The mini-incision technique for carpal tunnel release using nasal instruments in Chinese patients

Abstract

Treatment of carpal tunnel syndrome (CTS) remains a challenge for hand surgeons. Carpal tunnel release (CTR) using nasal instruments has the advantages of both endoscopy and open surgery. In this study we aimed to explore the effectiveness of CTR using nasal instruments in Chinese patients.We present a case series of 49 cases of idiopathic CTS treated with the mini-incision technique using nasal instruments. The average recovery days before return to normal work and complications were recorded. The mean grip strength, pinch strength, and sensation were evaluated. Subjective results were evaluated using the visual analogue scale (VAS), Levine Carpal Tunnel Syndrome Questionnaire (LCTSQ), Disabilities of the Arm, Shoulder, and Hand (DASH), and Medical Outcomes Study (MOS) 36-item short-form health survey (SF-36).The mean follow-up was 13 months. No return of symptoms or blood vessel injury occurred. The incidence of scar tenderness was only 8.1%, later pillar pain (after 4 weeks) was 18.4%, and average recovery time to return to normal work was 23.7 days. The mean grip strength, pinch strength, and sensation were significantly improved (P < .001). The VAS, LCTSQ, and DASH survey postoperative mean scores were lower than the preoperative scores (P < .001). SF-36 scores were significantly increased following surgery (P < .001).We conclude that the mini-incision technique for CTR using nasal instruments in Chinese patients is safe, effective, and low cost. It is worthwhile for the technique to be promoted and used.

Figure 1

(A) The incision design: A 1.0 cm longitudinal incision was made distal to the intersection of the third web axis and the outspread thumb axis, then a 1.5 cm transverse incision was made on the volar aspect of the wrist crease between the palmaris longus tendon and the flexor carpi radial tendon. (B) The proximal edge of the flexor retinaculum was exposed in the second incision, and the ligamentum carpi transversum was bluntly disassociated. (C) With the wrist hyperextension, a long nasal instrument was inserted proximally from the second incision to the first incision between the superficial and deep plane of the ligamentum carpi transversum. (D) The 2 mirror beaks separated the surrounding structures completely, exposing the ligamentum carpi transversum to the operator as clearly as possibly under direct visualization. (E) A No. 11 blade was gently pushed distally to longitudinally incise the ligamentum carpi transversum.

Figure 2

(A) The nasal instrument was inserted between the superficial and deep plane of the ligamentum carpi transversum at the ulnar side of median nerve. (B) The ligamentum carpi transversum was severed longitudinally in the middle of the 2 mirror beaks of nasal instrument.