Technique Of Carpal Tunnel Release Research Articles

Abordaje ecoguiado a nivel antecubital para cirugía del síndrome del túnel del carpo

IntroductionThere are various anaesthetic techniques for ambulatory surgery of carpal tunnel release. The ultrasound-guided nerve blocks offer advantages compared to other techniques. The purpose of this study was to evaluate the efficacy using ultrasound-guided block at the antecubital fossa, as well as to evaluate complications, patient satisfaction and surgeon satisfaction with the block. Materials and methodsProspective observational study with 32 elective patients for carpal tunnel release in a one-day case unit. An ultrasound-guided block with mepivacaine 1% was performed at the antecubital fossa, aiming for the median, ulnar and the lateral and medial cutaneous nerves of the forearm. The measurements of the anteroposterior and laterolateral diameters of the median and ulnar nerves were recorded, before and after injection. Motor and sensory levels were evaluated for the median and ulnar nerves at 5 and 30min post injection, and compared with the contralateral hand. Pain from the surgical incision time and recovery were recorded, together with complications, and patient and surgeon satisfaction with the block. ResultsThe antecubital fossa ultrasound-guided block was successful in 93.7% of the patients. No patients needed rescue analgesia in recovery and no complications were recorded. Patient satisfaction was 93.7% and surgeon satisfaction was 97%. ConclusionsA selective block of the medial, ulnar and medial and lateral cutaneous nerves of the forearm are effective and satisfactory anaesthetic techniques for carpal tunnel release in a one-day case unit. It allows early mobilization, minimises risks and amount of local anaesthetic used.

Endoscopic Carpal Tunnel Release Is Preferred Over Mini-open Despite Similar Outcome: A Randomized Trial

The decision to perform endoscopic versus the mini-open carpal tunnel release technique is most likely left to surgeons rather than patients with idiopathic carpal tunnel syndrome. We hypothesized that (1) at 3 months after surgery, the subjective outcomes of endoscopic release, performed on one hand, and mini-incision release, performed on the other, would not differ in patients with bilateral carpal tunnel syndrome; however, (2) each patient would likely prefer one technique over the other for specific reasons. Fifty-two patients with bilateral carpal tunnel syndrome had one hand randomized to undergo endoscopic release and the other to undergo mini-incision release. Each patient was assessed with the Boston Carpal Tunnel Questionnaire (BCTQ) and DASH preoperatively and at each followup. Three months after surgery, the patients commented on which technique they preferred and completed a questionnaire regarding the reasons for not preferring the other technique. The mean BCTQ symptom/function score and DASH improved similarly in the endoscopic release group and the mini-incision release group. Thirty-four patients preferred endoscopic release and 13 preferred the mini-incision technique. Scar or pillar pain was the most commonly cited factor in not preferring either technique followed by postoperative pain for the open technique and transient worsening of symptoms for the endoscopic technique. Despite similar improvements in BCTQ and DASH scores after endoscopic and open techniques at 3 months postoperatively, the majority of our patients preferred the endoscopic technique. The most concerning reason for not preferring the other technique was scar or pillar pain.

Minimally invasive ultrasound‐guided carpal tunnel release: A cadaver study

Carpal tunnel syndrome is a common condition frequently requiring surgical intervention. We describe a new minimally invasive surgical technique for carpal tunnel release utilizing ultrasound (US) visualization. The technique was performed on 20 fresh frozen cadaver specimens. A surgical metallic probe with a "U"-shaped trough and upward curved distal tip was precisely positioned in the carpal tunnel with US guidance followed by division of the flexor retinaculum (FR) with a "V"-shaped scalpel. Complete division of the FR was confirmed by US. Dissection performed on the specimens confirmed complete release of FR and absence of neurovascular injury. The distance from the division of the FR to these structures, the "safety margins," was measured. This new technique for carpal tunnel release appears to combine the safety and efficacy of open carpal tunnel surgery with the advantages of the minimally invasive techniques.

Carpal Tunnel Release Using the MANOS CTR System: Preliminary Results in 52 Patients

To describe a carpal tunnel release technique using the MANOS Carpal Tunnel Release device, with preliminary results in 52 patients. The MANOS Carpal Tunnel Release device is a blade that divides the transverse carpal ligament using wrist and palm skin punctures. The awake patient provides feedback as the surgeon navigates a 2.1-mm-diameter blunt probe across the undersurface of the ligament from a wrist incision with standard disposable nerve stimulator monitoring. The leading tip of the blunt probe is uninsulated and conducts 2 mA. The surgeon converts the blunt insulated probe into an uninsulated blade by advancing a 0.9-mm needle through the palm with a thumb-activated deployment feature. The surgeon saws the ligament through the 2 skin punctures. We used a validated outcome questionnaire to assess postoperative symptoms at 3 months. Symptom severity and functional status scores compare favorably with literature controls for open and endoscopic surgery at 3 months. One patient required reoperation for incomplete release. There were no tendon or nerve injuries. Preliminary results suggest the MANOS Carpal Tunnel Release device to be safe and effective. Therapeutic IV.

Comparison of Longitudinal Open Incision and Two-Incision Techniques for Carpal Tunnel Release

Comparison of Longitudinal Open Incision and Two-Incision Techniques for Carpal Tunnel Release

Comparison of Longitudinal Open Incision and Two-Incision Techniques for Carpal Tunnel Release

Comparison of Longitudinal Open Incision and Two-Incision Techniques for Carpal Tunnel Release

Comparison of Longitudinal Open Incision and Two-Incision Techniques for Carpal Tunnel Release

This study analyzes the long-term postoperative symptoms and functional outcomes of patients who underwent either traditional open (single-incision) or 2-incision carpal tunnel release (CTR). Because 2-incision CTR preserves the superficial nerves and subcutaneous tissue between the thenar and hypothenar eminences, it may account for fewer postoperative symptoms and improved functional recovery. A retrospective chart review identified patients who underwent either open or 2-incision CTR for isolated carpal tunnel syndrome between 2005 and 2008 by a single surgeon. Patients with a history of hand trauma or confounding comorbidities were excluded. We mailed a Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire and a Brigham and Women's Carpal Tunnel Questionnaire (BWCTQ) to all eligible participants. Data from the completed questionnaires were analyzed using independent t-tests and Pearson's correlation. Significance was set at p = .05. A total of 82 patients (106 hands; 27 men and 55 women; mean age, 60.5 y) were eligible to participate. Of these, 51 patients (63 hands; 20 men and 31 women; mean age, 61.1 y) responded (62% response rate). The mean duration of follow-up was 22 months (range, 12-37 mo; SD 7.3 mo). The 2-incision group mean BWCTQ Symptom Severity Scale score (1.13, SD 0.25) was significantly lower than the open group mean Symptom Severity Scale score (1.54, SD 0.70, p = .001). The 2-incision group mean BWCTQ Functional Status Scale score (1.24, SD 0.51) was significantly lower than the open group mean Functional Status Scale score (1.71, SD 0.76, p = .008). The 2-incision group mean DASH score (5.10, SD 12.03) was significantly lower than the open group mean DASH score (16.28, SD 19.98, p = .01). Patients treated with 2-incision CTR reported statistically significantly less severe long-term postoperative symptoms and improved functional status compared with patients treated with traditional open CTR. Future prospective studies with objective measures are needed to further investigate the difference in outcomes found between these 2 CTR techniques. Therapeutic III.

Surgeons Propose New Technique for Carpal Tunnel Release

Surgeons Propose New Technique for Carpal Tunnel Release

The mini incision technique for carpal tunnel decompression using nasal instruments

Mini incision techniques for carpal tunnel release have become increasingly popular for the treatment of carpal tunnel syndrome. The main advantages of mini incision techniques are shorter recovery and return-to-work time. However, the risk of neurovascular injury still remains worrisome. We present a novel method to release the carpal tunnel by using nasal instruments. This novel technique combines the advantages of endoscopic and open techniques while utilizing standard instruments. The advantages, disadvantages and results of this technique are discussed. Forty-five patients (15 male, 30 female, age 28-62; mean 48) with isolated carpal tunnel syndrome were enrolled to the study. Atotal of 55 wrists (bilateral in 7 cases, the right wrist in 41 and the left wrist in 14) underwent carpal tunnel decompression with a mini longitudinal incision technique. Grip strength--key pinch and sensorial evaluations were performed in all patients by one examiner using the Pressure-Specified Sensory Device. Significant differences between the pre- and postoperative periods were observed in either grip strength or pinch strength (p<0.05). No recurrence or injury to the neurovascular structures was noted in the follow-up period. The technique is simple and effective, employs inexpensive instruments, and has a low complication rate.

Variability in the Surgical Management of Carpal Tunnel Syndrome: Implications for the Effective Use of Healthcare Resources

Medicine has been said to be as much art as science, where physicians invoke their individual skills and judgment to address the unique aspects of each presenting patient. Yet to what extent should physicians exercise their own discretion in determining the use rates of hospital resources? This article examines the results of a study on surgeon use of surgical setting and anesthetic technique for carpal tunnel release (CTR) surgery - a simple, low-risk surgical procedure that can be performed in either a formal operating room or a minor surgical setting, using local, regional or general anesthetic. The selected combination of surgical setting and anesthetic technique employed by a surgeon has not been standardized and can significantly impact both patient outcomes and administrative healthcare costs for hospital resources, equipment and pharmaceuticals. While a certain amount of variability in surgical management is necessary to allow clinicians to practise their "art," policy makers have an opportunity to standardize some surgeon practices to control costs, particularly when those practices are found to be as strongly influenced by the subjective attitudes of individual surgeons as by evidence-based science and economics.

MINIMALLY INVASIVE CARPAL TUNNEL DECOMPRESSION USING THE KNIFELIGHT

Carpal tunnel syndrome is a common condition causing hand pain, dysfunction, and paresthesia. Endoscopic carpal tunnel decompression offers many advantages compared with conventional open surgical decompression. However, it is equipment intensive and requires familiarity with endoscopic surgery. We review a minimally invasive technique to divide the flexor retinaculum by using a new instrument, the KnifeLight (Stryker, Kalamazoo, Michigan), which combines the advantages of the open and endoscopic methods, without the need for endoscopic set-up. Between July 2003 and April 2005, 44 consecutive patients (26 women [59%] and 18 men [36%]), with clinical signs and symptoms, as well as electrodiagnostic findings consistent with carpal tunnel syndrome, who did not respond to non-surgical treatment, underwent the new procedure. All patients were asked about scar hypertrophy, scar tenderness, and pillar pain. The Michigan Hand Outcomes Questionnaire (MHQ) was used to determine overall hand function, activities of daily living, work performance, pain, aesthetics, and satisfaction with hand function. Other preoperative testing included grip strength and lateral pinch strength. Grip strength was measured using the Jamar hand dynamometer (Asimov Engineering Co., Los Angeles, CA); lateral key pinch was measured using the Jamar hydraulic pinch gauge. Postoperative evaluations were scheduled at 2 weeks, 3 months, and 6 months after the procedure. A small 10-mm incision was made in the wrist crease and a small opening was made at the transverse carpal ligament. The KnifeLight tool was inserted, and the ligament was incised completely. Follow-up evaluations with use of quantitative measurements of grip strength, pinch strength, and hand dexterity were performed at 2 weeks, 3 months, and 6 months after surgery. Fifty procedures were performed on 22 left hands (44%) and 28 right hands (56%). There were no complications related to the approach. All patients were able to use their hands immediately after the surgery. Scar tenderness and incisional pain were mild-to-moderate in the first 2 weeks, and these symptoms disappeared completely 6 months after surgery. Significant postoperative improvements in pain relief, patient satisfaction, hand function, daily activities, and work performance as assessed with the MHQ were noted at 3 and 6 months after surgery. Furthermore, significant improvement in patients' hand grip and pinch strength were observed 6 months after surgery. From a literature review, we found that the mean operation time of KnifeLight carpal tunnel release was the shortest compared with the conventional and endoscopic carpal tunnel release techniques. The median time needed for our patients to return to work was also the shortest among the different techniques. Excellent functional outcomes and satisfaction were achieved using the KnifeLight for carpal tunnel decompression. Our minimally invasive method offers a quick, easy, and effective alternative to conventional or endoscopic carpal tunnel decompression.

A comparison of two limited open techniques for carpal tunnel release

Review of the literature shows the effectiveness of limited open carpal tunnel release to be comparable to that of endoscopic carpal tunnel release in respect of recovery of grip strength, time of return to work and complication rate. A randomised, controlled study was designed to compare the effectiveness of a single versus a double limited open technique of carpal tunnel release. Sixty-five patients (73 hands) with a mean age of 48 years were operated on, 40 hands by the single incision and 33 by the double incision method. Grip and pinch strengths, digital sensibility (Filament and 2PD tests) and Levine scores were evaluated throughout 12 months of follow-up. We found that the single incision method offers better results in respect of grip and pinch strengths: less weakness at 1 month after surgery and a faster improvement relative to pre-operative values which is statistically significant. This, however, did not translate directly into Levine functional and symptom scores which, at each assessment, did not differ significantly between the two methods.

Limited Open Carpal Tunnel Syndrome Using the Safeguard System

Summary: Carpal tunnel syndrome is the most common compressive neuropathy of the upper-extremity. The frequency with which it is treated surgically results in a significant amount of cumulative postoperative morbidity in the form of pain and disability. Several techniques have been used to decrease this morbidity including endoscopic carpal tunnel release (CTR) and limited open CTR. The use of the Safeguard Mini-CTR System for limited open CTR provides a reliable method for alleviating carpal tunnel syndrome symptoms safely, while limiting postoperative pain and functional limitations. The technique for CTR using the Safeguard system and the literature regarding this and other limited open techniques is reviewed.

Endoscopic Carpal Tunnel Release Through a Single Distal Portal

Summary: Carpal tunnel release is one of the most common surgical procedures done today. Endoscopic carpal tunnel release has evolved from multiple techniques designed to minimize scar size and sensitivity. Multiple papers have been written on 2-portal and single proximal portal endoscopic carpal tunnel release techniques. This paper describes the endoscopic release of the transverse carpal ligament through a single distal incision.

Endoscopic Carpal Tunnel Release Using the Biportal Technique

The clinical study consisted of 27 patients and 30 hands that were operated on with the biportal endoscopic carpal tunnel release technique between 2000 and 2002. The mean follow-up time was 28 months. The time to return to work or complete recovery was found to average 12 days. The rate of functional recovery was 93% (27 hands), and 90% of hands (26 hands) were free of symptoms at the time of publication. According to our study, we conclude that the biportal endoscopic technique is an effective method to attain patient comfort; it is a minimally invasive method with a low complication rate in experienced hands for surgical treatment of carpal tunnel syndrome. Military persons can return to work quickly, without deficits in hand skills, with the use of this technique.

Mini-Open Blind Procedure Versus Limited Open Technique for Carpal Tunnel Release: A 30-Month Follow-Up Study

To evaluate prospectively the safety and effectiveness of a mini-open blind technique for carpal tunnel release (group A) when compared with a limited open technique (group B). From November 1999 to May 2001 (mean follow-up period, 30 mo) we performed 222 carpal tunnel release procedures on 185 consecutive patients. All patients were affected by mild to moderate median nerve compression. Patients in group A (82 patients, 99 procedures) had a short transverse incision at the wrist (length, 2 cm). We used a manual surgical instrument that helps in blindly dividing the flexor retinaculum because it has an integrated light source. The light makes it possible to locate precisely the tool blade by transillumination. Patients in group B (103 patients, 123 procedures) had a limited longitudinal incision (length, 3-4 cm). The preoperative and postoperative patient statuses were evaluated with an Italian modified version of the Boston Carpal Tunnel questionnaire with a mean of 30 months' follow-up after surgery (range, 24-39 mo). Group A patients showed better results than group B patients in all of the sections of the Italian modified version of the Boston Carpal Tunnel questionnaire at a mean follow-up period of 19 months, whereas after a mean of 30 months of follow-up evaluation the differences between groups A and B tended to decrease. Disease recurred in 7 group B patients, whereas only 1 patient in group A experienced symptom recurrence at the latest office evaluation. The blind mini-invasive technique has been shown to be as safe as traditional techniques but the recovery period is significantly shortened. With the technique we described a low recurrence rate was observed. All patients in group A reported great reduction in preoperative pain and numbness.

Comparative study between endoscopic technique by a proximal port and mini palmary incision in the surgical treatment of carpal tunnel syndrome

The authors present a prospective study comparing two surgical techniques for carpal tunnel release. A minimal - incision open decompression(3) is compared with an endoscopic release(2), that utilizes only a single proximal portal. There were operated on, 28 wrists in 28 patients, with clinical signs and EMG changes consistent on idiopathic carpal tunnel syndrome, that failed under previous conservative treatment. They were randomized into two groups , undertaken surgical treatment, either by endoscopic release or by open decompression. Grip strength (measured by dynamometric), sensitivity (measured by Semmes-Weinstein monofilaments), presence of pain and paresthesia, date of return to activities of daily living and complications were evaluated pre-operative and at 1, 2, 4, 6, 12 weeks after surgery. After 12 months average follow up, the results indicated that this proximal portal endoscopic technique can be safely performed, showing advantages over open conventional method, in terms of sooner return of grip strength, date of return to activities of daily living, and less incidence of pillar pain. No differences in paresthesia resolution, sensibility improvement or complications incidence were found.

Carpal tunnel release through a limited skin incision under direct visualization using a new instrument, the carposcope.

A new surgical technique with a set of instruments has been developed for the release of carpal tunnel. The technique allows division of the transverse carpal ligament through a short transverse skin incision (1.5 to 2 cm) of the wrist flexion crease under direct visualization. The technique has been used on 237 patients for 275 cases of carpal tunnel release (38 bilateral). Following the release, median time to activities of daily living was 7 days for 60 compensation patients and 6 days for 193 noncompensation patients (22 patients provided no information on the activities of daily living). The median time to return to work was 49 days for 51 compensation workers and 20 days for 64 noncompensation workers. The overall relief rate of preoperative symptoms was 86 percent (90 percent for noncompensation patients, 82 percent for compensation patients). There were no intraoperative complications among our studies of 275 cases by two surgeons (176 cases by the senior author). The described technique of carpal tunnel release is a useful alternative to open carpal tunnel release because of decreased short-term postoperative morbidity and to the endoscopic carpal tunnel release because of the simplicity and the lower cost of instrumentation.

Bilateral endoscopic carpal tunnel releases: Simultaneous versus staged operative intervention

Purpose: Open and endoscopic carpal tunnel release techniques have achieved excellent results for treatment of carpal tunnel syndrome. Symptoms frequently occur bilaterally but there are no reports of simultaneous operative intervention. The purpose of this study was to evaluate results in patients who underwent staged bilateral endoscopic carpal tunnel releases and in those who underwent simultaneous bilateral releases. Type of Study: Retrospective review. Methods: The efficacy of simultaneous and staged bilateral endoscopic carpal tunnel releases was evaluated using a retrospective chart review. This included patients who underwent these procedures during a 48-month period. Group A (48 patients) underwent staged procedures; group group B (48 patients) underwent simultaneous procedures. Inclusion criteria were a positive history and physical examination, positive electrical studies, and failure of conservative measures. Single-incision endoscopic releases were performed on an outpatient basis. Early rehabilitation with intermittent splinting was utilized. The analysis included complications, satisfaction, return to work, physician visits, physical therapy sessions, days to maximum medical improvement for all, and average percentage permanent partial impairment for Workers’ Compensation patients. Results: A decrease in return to work at regular duty was noted in the simultaneous group compared with the staged group for patients who had not filed Workers’ Compensation claims (P =.0158). The simultaneous group had fewer physician visits than the staged group (P =.0002). Overall patient satisfaction was equal. Conclusions: Simultaneous bilateral endoscopic carpal tunnel releases are well tolerated with mild restrictions and a decrease in cost.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 3 (March), 2002: pp 316–321

Carpal tunnel topography during endoscopic decompression

The safety of the endoscopic technique for carpal tunnel release remains a major concern. Serious complications such as division nerves, tendons or vessels may occur. In this study the topography of the carpal tunnel was studied in fresh cadaver hands after the introduction of the blade assembly of a one portal system. By using a plastination method, it was possible to study the in situ relationships in detail by serial cross sections. Furthermore a modified Spalteholz method allowed the position of the blade to be viewed in whole specimens.