Mini-open blind carpal tunnel release via 1- centimeter transverse incision above the wrist crease versus open release

ABSTRACT

Carpal tunnel release has become one of the most popular forms of hand surgery with high success rates. However, scar and post-operative morbidity accounts for most of the reported complications due to the presence of rich cutaneous nerves across the palm liable for iatrogenic injury and releasing of the superficial structures to the transverse carpal ligament as the subcutaneous fat palmar fascia, and palmaris brevis muscle. Minimally invasive surgical techniques employing endoscopic instruments or special mini-open techniques aimed at avoiding or minimising surgical scars in the palm, reducing scar morbidity, and post-operative pain, whilst enabling earlier and better functions. Between September 2006 and September 2007, a prospective comparative study evaluating the safety and effectiveness of a mini-open technique for blind [not under direct vision] carpal tunnel release using a 1 centimeter transverse incision proximal to the wrist crease, assisted with a 6 mm kuntscher nail and arthroscopic scissors for releasing the transverse carpal ligament, compared with limited open release. Twelve female patients and three male patients [30 wrists], with bilateral carpal tunnel syndrome aged [32-55 years], clinically and electro-physiologically diagnosed, with failed conservative management, were enrolled in this study. All cases were done under local anesthesia. Right hands underwent mini-open procedure, while the left hands underwent limited open release procedure. Details of the technique, patient satisfaction and outcomes are presented. This study revealed that the patients' right hands [mini-open CTR], have an easier postoperative course in comparison with their left hands [limited OCTR], reporting excellent improvement in symptoms severity, functional and cosmetic status post-operatively with high satisfaction, plus no encountered neurovascular or major complications. This technique is effective, simple and safe and cost effective. It can be used where endo-scopic release is expensive and not widely available