Mini-open carpal tunnel decompression

Carpal tunnel syndrome is the most common entrapment neuropathy, and it is caused by compression of the median nerve at the wrist. The authors describe the mini-open carpal tunnel technique for surgical release of the transverse carpal ligament. The success of the procedure depends on meticulous technique with attention to certain important anatomic details and careful avoidance of injury to the palmar cutaneous nerve and the recurrent motor branch.     

Symptomatic relief following carpal tunnel decompression with normal electroneuromyographic studies

Carpal tunnel syndrome is a frequently encountered clinical entity. A retrospective study of a selected patient population revealed 12% of patients to have normal electrodiagnostic studies. Operative release of the transverse carpal ligament in these patients alleviated median nerve entrapment symptoms. Entrapment neuropathy of the median nerve remains a clinical diagnosis, and absolute reliance on electrodiagnostic studies is unwarranted when making a decision to surgically treat a patient with a suspected carpal tunnel syndrome.     

Pitfalls in carpal tunnel decompression.

In the period 1972 to 1977, 35 patients with persistent pain and other disabilities after carpal tunnel decompression were referred for treatment. The pitfalls included: (i) wrong diagnosis--5 patients; (ii) inadequate decompression--9 patients; (iii) recurrent compression--4 patients; (iv) iatrogenic nerve injury--7 patients; and (v) postoperative complications--10 patients. The patients in Groups 1 and 5 were treated by non-operative measures. Most of the patients in Groups 2, 3, and 4 were treated by reoperation. This paper outlines the causes and prevention of pitfalls in carpal tunnel decompression.     

Early return to work following open carpal tunnel decompression in lamb freezing workers

Carpal tunnel syndrome is common at the largest lamb processing plant in the world, especially in new lamb boners. The purpose of this study was to establish the incidence and whether expeditious return to work following open carpal tunnel decompression was possible. Two hundred patients with a neurophysiologically confirmed diagnosis underwent surgery between 2002 and 2006. One hundred and eighty-seven patients were assessed retrospectively and 13 prospectively. The incidence in new lamb boners was 10% in their first season. On average, workers commenced rehabilitation at 11 days post-operatively and full duties at 29 days post-operatively with minimal further time off taken. Ninety percent returned to their previous role. By 8 weeks in the prospective group visual analogue pain scores had improved from 8.75 to 2.0 (P<0.01) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores had improved from 140 points to 68 (P<0.01). Grip/pinch testing, static two-point discrimination scores and complication rates were comparable with previous studies. This study provides good evidence that coordinated, early rehabilitation and return to work is effective in a high-demand population.     

Aberrant radial artery seen in the carpal tunnel at carpal tunnel decompression: case report

We present a case in which the radial artery was found running within the carpal tunnel at the time of routine carpal tunnel decompression. It appears to be an anomalous superficial palmar branch of the radial artery that is substituting for the normal radial artery.     

Absorbable versus non-absorbable suture in carpal tunnel decompression

This randomised prospective clinical study compared the use of an absorbable suture (subcuticular 4:0 polyglactin 910) and a non-absorbable suture (5:0 monofilament polypropylene) for elective carpal tunnel decompression wound closure. An increased perception of pain was reported by the patients in the polypropylene (Prolene) group. At the 6-week assessment, there was a higher level of residual wound inflammation in the polyglactin 910 (Vicryl) group.     

掌部小切口减压治疗腕管综合征

目的:介绍掌部小切口横断腕横韧带治疗腕管综合征的方法,并评价其疗效及安全性。方法:自2006年1月至2007年9月,采用掌部纵形小切口,切断腕横韧带治疗腕管综合征15例(18侧),男2例,女13例;年龄34～69岁,平均48岁;单侧12例,双侧3例;病程8～26个月,平均18个月。主要临床表现为:桡侧3个半指麻木或疼痛,腕部疼痛,并向前臂放射,夜间麻醒史,大鱼际肌肉萎缩,Tinel征阳性,Phalen征阳性。电生理检查均有正中神经感觉神经传导速度(SCV)减慢、感觉神经动作电位(SNAP)波幅下降或缺失,严重者拇短展肌可有自发电位。术后随访时采用GSS评分(Global symptom score),分别从疼痛、麻木感、感觉异常、肌力减退和夜醒等5个方面进行评价。结果:术后所有患者伤口均甲级愈合,无并发症发生。15例患者均获随访,时间20～28个月,平均24个月。除1例患者未完全缓解外,其余患者症状消失,拇短展肌肌力增强,GSS评分较术前有明显改善(P<0.05)。结论:小切口减压治疗腕管综合征具有安全性高、手术时间短、创伤小、瘢痕小等优点,直视下切断腕横韧带,可彻底松解正中神经,是安全、有效的手术入路。     

The outcome of carpal tunnel decompression in elderly patients

PURPOSE: To determine the outcomes of carpal tunnel decompression in elderly patients and whether outcomes can be predicted by the severity of presurgical nerve conduction study results. METHODS: We performed a retrospective study of all patients over 70 years of age who had elective carpal tunnel release at Dunedin Hospital between April 1999 and April 2002 with a minimum of 1-year follow-up evaluation. A grading system for presurgical nerve conduction studies was formulated that scored patients from 1 to 6 according to severity. Patients were evaluated by a mailed questionnaire (Symptom Severity Score) with follow-up telephone calls to nonresponders. RESULTS: Eighty-three carpal tunnel release procedures performed in 70 patients were included in the study. Eighty percent had marked to severe neurophysiologic changes (grades 4-6). The median postsurgical Symptom Severity Score was 1.3 (inter-quartile range, 1.1-1.7). Patients expressed satisfaction with the outcome of the surgery in 78 of 83 cases (94%). There was a significant relationship between presurgical nerve conduction grade and postsurgical Symptom Severity Score. CONCLUSIONS: This study shows that elderly patients have low postsurgical symptom scores and express high levels of satisfaction after surgery for carpal tunnel syndrome. There was a significant relationship between severity of neurophysiologic abnormalities and a higher Symptom Severity Score after surgery. Severe abnormality, however, should not exclude elderly patients from surgery.     

Acute carpal tunnel syndrome. Complications of delayed decompression

Five patients suffered injuries around the wrist complicated by acute tunnel syndrome. Pain associated with median nerve paraesthesia or hypo-aesthesia are indications for urgent treatment; in four patients where operation was delayed, the outcome was poor.     

Effect of wrist position on power grip and key pinch strength following carpal tunnel decompression

Power grip and thumb key pinch strength were measured pre- and immediately postoperatively in 30 patients with carpal tunnel syndrome while the wrist was in flexion and extension. The carpal tunnel decompression was performed under local infiltration with 1% lignocaine. Grip strength decreased more in wrist flexion than in wrist extension. No difference was found in thumb pinch strength. The authors conclude that some of the immediate postoperative loss of grip strength in wrist flexion can be attributed to prolapse of flexor tendons out of the carpal tunnel in this position.     

Reduction in pain associated with open carpal tunnel decompression

Patients treated by open carpal tunnel decompression under local anaesthetic experience significant pain with the introduction of local anaesthetic before operation. A prospective double-blind randomized placebo controlled trial was carried out to assess whether this pain could be reduced with the pre-application of a topical lignocaine-prilocaine anaesthetic cream. Nineteen patients undergoing simultaneous bilateral operations were studied. Pain, measured with a visual analogue scale, was significantly reduced on the sides treated with anaesthetic cream. On a four point verbal scale the rating on the placebo side was "moderate" or "severe", compared to "mild" on the anaesthetic cream side. The reduction in pain was greater in women, possibly due to a relatively thinner dermis. There were no adverse effects.     

Follow-up after carpal tunnel decompression - general practitioner surgery or hand clinic? A randomized prospective study.

We prospectively randomized 100 patients following carpal tunnel decompression who were having a 2-week postoperative assessment and removal of stitches to either their local general practitioner (GP) or the hospital outpatient department. All patients were seen at hospital 6 weeks postoperatively for a final assessment. The waiting time for assessment and suture removal was shorter at the GP surgery than in the outpatient department (mean 13 min and 28 min respectively) but significantly more patients were diagnosed as having wound infections (14% and 0% respectively); most were given antibiotics, perhaps unnecessarily.