Limited Open Carpal Tunnel Release through a Small Palmar Incision-Experience in the Usage of a New Instrument-The Indiana Carpal Tunnel Tome

Abstract

Surgical release of the carpal tunnel for carpal tunnel syndrome has become one of the most commonly performed procedures in hand surgery since the report by Phalen et al. Both the open carpal tunnel release and the endoscopic carpal tunnel release methods has its supporters and its adversaries. To be able to combine the simplicity and safety of both methods, and to reduce its hazard towards tissue trauma and postoperative morbidity, variable operation methods were developed. The Indiana carpal tunnel tome was designed by James W. Strickland, MD, in the Indiana Hand Center 12 This device divides the transverse carpal ligament through a small palmar incision. From April 1998 to August 1998, 8 carpal tunnel releases (CTR) were performed in 7 patients using the Indiana tome by multiple surgeons. The patients' ages ranged from 21 to 75 years (mean: 54.71 years). The duration of preoperative symptoms ranged from 2 months to 10 years (mean: 21.38 months). The mean follow-up period was 8 weeks. The efficacy of carpal tunnel release was determined by postoperative tenderness, recovery of postoperative strength, and satisfaction. In our series, four patients (4 CTR-50%) increased postoperative grip strength within 6-8 weeks, and six patients (6 CTR-75%) increased postoperative pinch strength. Seventy-five percent of the patients had either complete resolution or only minimum amount of residual symptoms. Furthermore, the tenderness at incision site, radial and ulnar pillar pain were relatively low. In our clinical experience, the technique of carpal tunnel release through a limited palmar incision with the Indiana tome really represents the advantages of simple, quick, easy learning and safety.