A Cadaveric Study of the Carpal Tunnel and Anatomical Variations of the Median Nerve in Vietnamese Adults: Implications for Single Portal Endoscopic Carpal Tunnel Release

@#Introduction: Single-portal endoscopic carpal tunnel release using modified Agee technique is widely used in Vietnam. Yet information on the anatomy of the target space of Vietnamese people regarding this technique is scarce. We aimed to characterise the anatomical landmarks and variations of the carpal tunnel to propose a safer surgery. Materials and methods: All twenty hands of ten fresh frozen, unembalmed cadavers of Vietnamese adults were included. Dissection was performed after the vertical line, Kaplan’s cardinal line and the distal wrist crease were drawn. The transverse carpal ligament (TCL), ulnar neurovascular bundle and superficial palmar arch were exposed. Measurements were made using Mitutoyo calliper. The variants of the median nerve and in the course of the thenar motor branch were recorded. Results: The median distances from the TCL distal margin to the distal wrist crease and superficial palmar arch were 31.2mm and 12.7mm, respectively. The ulnar neurovascular bundle was located 5.7mm and 4.4mm ulnar to the vertical line at the level of the TCL proximal margin and at the level of the TCL distal margin, respectively. The thenar motor branch of the median nerve was extra-ligamentous in 19 hands and preligamentous in 1 hand. Conclusion: If endoscopic portal is made along the distal wrist crease, blade assembly should not be inserted beyond the 35mm mark on its scale. Instruments should be aimed toward the radial border of the patient’s ring finger. Surgeons should be aware of the preligamentous course of the thenar motor branch although this variant type is rare.

Effects of small-incision carpal tunnel release on postoperative functional recovery and electrophysiological indexes in carpal tunnel syndrome / 中国医师进修杂志

Objective:To explore the effects of small-incision carpal tunnel release on postoperative functional recovery and electrophysiological indexes in carpal tunnel syndrome (CTS).Methods:A total of 75 patients with CTS treated in Shulan (Hangzhou) Hospital were enrolled as the research objects between April 2016 and April 2021. According to different surgical methods, they were divided into group A (34 cases, small-incision carpal tunnel release) and group B (41 cases, traditional carpal tunnel release). The operation time, hospitalization time, time to resume work, electrophysiological indexesbefore and after surgery, and postoperative complications were compared between the two groups.Results:Compared with group B, operation time, hospitalization time and time to resume work were shorter in group A: (12.32 ± 3.26) min vs. (34.65 ± 7.49) min, (5.15 ± 1.68) d vs. (7.83 ± 2.24) d, (18.22 ± 2.03) d vs. (37.35 ± 3.16) d ( P<0.05). After surgery, electrophysiological indexes in both groups were improved ( P<0.05), but there was no significant difference between the two groups ( P>0.05). The incidence rates of scar pain, decreased grip strength and hand piercing pain in group A were lower than those in group B: 2.94%(1/34) vs. 19.51%(8/41), 0 vs. 21.95%(9/41), 0 vs. 12.20%(5/41) ( P<0.05). Conclusions:Compared with traditional carpal tunnel release, clinical curative effect of small-incision carpal tunnel release is comparable on CTS patients. However, it can shorten operation time, hospitalization time and time to resume work, reduce incidence of postoperative complications.

Two-port Endoscopic Surgery for Carpal Tunnel Syndrome – A Prospective Cohort Study

@#Introduction: Carpal tunnel syndrome (CTS) is one of the most common peripheral neuropathies affecting patients' life. Performing endoscopic carpal tunnel release is now a new technique that is being gradually applied in Vietnam. This paper seeks to investigate the effectiveness of Chow’s method for CTS treatment. Materials and methods: This is a prospective cohort study involving seventy-seven patients with CTS who underwent Chow’s endoscopic method at our hospital from March 2019 to January 2020. The Boston Carpal Tunnel Questionnaire and electromyography (EMG) were used primarily to evaluate surgical decompression pre-operatively, one week, three weeks, three months, and six months after surgery. We also recorded incision length, pain at the scar, the improvement of symptoms and thenar atrophy and return-towork time after surgery. Results: A total of 85.7% of the patients were women. A moderate severity of EMG was seen in 64.9% of cases. Sixmonth post-operative functional status scale (FSS) (1.05±0.1) and symptom severity scale (SSS) (1.05±0.1) showed significant improvement when compared with preoperative FSS (2.8±0.5) and SSS (3.2±0.5). Post-operative EMG showed the distal sensory latency (DSL) and distal motor latency (DML) had returned to the norm in 88% and 89.3%, respectively. The average incision length was 12.1±1.2mm. Six months after surgery, numbness and hand pain had resolved in 97.4%, a painless scar was seen in 94.7%, but full recovery of thenar atrophy was only seen in 9.1%. Patients could get back to work after 10.2±2.4 days. Conclusion: Chow’s endoscopic carpal tunnel release is a safe and effective procedure for patients suffering from carpal tunnel syndrome that showed promising outcomes on clinical symptoms and functions on EMG with minimal pain and scarring, and early return to work.

Variantes anatómicas del canal carpiano y distancias de estructuras vasculares en ecografía / Anatomical variants the carpal tunnel and distances of vascular structures in ultrasound

El síndrome de canal carpiano es una patología frecuente. Si bien el diagnóstico es clínico, la ecografía cumple un rol en caso de duda diagnóstica y como apoyo a proce-dimientos intervencionales.Existen variables anatómicas y distancias de estructuras vasculares útiles de conocer antes de planear un gesto quirúrgico o de infiltración para disminuir el riesgo de lesiones secundarias, en donde la ecografía podría tener un rol.Estudiamos una muestra de 267 ecografías de muñeca con especial hincapié en va-riantes neurogénicas, vasculares o tendinosas que podrían resultar lesionadas en relación a algún procedimiento.

Carpal tunnel syndrome is a frequent pathology. Although the diagnosis is clinical, ultrasound plays a role in case of diagnostic doubt and as support and guide for inter-ventional procedures.There are anatomical variants and distances of vascular structures that may be useful to know before planning a surgical or infiltration procedure to reduce the risk of iat-rogenic injuries, where ultrasound could play a role.We studied a sample of 267 wrists ultrasounds with special emphasis on neurogenic, vascular or tendinous variants that could be injured in relation to procedures.

Changes in Clinical Symptoms, Functions, and the Median Nerve Cross-Sectional Area at the Carpal Tunnel Inlet after Open Carpal Tunnel Release

BACKGROUND: The aim of this study was to investigate the relationship between clinical symptoms and cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet before and after open carpal tunnel release (CTR). METHODS: Thirty-two patients (53 hands) that underwent open CTR for idiopathic carpal tunnel syndrome were prospectively enrolled. Median nerve CSA at the carpal tunnel inlet was measured preoperatively and at 2 and 12 weeks after CTR by high resolution ultrasonography. The Boston carpal tunnel questionnaire (BCTQ) was also completed at these times. RESULTS: BCTQ symptom (BCTQ-S) score was significantly improved at 2 weeks postoperatively, but BCTQ function (BCTQ-F) score and CSA were significantly improved at 12 weeks postoperatively. Preoperative CSA was significantly correlated with preoperative BCTQ-S and BCTQ-F scores but was not significantly correlated with postoperative BCTQ scores or postoperative changes in BCTQ scores. Postoperative median nerve CSA was not significantly correlated with postoperative BCTQ-S or BCTQ-F scores, and postoperative changes in median nerve CSA were not significantly correlated with postoperative changes in BCTQ-S or BCTQ-F scores. CONCLUSIONS: The study shows clinical symptoms resolve rapidly after open CTR, but median nerve swelling and clinical function take several months to recover. In addition, preoperative median nerve swelling might predict preoperative severities of clinical symptoms and functional disabilities. However, postoperative reductions in median nerve swelling were not found to reflect postoperative reductions in clinical symptoms or functional disabilities.

Relationship between Change of Median Nerve Cross-Sectional Area Measured by Ultrasonography and Prognosis after Carpal Tunnel Release / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate cross-sectional area of the median nerve using ultrasound in patients with carpal tunnel syndrome before and after endoscopic intervention, and to verify the level at which it can be used in prediction of outcome. MATERIALS AND METHODS: A prospective study was conducted in 21 patients who underwent endoscopic carpal tunnel release from March 2011 to March 2012. Median nerve cross-sectional area was measured before the operation and three months after the operation at the level of lunate, pisiform and hamate. The Boston questionnaire was evaluated before the operation and three months after the operation, and then allocated as two groups (group I: symptom improvement of more than 25%, group II: symptom improvement less than 25%). Then, differences of cross-sectional area between preoperative measurement and postoperative measurement on three levels were compared between the two groups. RESULTS: Nineteen patients were females and two were males ranging in age between 35-79 years (mean, 55.4 years). Significant differences were observed between the two groups at the lunate level. However, at the level of pisiform and hamate, no differences were observed between the two groups. CONCLUSION: Measurement of median nerve cross-sectional area at the lunate level showed significant correlation with outcome of carpal tunnel release.

Carpal Tunnel Syndrome in Congenital Radial Dysplasia

Congenital radial dysplasia is a rare disease with the defect or hypoplasia of radial side of forearm and hand. Congenital radial dysplasia is often accompanied by deformities of other parts. However, carpal tunnel syndrome caused by congenital radial dysplasia is very rare. We report one case of 53-year-old man with congenital radial dysplasia who underwent surgery for carpal tunnel syndrome.

The Efficacy of Carpal Tunnel Release with Mini-Open Incision / 고신대학교의과대학학술지

OBJECTIVES: We evaluated the effects of carpal tunnel release with a mini-open incision by analyzing symptom improvement. METHODS: We retrospectively reviewed 64 carpal tunnel syndrome patients who underwent carpal tunnel release with mini-open incisions between January 2001 and December 2010. The 22 males and 42 females had a mean age of 49 years and a mean follow-up of 12 months. We analyzed postoperative symptoms using The Michigan Hand Outcome Questionnaire. RESULTS: Patients reported complete resolution of their symptoms, and some patients who had presented with residual symptoms improved gradually. No complications or scar hypersensitivity were observed. MHQ(Michigan Hand outcomes Questionnaire) scores improved significantly between preoperative and postoperative 6 months and 12 months. CONCLUSIONS: Carpal tunnel release with mini-open incision provides a clinically effective, reliable and safe procedure.

Endoscopic carpal tunnel release in jamaica: seven years experience / Liberación endoscópica del túnel carpiano en jamaica: siete anos de experiencia

OBJECTIVE: To assess the patient profile and outcome of treatment, by endoscopic release, of patients with carpal tunnel syndrome. METHODS: A descriptive study was done using data from two sets ofpatients who had endoscopic carpal tunnel release in Jamaica from 2004 to 2006 and 2006 to 2010. The medical records of patients who had a diagnosis of carpal tunnel syndrome using symptoms, clinical signs and confirmation by nerve conduction test were reviewed. The data were analysed using SPSS and Micosoft Excel®. RESULTS: A total of 68 patients with 75 cases of carpal tunnel syndrome were done. Fifty-two (76%) of these patients were females and about 50% were older than 41 years old. There were 61 (90%) unilateral cases. Of these, the majority of cases affected the right hand. All patients had improvement in symptoms after one week, required minimal analgesic use, had good compliance with rehabilitation and returned to work after about two weeks. There were three cases of pilar tenderness, two cases of transient paraesthesia in the index finger which resolved after three weeks. There were three failed cases from the first series which had to be converted to open carpal tunnel release. The complication rate was 6.7%. No serious complications occurred in the second series and all were treated successfully without interventional surgery. The rate ofconversion to open release was 4%. CONCLUSION: Carpal tunnel affects mostly middle aged females and when treatment is done by endoscopic release, there is a fast resolution of symptoms and early return to work.

OBJETIVO: Evaluar el perfil del paciente y el resultado clínico del tratamiento de pacientes con el síndrome del túnel carpiano tratados mediante liberación endoscópica. MÉTODOS: Se llevó a cabo un estudio descriptivo, usando datos de dos conjuntos de pacientes a quienes se les realizó una liberación endoscópica del túnel carpiano en Jamaica entre 2004 y 2006; 2006 y 2010. Se revisaron las historias clínicas de pacientes con un diagnóstico de síndrome del túnel carpiano, usando síntomas, senales clínicas y confirmación mediante la prueba de conducción de nervio. Los datos fueron analizados usando SPSS y Micosoft Excel®. RESULTADOS: Se analizó un total de 68 pacientes con 75 casos de síndrome del túnel carpiano. Cincuenta y dos (76%) de estas pacientes fueron mujeres, y aproximadamente 50% tenían más de 41 anos de edad. Hubo 61 (90%) casos unilaterales. De éstos, la mayoría de casos tuvo afectación de la mano derecha. Todos los pacientes experimentaron una mejoría en los síntomas después de una semana; necesitaron un uso mínimo de analgésicos, cumplieron bien con la rehabilitación, y regresaron al trabajo luego de dos semanas aproximadamente. Hubo tres casos de sensibilidad del talón de la mano, y dos casos deparestesia transitoria del dedo índice, que se resolvieron después de tres semanas. Hubo tres casos fallidos que tuvieron que ser convertidos en liberación abierta del túnel carpiano. La tasa de complicación fue 6.7%. No ocurrió ninguna complicación seria en esta serie, y todas fueron tratadas exitosamente sin intervención quirúrgica. La tasa de conversión para abrir la liberación fue 4%. CONCLUSIÓN: El túnel carpiano afecta principalmente a las mujeres de mediana edad, y cuando el tratamiento se realiza mediante liberación endoscópica, se produce una resolución rápida de los síntomas y un temprano regreso al trabajo.

Diagnosis and Management of Carpal Tunnel Syndrome Caused by Local Lesions

PURPOSE: To discuss the diagnosis and treatment of nonidiopathic carpal tunnel syndrome (CTS) caused by variable local lesions. MATERIALS AND METHODS: Fifteen patients who underwent surgery for CTS caused by local lesions were studied. The average age was 53.3 years. There were 5 men and 10 women. Plain radiographs including carpal tunnel view and ultrasonography were routinely performed, and magnetic resonance imaging and computed tomography were taken in selected cases. Carpal tunnel release were done by a single surgeon. RESULTS: Lesions causing CTS included calcification in five cases, ganglion in two, malunion after distal radius fracture in one, osteophyte of carpal bone in one, tuberculosis tenosynovitis in one, synovitis by foreign body in one, acute lunate dislocation in one, lipoma in two, median artery in one. Following surgery, all cases showed alleviation of symptoms. CONCLUSION: Prior to surgical decompression of CTS, it is important to assess any lesion around median nerve and carpal tunnel through physical examination, radiographs including carpal tunnel view and ultrasonography.

Percutaneous Carpal Tunnel Release Using Preoperative Ultrasonography and the Wire Rope

PURPOSE: The aims of this study were to introduce a new method of percutaneous carpal tunnel release and report its results. MATERIALS AND METHODS: After preoperative ultrasonographic mapping, a percutaneous carpal tunnel release was performed using the wire rope through two skin needle punctures. Forty wrists of 30 patients were evaluated restrospectively in terms of the symptomatic resolution and complications. The mean age of patients was 53.7 years ranging from 44 to 79 years. The mean follow-up period was 12.8 months ranging from 6 to 18 months. RESULTS: All cases showed complete relief or marked improvement of symptoms postoperatively. There was no neurovascular injury or other major complication. At postoperative 6 months follow-up, according to the Boston questionnaire, symptom severity score improved from 3.67+/-0.25 preoperatively to 1.55+/-0.33 postoperatively, and functional status score improved from 3.52+/-0.38 preoperatively to 2.09+/-0.42 postoperatively. All patients regained grip strength and pinch strength after surgery. CONCLUSION: The percutaneous carpal tunnel release using the preoperative ultrasonograhic mapping and the wire rope is an effective, reliable and safe method with the benefits of less postoperative pain and early recovery.

Ulnar Neuropathy at the Wrist in a Patient with Carpal Tunnel Syndrome after Open Carpal Tunnel Release

Ulnar neuropathy at the wrist is rarely reported as complications of carpal tunnel release. Since it can sometimes be confused with recurrent median neuropathy at the wrist or ulnar neuropathy at the elbow, an electrodiagnostic study is useful for detecting the lesion in detail. We present a case of a 51-year-old woman with a two-week history of right ulnar palm and 5th digit tingling sensation that began 3 months after open carpal tunnel release surgery of the right hand. Electrodiagnostic tests such as segmental nerve conduction studies of the ulnar nerve at the wrist were useful for localization of the lesion, and ultrasonography helped to confirm the presence of the lesion. After conservative management, patient symptoms were progressively relieved. Combined electrodiagnostic studies and ultrasonography may be helpful for diagnosing and detecting ulnar neuropathies of the wrist following carpal tunnel release surgery.

Long-Term Changes of the Clinical and Nerve Electrophysiological Findings after Endoscopic Carpal Tunnel Release / 대한정형외과학회잡지

PURPOSE: The aim of this study was to analyze the clinical symptoms and function and the nerve electrophysiological changes between the pre-operative and long-term post-operative states of patients who underwent surgical treatment with endoscopic release of the carpal tunnel for idiopathic carpal tunnel syndrome. MATERIALS AND METHODS: This study was performed in 48 patients and 88 wrists with idiopathic carpal tunnel syndrome. All patients were treated with endoscopic carpal tunnel release using a single portal. The preoperative and the 3 years 5 months long-term postoperative clinical symptoms and function were evaluated using the Boston carpal tunnel questionnaire. The nerve electrophysiological status was evaluated using the Bland grade system. RESULTS: When the preoperative Bland grade was 2, 3, 4, 5, and 6, the range of the change of the symptom severity score was 1.38, 1.68, 2.40, 1.61 and 1.28, respectively, and the range of the change of the functional status score was 0.60, 1.34, 1.58, 0.93 and 0.88, respectively, at the long-term follow-up. The clinical symptoms were signifi cantly improved at the fi nal follow-up when the preoperative Bland grade was 2, 3, 4 and 5. The function was signifi cantly improved for all the preoperative Bland grades. On the nerve electrophysiological study, there was statistical improvement of the distal motor latency of the motor nerve and the nerve conduction velocity and amplitude of the sensory nerve. When the preoperative Bland grade was 2, 3, 4, 5 and 6, the extent of improved grade was 0.60, 0.75, 2.17, 2.87 and 4.25, respectively, at the long-term follow-up, and the Bland grade was signifi cantly improved when the preoperative Bland grade was 3, 4, 5 and 6. However, there was no statistical signifi cance between the Bland grade and the clinical state at the long-term follow-up. CONCLUSION: The clinical and nerve electrophysiological states were significantly improved at the long-term follow-up after endoscopic carpal tunnel release. When the preoperative Bland grade was 3, 4 and 5, the clinical symptoms, function and the nerve electrophysiological states were signifi cantly improved at the long-term follow-up.

Single Portal Endoscopic Carpal Tunnel Release in Patients Older than 65 Years

PURPOSE: There have been few reports about the endoscopic carpal tunnel release (ECTR) in elderly patients and its efficacy and safety are not well-known. We evaluated the clinical outcomes of ECTR using Agee technique in patients older than 65 years. MATERIALS AND METHODS: From October 2000 to January 2007, thirty-five patients (42 hands) who underwent ECTR using Agee technique were enrolled. The average age of the patients was 67.2 years (range, 65-71 years). The duration of symptoms averaged 10 months (range, 6-33 months). For evaluation of the clinical outcomes, physical examination and subjective assessment of the hand function using the Boston carpal tunnel questionnaire were performed at postoperative 1-year follow-up and compared with those obtained at preoperative evaluation. The mean follow-up period was 18 months (range, 12-24 months). RESULTS: There were no neurovascular injury and scar tenderness. At postoperative 1-year follow-up, paresthesia, numbness, Phalen's sign, tinel sign, two point discrimation, and grip power were significantly improved compared with those obtained at preoperation. According to the Boston questionnaire, symptom severity score improved from 3.43 preoperatively to 1.89 postoperatively, and functional status score improved from 3.18 preoperatively to 2.21 postoperatively (p<0.05). Thenar atrophy still remained in 32 hands (76.2%). CONCLUSION: Although thenar atrophy did not improve in many cases, symptom severity and functional status scores improved in most patients treated with ECTR. The single portal ECTR is a safe and efficacious treatment option in elderly patients with carpal tunnel syndrome.

Pseudoaneurysm of Ulnar Artery after Endoscopic Carpal Tunnel Release

The authors present an extremely rare case of a pseudoaneurysm of the ulnar artery as a complication of a two-portal endoscopic carpal tunnel release (ECTR). A 70-year-old man with chronic renal failure and on maintenance hemodialysis with a left arteriovenous fistula presented with paresthesia of his right hand. A clinical diagnosis of right carpal tunnel syndrome was confirmed by ultrasonography and an electrophysiologic study. He underwent two-portal ECTR, and the paresthesia was much improved. However, he presented to us one month after operation with severe pain, a tender mass distal to the right wrist crease and more aggravation of the paresthesia in the ulnar nerve distribution. Doppler ultrasound was performed and revealed a hypoechoic lesion 20 mm in diameter in the right palm, with arterial Doppler flow inside connected to the palmar segment of the ulnar artery. An ulnar artery pseudoaneurysm was diagnosed and treated by ultrasound-guided percutaneous thrombin injection. Transverse color Doppler ultrasound image showed complete thrombosis of the pseudoaneurysm and flow cessation after a total injection of 500 units of thrombin. The symptoms were also improved.

Endoscopic Versus Mini.open Carpal Tunnel Release in Patients with Bilateral Carpal Tunnel Syndrome

OBJECTIVE: The purpose of this study was to determine any differences in outcome and patient satisfaction between endoscopic release (ECTR) and open carpal tunnel release (OCTR) in patients with bilateral carpal tunnel syndrome who underwent both techniques. METHODS: Seven patients with confirmed bilateral idiopathic carpal tunnel syndrome were randomized to undergo endoscopic release using a single portal Agee technique to one hand and a minimal open release to the other. Subsequent assessments were made at 0, 3, and 12 months after operation using a modified Levin scale. We also analyzed subjective and objective outcomes retrospectively, including the time to return to full activity, patient preference, cosmetic satisfaction, scar tenderness, and pillar pain. The pain was assessed using a visual analogue scale from 1 to 10. RESULTS: Based on the Levin scale, there were no significant differences between hands at any follow-up interval. At the three-month follow up, mean scale scores were lower in the ECTR group; however, the differences did not reach statistical significance. Cosmetically, all patients were satisfied with their scar irrespective of the technique. There were no statistical differences in terms of scar tenderness and pillar pain. CONCLUSION:ECTR did not show any significant advantage over short-incision OCTR. Therefore, the operator's experience and skill in using a certain method is important, regardless of which technique is used.

A Long-Term Follow Up Study of Prognostic Factors after Carpal Tunnel Release

OBJECTIVE: The purpose of this study was to examine the factor influencing the improvement of symptoms and change of electrophysiologic findings of patients after carpal tunnel release. METHOD: We examined 16 patients (27 hands) who underwent carpal tunnel release operation after diagnosed with carpal tunnel syndrome by the electrodiagnostic study from March 2000 to February 2001. Nerve conduction tests and visual analogue scale were performed pre-operateively and 1 month and 3 years post-operatively. We also performed a correlation study to measure the improvements of symptoms with the patient's age, duration of symptoms, and severity of works. RESULTS: The improvement of visual analogue scale had no correlation with the age, severity of work and visual analogue scale at pre-operation. However, there was significant relationship between the improvement of visual analogue scale and duration of symptom. CONCLUSION: These findings suggest that the benifits of the carpal tunnel release operation were influenced by the patient's duration of the symptoms. The longer the symptoms were experienced, the improvements of the symptoms were reduced.

Outcomes of Carpal Tunnel Release in Diabetic and Non-Diabetic Patients

OBJECTIVE: To compare the surgical outcomes of carpal tunnel release in diabetic and non-diabetic patients. METHOD: Among the patients who underwent carpal tunnel release for carpal tunnel syndrome, 44 subjects (77 hands) were recruited and classified into two patient groups: group 1 composed of 20 subject (36 hands) with diabetes mellitus and group 2 with 24 subjects (41 hands) without diabetes mellitus. Electrodiagnostic parameters were included onset latency, peak latency, and amplitude of median motor and sensory nerves pre- and postoperatively. Also symptom (visual analogue scale) and complication were assessed. RESULTS: Postoperative evaluation was done at 42.8 months and 84.5 months in patients groups 1 and 2, respectively. All the electrodiagnostic parameters and symptoms showed improvement postoperatively in both groups of patients (p 0.05). CONCLUSION: To relieve the carpal tunnel syndrome in diabetic patients, as in non diabetic patients, surgical release of carpal tunnel would be considered positively.

Endoscopic Carpal Tunnel Release and Radiological Measures of Carpal Tunnel to Predict the Ease of Access / 대한정형외과학회잡지

PURPOSE: The aim of this study was to evaluate the correlation between the preoperative radiological measures of the carpal tunnel and the ease of access of the instruments into the carpal tunnel during an endoscopic carpal tunnel release (ECTR) and to estimate changes in the radiological measures after ECTR. MATERIALS AND METHODS: Carpal tunnel views were possible in 45 patients, 78 wrists taken before the ECTR and the distances between scaphoid and pisiform (S-P) and between trapezium and hamate (T-H) were measured. The correlation between the measured distances and the ease of access of instrument was analyzed. In addition, the radiographic carpal tunnel views were taken three months after surgery and the distance changes after ECTR were measured. RESULTS: In "easy" rated access, the average S-P and T-H distances were 34.5 mm and 24.8 mm in females and 37.0 mm and 26.1 mm in males, respectively. In the "difficult" rated access, the average distances were 29.5 mm and 20.0 mm in females and 32.4 mm and 22.7 mm in males, respectively. Therefore, as the distances became shorter, the insertion of the endoscopic instrument became more difficult (p<0.001). However, after ECTR, the average distances were significantly increased in all cases by 2.5 mm (7.6%) and 2.4 mm (9.6%) in females and 2.8 mm (7.9%) and 2.8 mm (11.2%) in males, respectively (p<0.001). CONCLUSION: The ease of access of an endoscopic device into the carpal tunnel on ECTR had a significant correlation with the radiological measures of the S-P and T-H distances on the preoperative carpal tunnel view. In view of such radiological measures, it is believed that the carpal tunnel is widened after ECTR.

Percutaneous Carpal Tunnel Release Using Curved Hemostat and Meniscectomy Hook Knife / 대한정형외과학회잡지

PURPOSE: The aims of this study were to introduce a method of percutaneous carpal tunnel release and report the results of our experience. MATERIALS AND METHODS: A percutaneous carpal tunnel release was performed using a curved hemostat and a meniscectomy hook knife through a small transverse incision at the proximal wrist crease. Among 125 cases from 81 patients, 91 wrists from 58 patients were evaluated retrospectively in terms of the symptomatic resolution and complications. The mean follow up period was 38.9 months ranging from 12 to 118 months. RESULTS: All but one cases (99%) showed a complete symptomatic resolution or a marked improvement postoperatively, and 94.5% of cases were satisfied with the final result. Two patients had a second operation, one chronic renal failure patient showed recurrent symptoms after an initial improvement and the other showed persistent symptoms. There were two superficial palmar arch injuries and one digital nerve injury. However two of them were the earliest cases of an inexperienced surgeons. CONCLUSION: When an experienced surgeon performs a percutaneous carpal tunnel release meticulously, it is a safe and reliable method with the benefits of less postoperative pain and an early recovery.