Abstract
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.
Highlights
Carpal tunnel syndrome (CTS) is the most common cause of upper extremity compressive neuropathy
The diagnosis was made based on clinical examination, followed by an ENMG
Using standard surgical scissors for the hand, the ligament is cut proximally to the forearm fascia and distally until a faint crackling sound is heard, which means that the ligament had been completely cut
Summary
Carpal tunnel syndrome (CTS) is the most common cause of upper extremity compressive neuropathy. It occurs as a result of a badly set distal radius fracture, inadequate immobilisation of distal radius fracture, in systemic diseases (rheumatoid arthritis, amyloidosis, Raynaud syndrome...), diabetes mellitus, obesity and pregnancy It can develop as a consequence of tumours inside the carpal tunnel, infection or scarring due to injury in the vicinity of the tunnel. Phalen and associates published several articles describing the nature of idiopathic CTS and the surgical treatment technique [4]. Even with the development of the endoscopic and mini-open surgical techniques, as well as surgical equipment advances, 30% of the surgeons still prefer the classic open surgical method of decompression. According to the American Academy of Orthopedic Surgeons (AAOS), the key point of surgical treatment success is the adequate visualization of the transverse ligament and median nerve followed by a complete ligament resection [7,8], which is exactly why 30% of the surgeons still prefer the classic open decompression technique [5,9]
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