The Functional Outcome of Mini Carpal Tunnel Release

Abstract

Introduction Carpal tunnel syndrome (CTS) is one of the most common compression neuropathies in the upper limbs and requires surgery if conservative treatment fails. This study assessed the functional outcome of vertical mini carpal tunnel release (CTR) at distal wrist crease. Objective To evaluate prospectively the safety, effectiveness, and reproducibility of vertical mini-open blind technique for CTR. Methods In total, 36 patients (40 hands) aged between 22 and 71 years with mild to moderate CTS based on nerve conduction studies were selected and screened based on inclusion and exclusion criteria. The surgery was done with vertical mini-incision CTR at distal wrist crease. The preoperative and postoperative clinical outcomes and grip strength were evaluated with Levine-Katz questionnaire and JAMAR Hydraulic Hand Dynamometer with 3 months follow-up after surgery. Results The mean score for both symptom severity and functional status reduced and mean handgrip strength improved 29.5% at 3 months after surgery. All the patients were satisfied with the cosmetic outcome of the scar. Three patients had scar tenderness. All patients were able to return to work within 4 weeks after surgery, except one who developed chronic regional pain syndrome. Conclusion The vertical mini-open blind technique has been shown to be safe and easily reproducible and has short recovery period. All patients return to good functional status 3 months postoperative.

Keywords: Levine–Katz questionnaire; carpal tunnel syndrome; handgrip strength; mini carpal tunnel release.

Fig. 1

Image shows accurate location of mini-open vertical incision at the distal wrist crease. White dot A is the junction of the middle/ring finger axis and a line at distal wrist crease. White dot B is the distal end of the incision. The distance between point A and B is 1 cm. SPA, Superficial palmar arch; PL, palmaris longus; FCR, flexor carpi radialis.

Fig. 2

The appearance of the transverse carpal ligament (white arrow) upon dissection of palmar aponeurosis and soft tissue.

Fig. 3

Dissection of the transverse carpal ligament until the appearance of median nerve (white arrow).

Fig. 4

The introduction of McDonald dissector (white arrow) into the tunnel where the base protects the median nerve prior to the transverse carpal ligament release.

Fig. 5

Complete release of the transverse carpal ligament exposes the median nerve (white arrow) underneath.