ◽  
pp. e1-e4
Author(s):  
Amgad S. Hanna ◽  
Zhikui Wei ◽  
Barbara A. Hanna
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Distal Forearm ◽  
Flexor Digitorum Superficialis ◽  
Anatomical Variant ◽  
Motor Branch ◽  
Surgical Interventions ◽  
Tunnel Syndrome ◽  
Flexor Digitorum

AbstractMedian nerve anatomy is of great interest to clinicians and scientists given the importance of this nerve and its association with diseases. A rare anatomical variant of the median nerve in the distal forearm and wrist was discovered during a cadaveric dissection. The median nerve was deep to the flexor digitorum superficialis (FDS) in the carpal tunnel. It underwent a 360-degree spin before emerging at the lateral edge of FDS. The recurrent motor branch moved from medial to lateral on the deep surface of the median nerve, as it approached the distal carpal tunnel. This variant doesn't fall into any of Lanz's four groups of median nerve anomalies. We propose a fifth group that involves variations in the course of the median nerve. This report underscores the importance of recognizing variants of the median nerve anatomy in the forearm and wrist during surgical interventions, such as for carpal tunnel syndrome.

Experimentally and Theoretically Narrowing Carpal Arch Width to Increase the Area Formed by the Transverse Carpal Ligament

2011 ◽  
Author(s):  
Suk H. Yu ◽  
Tracy A. Mondello ◽  
Zong-Ming Li
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Transverse Carpal Ligament ◽  
Cross Sectional ◽  
Arch Width ◽  
Endoscopic Release ◽  
Volar Aspect ◽  
Tunnel Syndrome

Carpal tunnel syndrome is conventionally treated by open and endoscopic release surgeries in which transecting the transverse carpal ligament (TCL) relieves mechanical insults around the median nerve. The TCL release surgeries yield an increase in the tunnel cross-sectional area particularly within the volar aspect of the tunnel, the arch area, where the median nerve is located. As a result of increased arch area, post-operative follow-up studies using MRI confirmed a significant volar migration of the median nerve [1]. However, transecting the TCL compromises critical biomechanical roles of the carpal tunnel [2], and therefore, it is imperative to investigate an alternative method for treating carpal tunnel syndrome patients while preserving the TCL. Li et al. suggested that increasing the TCL length and narrowing the carpal arch width (CAW) as potential alternatives for increasing the arch area [3]. However, the data from their application of palmarly directed forces to the TCL from inside of the tunnel showed that the TCL length remained relatively constant while the carpal bones were mobilized to increase the arch area [3]. The purpose of this study was to investigate the relationship between CAW narrowing and the TCL-formed arch area by experimental and geometrical modeling.

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.

scholarly journals Mini-open Carpal Tunnel Release

2018 ◽  
Vol 19 (4) ◽  
pp. 21-27
Author(s):  
Paulo Henrique Pires De Aguiar ◽  
Carlos Alexandre Martins Zicarelli ◽  
Fabio V. C. Sparapani ◽  
Pedro Augusto De Santana Jr ◽  
Alexandros Theodoros Panagoupolos ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Neurological Deficits ◽  
Motor Branch ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release ◽  
Nerve Entrapment Syndrome ◽  
Mini Open

Introduction: Median nerve compression is the most common nerve entrapment syndrome. After carpal tunnel release, patients often complain about the scar cosmetic appearance. Objective: The aim of our study was to evaluate the clinical outcome, surgical technique and complications of mini-open carpal release. Methods: We reviewed data from 48 surgical procedures for Carpal Tunnel Syndrome in 32 patients at the Pinheiros Neurologicaland Neurosurgical Clinic in the period of 2000 and 2008. The mean age was 49 years-old. We used a 2 cm incision and microscopic technique to obtain meticulous access of the palmar hand anatomy with special attention to both the recurrent motor branch and palmar cutaneous nerve. Results: Twenty-two patients had total resolution of symptoms. Two patients had no change of neurological symptoms. During the follow up no infection or neurological deficits were observed. Conclusion: Mini-open is a safe and effective approach for carpal tunnel syndrome release. However detailed palmar hand anatomy is mandatory to prevent lesion of branching palmar nerve. The use of microscope is desirable to help identify important structures and avoid complications.

scholarly journals MRI Assessment of Changes in Swelling of Wrist Structures Following OMT in Patients With Carpal Tunnel Syndrome

2017 ◽  
Vol 27 (3) ◽  
pp. 25-31
Author(s):  
Kenneth A. Ramey ◽  
Robert E. Kappler ◽  
Murthy Chimata ◽  
John Hohner ◽  
Angelique C. Mizera
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Thoracic Spine ◽  
Nerve Conduction ◽  
Transverse Carpal Ligament ◽  
Upper Thoracic Spine ◽  
Pain Ratings ◽  
Tunnel Syndrome ◽  
Upper Thoracic

Abstract We treated patients with carpal tunnel syndrome using OMT. Treatments were focused on the upper thoracic spine, lower cervical spine, and tenderpoints in the forearm muscles. OMT was not applied to the wrist in an attempt to stretch the transverse carpal ligament. MRI images were used to assess changes in fluid content in both the carpal tunnel and median nerve after OMT treatment. MRI measurements of median nerve area, carpal tunnel area and length of the transverse carpal ligament were also obtained. These measurements were correlated with changes in nerve conduction velocities (NCVs), pain ratings, wrist motion measurements, and somatic dysfunction information. The numeric data were compared and contrasted using Hest statistics. Significance probabilities of P < 0.05 were computed. Statistically significant changes were noted in pain ratings, wrist motions and nerve conduction (sensory amplitude). Five patients responded with improvement in symptoms and one did not. The responder group demonstrated a decrease in the amount of swelling of both the median nerve and carpal tunnel. The nonresponder demonstrated increased swelling in both the median nerve and carpal tunnel. Changes in the swelling of both the median nerve and carpal tunnel appear to more closely parallel changes in hand symptoms than nerve conduction results.1 No statistically significant increases occurred in the length of the transverse carpal ligament or the carpal tunnel area. Minimal changes in both the length of the transverse carpal ligament and carpal tunnel area did occur despite no active attempts to stretch this region. All six patients had a predominance of acute changes in the upper thoracic spine and upper ribs. Most patients had tension in the flexor muscles of the forearm. Treatment of the upper thoracic spine, upper ribs, and forearms are all important in the management of carpal tunnel syndrome.

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