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ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2020, Number 1

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An Med Asoc Med Hosp ABC 2020; 65 (1)

Minimally invasive carpal tunnel release without special instrumentation. Surgical technique and case series

Farías CE, Romo RR, Limón MM, Özyurekoglu T

Language: Spanish
References: 28
Page: 9-15
PDF size: 902.12 Kb.


ABSTRACT

Introduction: The carpal tunnel syndrome is the most common compressive neuropathy. Its clinical presentation includes paresthesias and dysesthesias in the territory supplied by the median nerve in the hand. There are several techniques available to treat this world-wide high-prevalence syndrome, in all of them the carpal transverse ligament is completely sectioned. The minimally invasive techniques, have shown several advantages over the conventional technique, including a smaller scar, absence of palmar bowstringing of the flexor tendons, and avoidance of a direct contact of the median nerve with the skin’s scar. Objective: The aim of the study was to present a minimally invasive technique for carpal tunnel release that does not require special instrumentation. We also aimed to review the clinical outcomes of patients treated with this technique. Material and methods: The study is a retrospective case series study. Eight cases treated with a carpal tunnel release technique without special instrumentation. With an eight-week follow-up. Preoperative and postoperative Weber test and Quick-DASH questionnaire were assessed. The results were analyzed with descriptive statistics and t-test, as needed. Results: In all cases there was clinical improvement. Two cases presented pilar pain that resolved after two months. Clinical improvement with statistical significance was obtained in the Quick-DASH scale, with a change from a preoperative value of 65.3 to a postoperative value of 21.3 (p= 0.0005 [CI95% 23-67]). Conclusion: This is a surgical technique with advantages over the traditional open technique, the endoscopic technique, and the mini-open technique without special instrumentation.


REFERENCES

  1. Mackinnon SE, Novak CB. Compression Neuropathies. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia, PA: Elsevier Inc; 2011.

  2. Farías E, Valencia DF, León SR, Avilés LA, Espinosa A. Functional results after carpal tunnel endoscopic release on a public health out-patient surgical campaign. Investig en Discapac. 2018; 7 (3): 79-90.

  3. Bickel KD. Carpal tunnel syndrome. J Hand Surg. 2010; 35 (1): 147-152.

  4. Parisi DM, Trumble TE. Wrist and hand reconstruction. In: Vaccaro AR, editor. Orthopaedic knowledge update home study syllabus. 8th ed. Rosemont IL: American Academy of Orthopaedic Surgeons; 2005. pp. 351-373.

  5. Davidge KM, Sammer DM. Median nerve entrapment and injury. In: Mackinnon SE, Yee A, editors. Nerve Surgery. New York, N.Y.: Thieme; 2015. pp. 207-250.

  6. Cheng CJ, Mackinnon-Patterson B, Beck JL, Mackinnon SE. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. J Hand Surg Am. 2008; 33: 1518-1524.

  7. Rempel D, Evanoff B, Amadio PC, de Krom M, Franklin G, Franzblau A et al. Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Health. 1998; 88: 1447-1451.

  8. Mendoza MM, Hernández BR, Farías CE. Tratamiento qirúrgico del síndrome del túnel del Carpo. In: Ibarra LG, Ibarra Ponce de León JC, editors. Cirugía para el tratamiento de la discapacidad. México, D.F.: Alfil; 2014. pp. 223-246.

  9. Keith MW, Masear V, Amadio PC, Andary M, Barth RW, Graham B et al. Treatment of carpal tunnel syndrome. J Am Acad Orthop Surg. 2008; 17: 397-405.

  10. Maggard M, Harness N, Chang W, Parikh J, Asch S, Nuckols T et al. Indications for performing carpal tunnel surgery: clinical quality measures. Plast Reconstr Surg. 2010; 126 (1): 169-179.

  11. Buncke G, McCormack B, Bodor M. Ultrasound-guided carpal tunnel release using the manos CTR system. Microsurgery. 2013; 33 (5): 362-366.

  12. Tsai TM, Laurentin-Perez LA, Wong MS, Tamai M. Ideas and innovations: radial approach to carpal tunnel release in conjunction with thumb carpometacarpal arthroplasty. Hand Surg. 2005; 10 (1): 61-66.

  13. Chan CM, Farías Cisneros E, Tsai TM. Trapeziometacarpal joint arthroplasty of the thumb without osseous tunnels and concurrent carpal tunnel release via a radial approach; surgical technique and results. Surg J. 2019; 5: e120-125.

  14. Herrera J, Ceja B, Hernández J, Sesma R, Gargollo C. Carpal tunnel release with minimal incisions. Evaluation of the technique in fresh cadaver models. Acta Ortop Mex. 2013; 27 (4): 260-264.

  15. Kim P, Lee H, Kim T, Jeon I. Current approaches for carpal tunnel syndrome. Clin Orthop Surg. 2014; 6 (3): 253-257.

  16. Reynolds N, Thirkannad SM. The recall DASH score-a novel research tool. Hand Surg. 2013; 18 (1): 11-14.

  17. Sambandam S, Priyanka P, Gul A, Ilango B. Critical analysis of outcome measures used in the assessment of carpal tunnel syndrome. Int Orthop. 2008; 32 (4): 497-504.

  18. Chow J. Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome. Arthroscopy. 1989; 5: 19-24.

  19. Paternostro-Sluga T, Grim-Stieger M, Posch M, Schuhfried O, Vacariu G, Mittermaier C et al. Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med. 2008; 40 (8): 665-671.

  20. Agee JM, Peimer CA, Pyrek JD, Walsh WE, Bickel KD, Jebson PJL et al. Carpal tunnel syndrome. J Hand Surg. 2010; 35 (2): 165-171.

  21. Taleisnik J. The palmar cutaneous branch of the median nerve and the approach to the carpal tunnel. An anatomical study. J Bone Joint Surg Am. 1973; 55 (6): 1212-1217.

  22. Vasiliadis HS, Nikolakopoulou A, Shrier I, Lunn MP, Brassington R, Scholten RJP et al. Endoscopic and open release similarly safe for the treatment of carpal tunnel syndrome. A systematic review and meta-analysis. PLoS One. 2015; 10 (12): 1-16.

  23. Wilson K. Double incision open technique for carpal tunnel release: an alternative to endoscopic release. J Hand Surg Am. 1994; 19 (6): 907-912.

  24. Gaba S, Bhogesha S, Singh O. Limited incision carpal tunnel release. Indian J Orthop. 2017; 51 (2): 192-198.

  25. Bromley G. Minimal-incision open carpal tunnel decompression. J Hand Surg Am. 1994; 19 (1): 119-120.

  26. Pagnanelli DM, Barrer SJ. Carpal tunnel syndrome: surgical treatment using the paine retinaculatome. J Neurosurg. 1991; 75 (1): 77-81.

  27. Hwang P, Ho C. Minimally invasive carpal tunnel decompression using the KnifeLight. Neurosurgery. 2007; 60 (2 Suppl 1): ONS162-1689.

  28. Lee WP, Schipper BM, Goitz RJ. 13-year experience of carpal tunnel release using the indiana tome technique. J Hand Surg Am. 2008; 33 (7): 1052-1056.




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