Comparison of carpal tunnel release with double mini-incision approach and traditional approach: A retrospective study

Abstract

The aim of this study was to investigate the safety and efficacy of the double mini-incision approach, and to clarify its surgical details. We retrospectively enrolled 82 patients with primary carpal tunnel syndrome. Among them, 30 patients with conventional approach were enrolled in group A, and the other 52 patients with double mini-incision approach were enrolled in group B. Objective tests were performed on patients, and basic information and subjective evaluation of patients were collected. The surgical effects and complications of the 2 approaches were compared. In addition, the surgical details of double mini-incision were further explored. The incision length of group B (26.1 ± 6.1 mm) was significantly shorter than that of group A (45.7 ± 5.9 mm, P ＜ .001). Patients in group B (93.7 ± 5.4) had significantly higher satisfaction with incision appearance than those in group A (84.3 ± 6.1, P ＜ .001). At the 12-month follow-up, no statistically significant difference in clinical outcomes were observed between the 2 groups (P > .05). However, there were 2 cases with wound pain and 1 case with pillar pain in group A, but none in group B. Two patients in group B who underwent the distal incision 1st were transferred to the conventional approach because of the epineurium and perineurium injury. The double mini-incision approach offers a sufficient range of release and surgical field, resulting in favorable surgical outcomes. The proximal incision made 1st helps to reduce the risk of nerve injury.

Keywords: carpal tunnel syndrome; double mini-incision; pillar pain; surgical details; traditional approach; wound pain.

Figure 1.

Anatomical variations of the median nerve at wrist. (A) Normal median nerve anatomy. (B) Structural variation of median nerve located on the ulnar side of palmaris longus.

Figure 2.

Effective release range of double mini-incision approach.

Figure 3.

Surgical diagram of the double mini-incision approach. (A) Preoperative diagram. (B) Carpal tunnel release was performed through the proximal incision under dorsiflexion of the wrist. (C) Carpal tunnel release was performed through the distal incision under volar flexion of the wrist. (D) Double mini-incision diagram.