Mini-open Carpal Tunnel Release Research Articles

Comparison of early clinical outcome in carpal tunnel release - mini-open technique with palmar incision vs. endoscopic technique with wrist crease incision-

BackgroundThe purpose of this study was to examine two techniques for Carpal Tunnel Syndrome, mini-Open Carpal Tunnel Release (mini-OCTR) and Endoscopic Carpal Tunnel Release (ECTR), to compare their therapeutic efficacy.MethodsSixteen patients who underwent mini-OCTR in palmar incision and 17 patients who underwent ECTR in the wrist crease incision were included in the study. All patients presented preoperatively and at 1, 3, and 6 months postoperatively and were assessed with the Visual Analogue Scale (VAS) and the Disabilities of Arm, Shoulder and Hand Score (DASH). We also assessed the pain and cosmetic VAS of the entire affected hand or surgical wound, and the patient’s satisfaction with the surgery.ResultsIn the objective evaluation, both surgical techniques showed improvement at 6 months postoperatively. The DASH score was significantly lower in the ECTR group (average = 3 months: 13.6, 6 months: 11.9) than in the mini-OCTR group (average = 3 months: 27.3, 6 months: 20.6) at 3 and 6 months postoperatively. Also, the pain VAS score was significantly lower in the ECTR group (average = 17.1) than in the mini-OCTR group (average = 36.6) at 3 months postoperatively. The cosmetic VAS was significantly lower in the ECTR group (average = 1 month: 15.3, 3 months: 12.2, 6 months: 5.41) than in the mini-OCTR group (average = 1 month: 33.3, 3 months: 31.2, 6 months: 24.8) at all time points postoperatively. Patient satisfaction scores tended to be higher in the ECTR group (average = 3.3) compared to the mini-OCTR group (average = 2.7).ConclusionsECTR in wrist increase incision resulted in better pain and cosmetic recovery in an early postoperative phase compared with mini-OCTR in palmar incision. Our findings suggest that ECTR is an effective technique for patient satisfaction.

Clinic Carpal Tunnel Release Surgery Outcomes and High-Value Care.

As healthcare costs continue to rise, the importance ofdelivering high-value healthcare increases.The volume of carpal tunnel release surgeries performed annually generates a significant cost burden for the healthcare system. The fundamental expenses of carpal tunnel release surgery are facility fees, anesthesia fees, and surgeon fees. Performing open carpal tunnel release surgeries in the clinic utilizing local anesthesia and field sterilization minimizes facility and anesthesia costs. We compared patient outcomes, as measured by infection and revision rates, between hospital-based, ambulatory surgery center-based, and clinic-based carpal tunnel release operations. Three hundred and eighty-eight patients were treated with isolated mini-open carpal tunnel release procedures by three fellowship-trained hand surgeons: 12 patients had hospital-based procedures, 229 had ASC-based procedures, and 147 had clinic-based procedures. All procedures were performed using amini-open approach. No patients were diagnosed with deep infections post-procedurally, irrespective of venue. Our results show no significant difference in outcomes between venues. Therefore, we conclude that the outcomes of open carpal tunnel release surgeries performed in the clinic were not inferior to carpal tunnel release operations performed at the ambulatory surgery center or the hospital. The cost savings from field sterilization, local anesthesia, and the absence of a facility fee provide an opportunity to expand high-value care.

Libération du canal carpien sous WALANT chez les patients hémodialysés avec shunt artério-veineux

IntroductionLong-term hemodialysis patients experience many hand diseases caused by dialysis-related amyloidosis (DRA), with carpal tunnel syndrome (CTS) being the most common. For the patients with arteriovenous (AV) shunt, surgical decompression remains challenging because of the contraindications of a tourniquet. A technique called wide-awake local anesthesia with no tourniquet (WALANT), in which epinephrine provides hemostasis instead of the tourniquet, can be a good option for hemodialysis patients. The purpose of this study was to assess the prevalence of CTS and related factors in hemodialysis patients and to establish the efficacy and safety of WALANT on hemodialysis patients with AV shunt. Materials and methodsThis prospective study included 275 hemodialysis patients between March 2013 and July 2019. Forty-three patients were diagnosed with CTS, involving surgical treatment on 70 wrists. We performed mini-open carpal tunnel release using WALANT on the AV shunt arm (defined as the WALANT group), while using lidocaine and a tourniquet on the arm without an AV shunt (defined as the tourniquet group). The operative time, surgical field bleeding (blood loss and hemostasis score), surgical pain (injection pain and tourniquet pain), outcomes, complications, and satisfaction were compared between the two groups. ResultsThe incidence of CTS in hemodialysis patients was 15.6%. Longer dialysis durations were related to higher proportions of patients with CTS. There was no significant difference in blood loss (p=0.184) and hemostasis score (p=0.165) between the two groups. Clinical symptoms improved in all patients and there were no severe complications. The WALANT group had a significantly longer preparation time of approximately 20minutes, but they had low injection pain and no tourniquet pain. There was also no significant difference in terms of satisfaction levels (p=0.212). DiscussionCTS is a very common disease among hemodialysis patients. WALANT provided sufficient hemostasis without a tourniquet, despite the patients’ high bleeding tendency. The technique also had the advantages of low injection pain, no tourniquet pain, and no major complications. In this respect, WALANT can be a good choice for hemodialysis patients with AV shunt. Level of evidenceII.

Mini-Open Carpal Tunnel Release in Carpal Tunnel Syndrome

Mini-Open Carpal Tunnel Release in Carpal Tunnel Syndrome

Comparison of Minimally Invasive Carpal Tunnel Release with Open Carpal Tunnel Release

Objective: To compare the long-term results of conventional treatment [open carpal tunnel release (OCTR)] with the results of mini-open carpal tunnel release surgery (MCTR), performed through the palmar approach. Study design: retrospective study Place and Duration: This study was conducted at Pakistan Institute of Medical Sciences Islamabad from June 2020 to June 2022 Methodology: This research involves a total of 40 patients who were divided into 2 groups. Each group contained 20 patients respectively. One group was treated with mini-open carpal tunnel surgery and the other was treated with conventional treatment. Each patient had to conduct follow-ups for at least one years. The results were evaluated through SSS (Symptom Severity Scale), VAS (Visual Analogue Scale), DASH Score (Disability of arms, shoulder and hand), and FSS (Functional Status Scale). For a statistical analysis, confidence interval of 95% was set and significance was 0.05. Results: In the long-term follow-up, both groups showed comparable results. The mean follow-up for MCTR and conventional method was 2 years. The DASH score was 4.2 and 8.9, SSS was 1.2 and 1.1, VAS was 0.5 and 0.9, and the FSS was 1.4 and 1.1. The scar sensitivity was lower in MCTR. It was 5 percent in MCTR while 12 percent in conventional treatment. The pain, time taken in surgery, and recovery time were also lower in the MCTR group. Both groups showed less complications and there was not a single recurrence. Practical implication : To compare the long-term results of conventional treatment [open carpal tunnel release (OCTR)] with the results of mini-open carpal tunnel release surgery (MCTR), performed through the palmar approach. Practically less invasive surgery (minimal invasive) is more beneficial for patient in terms of wound complications Conclusion: Mini-open carpal tunnel release is a better option than the conventional treatment. It is a fast, reliable, and simple process which relieves the patient from scar sensitivity. Keywords: Mini-open carpal tunnel release, open carpal tunnel release, carpal tunnel syndrome

Trial of ultrasound guided carpal tunnel release versus traditional open release (TUTOR).

Background:Carpal tunnel release (CTR) is a surgical treatment option for patients with carpal tunnel syndrome (CTS) symptoms that are unresponsive to conservative treatment. Most patients experience symptomatic relief after CTR regardless of the surgical technique. However, direct comparisons of the safety and effectiveness between CTR surgical techniques are limited. The purpose of this randomized controlled trial is to compare the safety and effectiveness of CTR with ultrasound guidance (CTR-US) versus mini-open CTR (mOCTR) in subjects with symptomatic CTS.Design and methods:TUTOR (Trial of Ultrasound guided CTR versus Traditional Open Release) is a randomized controlled trial in which 120 subjects at up to 12 sites in the United States will be randomized (2:1) to receive CTR-US or mOCTR. The primary endpoint of the study is the percentage of patients who return to normal daily activities within 3 days of the procedure. Secondary endpoints of the study are median time to return to normal daily activities, percentage of patients who return to work within 3 days of the procedure, median time to return to work, Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) change score at 3 months, BCTQ Functional Status Scale (BCTQ-FSS) change score at 3 months, Numeric Pain Scale change score at 3 months, EuroQoL-5 Dimension 5-Level (EQ-5D-5L) change score at 3 months, and the incidence of device- or procedure-related adverse events at 3 months. Patient follow-up in this trial will continue for 1 year.Ethics and dissemination:This study was approved by a central institutional review board and ongoing trial oversight will be provided by a data safety monitoring board (DSMB). The authors intend to report the results of this trial at medical conferences and peer-reviewed journals. The outcomes of TUTOR will have important clinical and economic implications for all stakeholders involved in treating patients with CTS.Study registration:ClinicalTrials.gov (https://clinicaltrials.gov): NCT05405218.Level of evidence:1

Carpal tunnel release under wide awake local anesthesia with no tourniquet in hemodialysis patients with arteriovenous shunt

IntroductionLong-term hemodialysis patients experience many hand diseases caused by dialysis-related amyloidosis (DRA), with carpal tunnel syndrome (CTS) being the most common. For the patients with arteriovenous (AV) shunt, surgical decompression remains challenging because of the contraindications of a tourniquet. A technique called wide-awake local anesthesia with no tourniquet (WALANT), in which epinephrine provides hemostasis instead of the tourniquet, can be a good option for hemodialysis patients. The purpose of this study was to assess the prevalence of CTS and related factors in hemodialysis patients, and to establish the efficacy and safety of WALANT on hemodialysis patients with AV shunt. Materials and methodsThis prospective study included 275 hemodialysis patients between March 2013 and July 2019. 43 patients were diagnosed with CTS, involving surgical treatment on 70 wrists. We performed mini-open carpal tunnel release using WALANT on the AV shunt arm (defined as the WALANT group), while using lidocaine and a tourniquet on the arm without an AV shunt (defined as the tourniquet group). The operative time, surgical field bleeding (blood loss and hemostasis score), surgical pain (injection pain and tourniquet pain), outcomes, complications, and satisfaction were compared between the two groups. ResultsThe incidence of CTS in hemodialysis patients was 15.6%. Longer dialysis durations were related to higher proportions of patients with CTS. There was no significant difference in blood loss (p=0.184) and hemostasis score (p=0.165) between the two groups. Clinical symptoms improved in all patients, and there were no severe complications. The WALANT group had a significantly longer preparation time of approximately 20minutes, but they had low injection pain and no tourniquet pain. There was also no significant difference in terms of satisfaction levels (p=0.212). DiscussionCTS is a very common disease among hemodialysis patients. WALANT provided sufficient hemostasis without a tourniquet, despite the patients’ high bleeding tendency. The technique also had the advantages of low injection pain, no tourniquet pain, and no major complications. In this respect, WALANT can be a good choice for hemodialysis patients with AV shunt. Level of evidenceII.

Mini-Open Carpal Tunnel Release in Carpal Tunnel Syndrome

Mini-Open Carpal Tunnel Release in Carpal Tunnel Syndrome

Mini-open carpal tunnel release: technique, feasibility and clinical outcome compared to the conventional procedure in a long-term follow-up

We sought to evaluate the findings of our anatomically landmarks based mini-open procedure (MCTR) through a palmar approach and to compare its outcome and practicability to the conventional method (OCTR). The study consisted of 100 matched patients (n = 50 MCTR, n = 50 OCTR) with a minimum follow-up of three years. The outcome was characterized via the Disabilities of Arm, Shoulder and Hand Score (DASH), Symptom Severity Scale (SSS), Functional Status Scale (FSC), and Visual Analogue Scale (VAS). All adverse events were observed. An alpha of 0.05 and a confidence level of 95% were set for statistical analyses. Both techniques showed comparable functional results in a long-term period (mean follow-up MCTR: 60 months and OCTR: 54 months). MCTR versus OCTR at mean: DASH: 4.6/8.3 (p = 0.398), SSS: 1.3/1.2 (p = 0.534), FSC: 1.3/1.2 (p = 0.617), VAS: 0.4/0.7 (p = 0.246). The MCTR convinced through a lower rate of scar sensibility (MCTR: 0% vs. OCTR: 12%, 0/50 vs. 6/50; p = 0.007) and pillar pain, as well as a shortened recovery period and surgical time relative to the OCTR. Low complication rates were observed in both groups, no recurrences had to be documented. The MCTR procedure revealed a similar good clinical outcome as the conventional technique. MCTR is a minimally-invasive, reliable, fast and simple procedure with an obvious benefit regarding scar sensibility.

Mini-Open Carpal Tunnel Release with a Pediatric Nasal Speculum: A 10-Year Retrospective Case Series

Background Nasal speculum assisted carpal tunnel release (CTR) is performed using smaller incisions than are normally achieved with open procedures. We performed a retrospective case series analysis to evaluate short and long-term symptom and functional outcomes of a single surgeon’s results with this technique. Methods During the period of 2005-2011, 678 cases met the inclusion criteria. Of these, 198 cases representing 152 unique individuals were contacted and consented to participate in the study. A chart review was performed to identify demographics, pre-operative questionnaire results, and post-operative characteristics. Post-operative Symptom Severity Scale and Functional Status Scale results from the Carpal Tunnel Questionnaire were then obtained via telephone interviews. Results The mean (StDev) time to follow up was 4.08 (2.1) years with the mean age at follow up 61.94 (14) years. More females (56%) were included than males (44%). Using linear mixed models, patients with nasal speculum assisted CTR had significant improvements in both Symptom Severity and Functional Status Scales following surgery. In addition, 97.7% of patients reported their incisions were aesthetically pleasing and only 78.7% reported their incisions were still visible. Several pre-operative factors had a significant association with good surgical outcomes, including: Positive Compression Test/Durkin’s; Severe/very severe difficulties on the Functional Status Scale; High scores on the Symptom Severity and Functional Status Scales. Conclusions This surgeon’s experience with nasal speculum assisted CTR shows that this technique results in not only aesthetically pleasing results, but also excellent symptomatic and functional outcomes. Level of Evidence Level IV Case Series

Predicting Clinically Relevant Patient-Reported Symptom Improvement After Carpal Tunnel Release: A Machine Learning Approach.

Symptom improvement is an important goal when considering surgery for carpal tunnel syndrome. There is currently no prediction model available to predict symptom improvement for patients considering a carpal tunnel release (CTR). To predict using a model the probability of clinically relevant symptom improvement at 6 mo after CTR. We split a cohort of 2119 patients who underwent a mini-open CTR and completed the Boston Carpal Tunnel Questionnaire preoperatively and 6 mo postoperatively into training (75%) and validation (25%) data sets. Patients who improved more than the minimal clinically important difference of 0.8 at the Boston Carpal Tunnel Questionnaire-symptom severity scale were classified as "improved." Logistic regression, random forests, and gradient boosting machines were considered to train prediction models. The best model was selected based on discriminative ability (area under the curve) and calibration in the validation data set. This model was further assessed in a holdout data set (N = 397). A gradient boosting machine with 5 predictors was chosen as optimal trade-off between discriminative ability and the number of predictors. In the holdout data set, this model had an area under the curve of 0.723, good calibration, sensitivity of 0.77, and specificity of 0.55. The positive predictive value was 0.50, and the negative predictive value was 0.81. We developed a prediction model for clinically relevant symptom improvement 6 mo after a CTR, which required 5 patient-reported predictors (18 questions) and has reasonable discriminative ability and good calibration. The model is available online and might help shared decision making when patients are considering a CTR.

What’s New in Hand and Wrist Surgery

What’s New in Hand and Wrist Surgery

Evidence for Ultrasound-Guided Carpal Tunnel Release

This report is a narrative review of the clinical evidence for ultrasound (US)-guided carpal tunnel release (USGCTR) in patients with carpal tunnel syndrome (CTS). To date, there are 23 clinical publications (case reports, prospective and retrospective case series, and randomized comparative studies) on USGCTR, involving 1,072 wrists. Although many different devices have been used to perform USGCTR, current publications report > 98% clinical success rate without any documented neurovascular injuries. Of the publications, 7 were done by orthopedic surgery, 6 by physiatry, 6 by family medicine, and 1 each by interventional radiology, rheumatology, plastic surgery, and neurosurgery. There is evidence that USGCTR can improve symptom severity, improve functional outcomes, reduce scarring, shorten recovery time, and hasten return to work, even in patients undergoing bilateral release. Based on current studies, USGCTR appears to be a safe and effective method for transecting the transverse carpal ligament (TCL), with reported faster recovery and functional improvement than mini-open carpal tunnel release. It is performed by physicians from many different fields of medicine trained in USG procedures. Additional randomized controlled trials, with long-term follow-up, are needed to help to confirm the best device and technique to perform this procedure.

Mini-inciziona tehnika u zbrinjavanju sindroma karpalnog tunela

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.

Angiographic Findings of the Median Artery in Two Patients with Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the most common type of entrapment neuropathy. The majority of CTS cases are idiopathic and affect females between 40 and 60 years old. Conversely, this report describes two female patients in their mid-30's diagnosed with CTS caused by a median artery in the carpal tunnel using ultrasonography. We visualized the median artery which emerged from the radial artery and common interosseous artery in the proximal forearm of each patient by magnetic resonance angiography (MRA) before surgery. After the vertical incision of the transverse carpal ligament, the anomalous vessel was encountered, which ran over the median nerve at the radial aspect, and a simple mini-open procedure was performed for carpal tunnel release. Postoperatively, the CTS symptoms were relieved in both patients. The purpose of this report is to describe the persistent median artery using MRA in two patients and to report on their postoperative mini-open carpal tunnel release outcomes.

Prospective Evaluation of Surgical and Anesthetic Technique of Carpal Tunnel Release in an Orthopedic Practice

The goal of this study was to determine whether the type of anesthesia (monitored anesthesia care [MAC] vs wide-awake local anesthesia no tourniquet technique [WALANT]) or the surgical technique (mini-open vs endoscopic) would affect patient satisfaction with postoperative pain control, postoperative pain, or opioid use after carpal tunnel release (CTR). The hypothesis was that endoscopic and open CTR surgery would have the same patient satisfaction with postoperative pain control, postoperative pain, and opioid use, but WALANT surgery would have higher patient satisfaction with postoperative pain control, postoperative pain, and opioid use than MAC. This prospective study examined all patients undergoing carpal tunnel surgery by 4 hand surgeons at our institution. Two surgeons perform primarily 1-incision endoscopic CTR and the other 2 perform mini-open CTR. Two surgeons perform all procedures under WALANT; the other 2 employ MAC with a local anesthetic. Postsurgical questionnaires were completed at the 2-week postoperative visit. Patients reported remaining pills, average pain, highest pain, lowest pain, and overall satisfaction with postoperative pain control. A total of 93 patients underwent CTR by the 4 participating hand surgeons. Of these, 43 underwent open CTR and 50 underwent endoscopic CTR. Sixty-two were performed under MAC and 31 with WALANT. With regard to anesthesia type, overall there was 5.5 mean morphine equivalents (MME) less prescribed and an average of 3.6 MME more remaining on the first postoperative visit with WALANT compared with MAC. Patient satisfaction with postoperative pain control was an average score of 7.9 for MAC and 7.4 for WALANT. With regard to surgical technique, overall, there was 15.2 MME less prescribed and an average of 1.03 MME more remaining on the first postoperative visit with endoscopic CTR compared with open CTR. Patient satisfaction with postoperative pain control between endoscopic and open release demonstrated an average score of 7.1 and 8.0, respectively. This study demonstrates minimal differences in opioid pain medication use, patient satisfaction with postoperative pain control, and pain scores in a comparison of surgical technique as well as anesthesia type. Therapeutic IV.

AB125. Ten year results of mini open carpal tunnel release for severe carpal tunnel syndrome-sustained clinical improvement

AB125. Ten year results of mini open carpal tunnel release for severe carpal tunnel syndrome-sustained clinical improvement

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

PurposeThe purpose of this study was to determine whether there is a difference in the change in cross-sectional area (CSA) of the median nerve in patients undergoing carpal tunnel release (CTR) based on surgical technique and whether this change is associated with changes in patient-reported outcomes evaluated using the Carpal Tunnel Syndrome Assessment Questionnaire.MethodsIndividuals with carpal tunnel syndrome were evaluated with ultrasound and the CTSAQ before and 6 weeks after surgery. Patients were eligible for inclusion if they underwent either a mini-open CTR (MOCTR) or endoscopic CTR (ECTR). A single surgeon performed all surgeries. Changes in median nerve CSA, Carpal Tunnel Syndrome Assessment Questionnaire scores, and their associated surgical technique (MOCTR vs ECTR) were analyzed.ResultsA total of 77 patients were enrolled, 13 of whom were lost to follow-up, which left 64 for analysis. Of those, 42 patients underwent ECTR and 22 MOCTR. Mean age was 55 years; there were 52 women and 12 men. Mean changes in CSA for endoscopic and mini-open techniques from before to 6 weeks after surgery were –1.9 mm2 (95% confidence interval [CI], –1.1 to –2.7) and +0.6 mm2 (95% CI, –1.6 to 0.4), respectively. Mean Symptom Severity Scores improved after endoscopic and mini-open release by 1.7 (95% CI, 1.4–2.1) and 1.5 (95% CI, 1.2–1.9), respectively. Mean Functional Status Scores improved after endoscopic and mini-open release by 1.2 (95% CI, 0.9–1.9) and 0.7 (95% CI, 0.03–1.3), respectively.ConclusionsPatients undergoing ECTR demonstrated decreased median nerve CSA, whereas those undergoing MOCTR demonstrated increased median nerve CSA at 6 weeks. All patients undergoing surgical intervention demonstrated improvement in both Symptom Severity Scores and Functional Status Scores after surgery. Whereas both techniques successfully improve patient outcome scores, an increase in CSA after MOCTR may be seen in the initial postoperative period, potentially contributing to a slower short-term improvement in outcome in functional scores compared with ECTR.Type of study/level of evidenceTherapeutic IV.

Functional Outcome Of Mini-Open Carpal Tunnel Release In Carpal Tunnel Syndrome

Introduction: Carpal tunnel syndrome is the most common compression neuropathy in clinical practice and is also the most extensively studied. In Mini-open carpal tunnel release, the transverse carpal ligament is transected using a small open cut at the volar aspect of the proximal palm. The objectives of this study were to determine the functional outcome of mini-open carpal tunnel release procedure, to use the Boston Questionnaire to determine the functional outcome following mini open carpal tunnel release which includes pain, numbness, weakness and fine hand activities.
 Methods: This descriptive cross-sectional was conducted in National After informed consent, the cases who meet the informed criteria were examined and relevant details were filled up in the proforma preoperatively and two weeks post-operatively. Assessment of the patient’s symptom severity and functional status was done with the Boston questionnaire.
 Results: CTS was most common in the age group of 25-29 years (36.36%) and was predominant in housewives (18.20%). Mean symptom severity scores per person improved from 3.11 pre-operatively to 1.12 post-operatively. Mean functional status scores per person improved from 2.65 pre-operatively to 1.03 post-operatively. There was a statistically significant improvement in postoperative outcomes in our population.
 Conclusions: The findings in this study indicate that mini-open carpal tunnel release has a good functional outcome.
 Keywords: carpal tunnel syndrome; compression neuropathy; transverse carpal ligament.

Effectiveness of mini-open carpal tunnel release: An outcome study.

BackgroundCarpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy with a high morbidity and healthcare-related costs. Currently there is no consensus about the best treatment option. The purpose of this prospective cohort study conducted at a single institution was to evaluate the clinical outcomes and patient satisfaction following a mini-open carpal tunnel release for idiopathic CTS.MethodsA total of 72 patients (53 female and 19 male patients; mean age, 57.8±15.3 years; range, 24–94 years) had a mini-open carpal tunnel release performed by a single senior surgeon between June 2015 and June 2016. The patients were evaluated preoperatively, and at 3 and 12 months post-intervention. At every follow-up, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and visual analogue scale (VAS) scores for pain and satisfaction were completed. Digital sensibility (using Semmes- Weinstein monofilaments) was assessed and pinch and grip strengths were measured.ResultsStatistically significant and clinically relevant improvement was found in terms of digital sensibility, grip and pinch strength (except for 2-point pinch), BCTSQ scores and pain scores. The complication rate was minimal, and no major complications occurred. Two patients experienced recurrence. The availability of follow-up records (including patient-reported outcomes, BCTSQ and VAS scores, and the complication rate) at 1-year post-intervention varied between 69% and 74% (50–53 patients) depending on which parameter was assessed. Patient satisfaction was high (mean, 80.9±26.0; range, 0–100).ConclusionsThis study demonstrates that mini-incision carpal tunnel release is clinically effective in the short and long term.