2013, Number 4
<< Back Next >>
Acta Ortop Mex 2013; 27 (4)
Carpal tunnel release with minimal incisions. Evaluation of the technique in fresh cadaver models
Herrera JT, Ceja BC, Hernández JM, Sesma RV, Gargollo C
Language: Spanish
References: 20
Page: 260-264
PDF size: 256.32 Kb.
ABSTRACT
Objective: To assess the carpal tunnel release technique with minimal incisions, blindly, based on the portals of Chow’s endoscopic technique in fresh cadaver models.
Material and methods: From January 2007 to June 2009, 23 carpal tunnel releases were performed in fresh cadavers, using Chow’s endoscopic portals. A malleable retractor and a fluted probe were introduced and the transverse carpal ligament was released with a retrograde scalpel from distal to proximal. We then meticulously dissected the palmar region and the anterior aspect of the forearm under magnification. We recorded the possible injuries to neurovascular and tendinous structures and whether the ligament release had been complete or incomplete, as well as the anatomical variants found. All the procedures were performed by the first author.
Results: 21 complete transverse carpal ligament releases were performed (91.3%). In two specimens the release of the thenar-hypothenar fascia was incomplete. We found the type I Lanz anatomical variant in one specimen and the type III in two. No associated neurovascular or tendinous injuries were reported.
Final remarks: Transverse carpal ligament blind release with minimal incisions should be taken with reservations. With proper training it may be a practical and low cost procedure for the treatment of carpal tunnel syndrome in our hospital setting. It may be performed quickly, with minimal scars and may decrease the recovery time and the loss of grip strength.
REFERENCES
Gelberman R, Eton R, Urbaniak J: Periphereal nerve compression. Instructional course lecture AAOS. J Bone Joint Surg Am. 1993; 75A: 1854-78.
Mackinnon S: Pathophysiology of nerve compression. Hand Clin. 2002; 18: 231-241.
Michelsen H, Posner M: Medical history of carpal tunnel syndrome. Hand Clin. 2002; 18: 257-68.
Graham B, et al: Development validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg. 2006; 31A: 919-24.
Kyle D: Carpal tunnel syndrome. J Hand Surg. 2010; 35A: 147-52.
MacDermind J, Richards R, Roth J, Ross D: Endoscopic versus open carpal tunnel release: A randomized trial. J Hand Surg. 2003; 28A: 475-80.
Trumble T, Diao E, Abrams R, Gilbert M: Single portal endoscopic carpal tunnel release compared with open release. J Bone Joint Surg Am. 2002; 84: 1107-15.
Espinosa A, Renan S, Iriarte L: Eficacia comparativa en el tratamiento quirúrgico de pacientes con el síndrome del túnel del carpo. Acta Ortop Mex. 2006; 20(4): 156-63.
Gutiérrez C, Gargollo C, Jiménez Y: Manejo del síndrome del túnel del carpo en el Hospital General Dr. Manuel Gea González. Cir Plast. 2002; 12(1): 25-30.
Chow J, Hantes M: Endoscopic carpal tunnel release: Thirteen years’ experience with the Chow technique. J Hand Surg. 2002; 27A: 1011-8.
Thoma A, Veltri K, Haines T, Duku E: A meta-analysis of randomized controlled trials comparing endoscopic and open carpal tunnel descompression. Plast Reconstr Surg. 2004; 114: 1137-46.
Celloco P, Rossi C, Bizzarri F, Patrizio L, Constanzo G: Mini-open blind procedure versus limite open technique for carpal tunnel release: A 30 month follow-up study. J Hand Surg. 2005; 30A: 493-9.
Siegmeth A, Hopkinson-Woolley J: Standard open descompression in carpal tunnel syndrome compared with a modified open technique preserving the superficial skin nerves: A prospective randomized study. J Hand Surg. 2006; 31A: 1483-9.
Ahcan U, Arnez Z, Bajrovic F, Zorman P: Surgical technique to reduce scar discomfort after carpal tunnel surgery. J Hand Surg. 2002; 27A: 821-7.
Rowland E, Kleinert J: Endoscopic carpal-tunnel release in cadaver. J Bone Joint Surg Am. 1994; 76A: 266-8.
Van Heest A, Waters P, Simmons B, Schwartz T: A cadaveric study of the single-portal endoscopic carpal tunnel release J Hand Surg. 1995; 20A: 363-6.
Lanz U: Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg 1977; 2: 44-53.
Gannon C, Muffly M, Rubright M: Aberrant nerve in limited open carpal tunnel release J Hand Surg. 2006; 31A: 1407-8.
Lindley K: Prevalence of anatomic variations encountered in elective carpal tunnel release. J Hand Surg. 2003; 28A: 849-55.
Wilson K: Double incision open technique for carpal tunnel release: An alternative to endoscopic release. J Hand Surg. 1994; 19A: 907-12.