scholarly journals Mini-open carpal tunnel release technique

2021 ◽  
Vol 27 (2) ◽  
pp. 52-57
Author(s):  
Mihajlo Mitrović ◽  
Dražen Jelača
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Intraoperative Complications ◽  
Ring Finger ◽  
Superficial Fascia ◽  
Wrist Flexion ◽  
Compressive Neuropathy ◽  
Release Technique ◽  
Open Carpal Tunnel Release ◽  
Mini Open

Introduction/Aim: Carpal tunnel syndrome (CST) is the most common cause of upper extremity compressive neuropathy. Until the introduction of endoscopy, the dominant surgical method was classic open surgery. The objective of the paper is to examine the efficacy, safety and economic value of the mini-open carpal tunnel release technique using a longitudinal 2 cm long incision in the carpal region. Methods: The diagnosis was made based on clinical examination, followed by an ENMG. The study includes only patients with idiopathic CTS, while those who have developed CTS as a result of secondary causes have been excluded from the study. All patients were operated on under local anaesthesia, WALANT, without the use of a tourniquet. A longitudinal incision 2 cm long is made in the line of the radial edge of the ring finger, 2-3 cm distal to the wrist flexion crease, immediately proximal of the Caplan cardinal line and ulnar to the thenar crease. Upon cutting through the skin and subcutaneous soft tissue, the superficial fascia is identified and then cut with the same scalpel in the same direction and the same length. The transversal ligament is then identified and carefully incised with a scalpel enough to allow further decompression with the use of scissors. Using standard surgical scissors for the hand, the ligament is cut proximally to the forearm fascia and then distally until a faint crackling sound is heard, which means that the ligament had been completely cut. This must be checked by inserting the Freer elevator proximally and distally to the edge of the ligament. Now it is possible to identify the nerve and accompanying hand flexor tendons. Sutures are placed only on the skin and a roll of gauze is fixed to the wound with an elastic bandage to provide compression. The first check-up is on the very next day and the patient is advised to start doing hand exercises. The sutures are removed 10-14 days after surgery. Results: From January 2018 to December 2019, 35 carpal tunnel decompressions were performed on 30 patients using the mini-open decompression technique and standard surgical scissors. The surgery was performed on 22 patients in the operating room and 8 patients in the infirmary. There were no intraoperative complications. All patients reported no night pain from the very first day after surgery. Pillar pain, incision pain and hand weakness were progressively becoming less pronounced during the next 12 weeks. At the final check-up, only one patient still had pronounced symptoms that required a reintervention. The rest of the patients had completely recovered. Even though the endoscopic procedure for carpal tunnel decompression is constantly evolving, the classic open method and newly developed mini-open carpal tunnel release technique remain the treatments of choice. Conclusion: Our research shows that the mini-open carpal tunnel release technique is a quick, efficient, safe and cheap surgical technique for treating carpal tunnel compressive neuropathy.

Outcomes of Mini-Open Carpal Tunnel Release in Patients With Unrecordable Preoperative Nerve Conduction Potentials at a Minimum of 5 Years

Hand ◽  
2019 ◽  
pp. 155894471985781
Author(s):  
Dafang Zhang ◽  
Peter Ostergaard ◽  
Charles Cefalu ◽  
Matthew Hall ◽  
Brandon E. Earp ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Carpal Tunnel Release ◽  
Open Carpal Tunnel Release ◽  
Mini Open

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 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.

Rates of and Risk Factors for Trigger Finger after Open Carpal Tunnel Release

2021 ◽  
Author(s):  
Jeremy E. Raducha ◽  
Winston Jiang ◽  
Lindsey Kahan ◽  
James Houston Dove ◽  
Christopher Cochran ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Ring Finger ◽  
Middle Finger ◽  
Chi Square ◽  
Level Of Evidence ◽  
Patient Demographics ◽  
History Of ◽  
Chi Square Analysis ◽  
Open Carpal Tunnel Release

Abstract Background We have anecdotally noticed a higher rate of trigger fingers (TFs) developing in patients who have undergone carpal tunnel release (CTR). Questions/Objective Is the rate of TFs after CTR greater compared to the nonoperative hand? Is the thumb more commonly involved postoperatively compared with spontaneous TFs? Do particular associated comorbidities increase this risk? Patients and Methods We queried our institutional database for patients who had undergone open CTR during a 2-year period and recorded the development of an ipsilateral TF after a CTR or a contralateral TF in the nonoperative hand. Patient demographics, comorbidities, concurrent initial procedures, time to diagnosis, and finger involvement were recorded. Results A total of 435 patients underwent 556 CTRs during this period. Furthermore, 46 ipsilateral TFs developed in 38 of 556 cases (6.83%) at an average of 228.1 ± 195.7 days after surgery. The thumb was most commonly involved (37.0%) followed by the ring finger (28.3%). The incidence rate of TF in the nonoperative hand during this period was 2.7%, with the ring finger and middle finger most commonly involved (33.3 and 28.6%, respectively). Only history of prior TF in either hand was found to be a significantly associated on Chi-square analysis and multivariable regression (p < 0.001). Conclusion In patients with carpal tunnel syndrome, ipsilateral TFs occurred after 6.83% of CTRs, compared with a rate of 2.7% in the nonoperative hand, making it an important possible outcome to discuss with patients. The thumb was more commonly involved in triggering in the surgical hand compared with the nonoperative hand. Patients with a history of prior TFs in either hand were more likely to develop an ipsilateral TF after CTR. Level of Evidence This is a Level III, retrospective study.

Duration of Postoperative Dressing after Mini-open Carpal Tunnel Release: A Randomized Clinical Control Trial

2011 ◽  
Vol 36 (8) ◽  
pp. 9-10
Author(s):  
Andrew W. Ritting ◽  
Robin R. Leger ◽  
Robert Tucker ◽  
Heather Mogielnicki ◽  
Craig M. Rodner
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Clinical Control ◽  
Clinical Control Trial ◽  
Open Carpal Tunnel Release ◽  
Mini Open

scholarly journals A Comparison of Changes in Median Nerve Cross-sectional Area Between Endoscopic and Mini-Open Carpal Tunnel Release

2020 ◽  
Vol 2 (2) ◽  
pp. 80-83
Author(s):  
William R. Smith ◽  
David C. Hirsch ◽  
David O. Osei-Hwedieh ◽  
Robert J. Goitz ◽  
John Fowler
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Open Carpal Tunnel Release ◽  
Mini Open

A Prospective Study of Outcome Following Mini-open Carpal Tunnel Release

Hand Surgery ◽  
2003 ◽  
Vol 08 (01) ◽  
pp. 59-63 ◽  
Author(s):  
Michael P. Bradley ◽  
Edward P. Hayes ◽  
Arnold-Peter C. Weiss ◽  
Edward Akelman
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Historical Cohort ◽  
Endoscopic Release ◽  
Severity Scores ◽  
Tunnel Syndrome ◽  
A Prospective Study ◽  
Open Carpal Tunnel Release ◽  
Mini Open

Mini-open carpal tunnel release has been the focus of recent attention for surgical decompression of carpal tunnel syndrome. Other techniques such as standard open carpal tunnel release and endoscopic release have been well established, and outcomes, complications and results for these operations have been published widely. Our study uses the validated Levine Katz questionnaire for carpal tunnel syndrome to measure patient subjective outcomes at one year follow-up after mini-open carpal tunnel release. Thirty-four consecutive hands were enrolled prospectively with preoperative and postoperative questionnaires. Mean symptom severity scores per question improved from 2.8 to 1.3 and mean function severity scores per question improved from 2.6 to 1.3. Comparing our data to the historical cohort of Levine et al., there was a statistically significant improvement in postoperative outcomes in our population (p < 0.0001).

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