DOI QR코드

DOI QR Code

Surgical Treatment of Carpal Tunnel Syndrome through a Minimal Incision on the Distal Wrist Crease: An Anatomical and Clinical Study

  • Yoo, Hye Mi (Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, GNUH Gyeongsang National University School of Medicine) ;
  • Lee, Kyoung Suk (Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, GNUH Gyeongsang National University School of Medicine) ;
  • Kim, Jun Sik (Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, GNUH Gyeongsang National University School of Medicine) ;
  • Kim, Nam Gyun (Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, GNUH Gyeongsang National University School of Medicine)
  • Received : 2014.12.12
  • Accepted : 2015.02.25
  • Published : 2015.05.15

Abstract

Background An anatomical analysis of the transverse carpal ligament (TCL) and the surrounding structures might help in identifying effective measures to minimize complications. Here, we present a surgical technique based on an anatomical study that was successfully applied in clinical settings. Methods Using 13 hands from 8 formalin-fixed cadavers, we measured the TCL length and thickness, correlation between the distal wrist crease and the proximal end of the TCL, and distance between the distal end of the TCL and the palmar arch; the TCL cross sections and the thickest parts were also examined. Clinically, fasciotomy was performed on the relevant parts of 15 hands from 13 patients by making a minimally invasive incision on the distal wrist crease. Postoperatively, a two-point discrimination check was conducted in which the sensations of the first, second, and third fingertips and the palmar cutaneous branch injuries were monitored (average duration, 7 months). Results In the 13 cadaveric hands, the distal wrist crease and the proximal end of the TCL were placed in the same location. The average length of the TCL and the distance from the distal TCL to the superficial palmar arch were $35.30{\pm}2.59mm$ and $9.50{\pm}2.13mm$, respectively. The thickest part of the TCL was a region 25 mm distal to the distal wrist crease (average thickness, $4.00{\pm}0.57mm$). The 13 surgeries performed in the clinical settings yielded satisfactory results. Conclusions This peri-TCL anatomical study confirmed the safety of fasciotomy with a minimally invasive incision of the distal wrist crease. The clinical application of the technique indicated that the minimally invasive incision of the distal wrist crease was efficacious in the treatment of the carpal tunnel syndrome.

Keywords

References

  1. Paget J. Lectures on surgical pathology. 2nd ed. Philadelphia: Lindsay & Blakiston; 1854.
  2. Pfeffer GB, Gelberman RH, Boyes JH, et al. The history of carpal tunnel syndrome. J Hand Surg Br 1988;13:28-34. https://doi.org/10.1016/0266-7681(88)90046-0
  3. Learmonth JR. The principle of decompression in the treatment of certain diseases of peripheral nerves. Surg Clin North Am 1933;13:905-13.
  4. Atroshi I, Gummesson C, Johnsson R, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282:153-8. https://doi.org/10.1001/jama.282.2.153
  5. Graham B, Regehr G, Naglie G, et al. Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am 2006;31:919-24.
  6. Kim DH. Carpal tunnel syndrome: open carpal tunnel release. J Korean Neurotraumatol Soc 2008;4:1-7. https://doi.org/10.13004/jknts.2008.4.1.1
  7. Tinel J. Le signe du fourmillement dans les lesions des nerfs peripheriques. Presse Med 1915;23: 388-9.
  8. Phalen GS. The carpal tunnel syndrome: seventeen years' experience in diagnosis and treatment of 654 hands. J Bone Joint Surg Am 1966;48:211-28. https://doi.org/10.2106/00004623-196648020-00001
  9. Bezuhly M. Nerve entrapment syndrome. In: Neligan PC, editor. Plastic surgery. 3rd ed. Philadelphia: Elsevier Saunders; 2013. p.507.
  10. Okutsu I, Hamanaka I, Tanabe T, et al. Complete endoscopic carpal canal decompression. Am J Orthop (Belle Mead NJ) 1996;25:365-8.
  11. Watchmaker GP, Weber D, Mackinnon SE. Avoidance of transection of the palmar cutaneous branch of the median nerve in carpal tunnel release. J Hand Surg Am 1996;21:644-50. https://doi.org/10.1016/S0363-5023(96)80019-0
  12. Lee DH, Masear VR, Meyer RD, et al. Endoscopic carpal tunnel release: a cadaveric study. J Hand Surg Am 1992;17: 1003-8. https://doi.org/10.1016/S0363-5023(09)91046-2
  13. Cellocco P, Rossi C, Bizzarri F, et al. Mini-open blind procedure versus limited open technique for carpal tunnel release: a 30-month follow-up study. J Hand Surg Am 2005;30:493-9. https://doi.org/10.1016/j.jhsa.2005.02.007
  14. Hamed SA, Harfoushi FZ. Carpal tunnel release via mini-open wrist crease incision: procedure and results of four years clinical experience. Pak J Med Sci 2006;22:367-72.
  15. Rotman MB, Donovan JP. Practical anatomy of the carpal tunnel. Hand Clin 2002;18:219-30. https://doi.org/10.1016/S0749-0712(01)00003-8
  16. Kang YK, Kim DH, Lee SH, et al. Tenelectrodes: a new stimulator for inching technique in the diagnosis of carpal tunnel syndrome. Yonsei Med J 2003;44:479-84. https://doi.org/10.3349/ymj.2003.44.3.479
  17. Ikeda K, Osamura N, Tomita K. Segmental carpal canal pressure in patients with carpal tunnel syndrome. J Hand Surg Am 2006;31:925-9. https://doi.org/10.1016/j.jhsa.2006.03.004
  18. Sunil, Dikshit PC, Aggrawal A, et al. Estimation of stature from hand length. J Indian Forensic Sci 2005;27:219-21.

Cited by

  1. Proximal carpal crease incision for carpal tunnel release: a pilot study vol.42, pp.1, 2015, https://doi.org/10.1007/s00238-018-1450-z
  2. Effectiveness and Safety in Closed Mini-Transverse Incision with Hydro-Dissection Technique in Carpal Tunnel Release: A Cadaveric Study vol.24, pp.2, 2019, https://doi.org/10.1142/s2424835519500309