Limited mid palmar versus extended incision in surgical treatment of carpal tunnel syndrome: Clinical analysis

Jagar Omar Doski; Reber Saeed Sindy; Farhad Taher Hamzani; Hishyar Osman Omar

doi:10.15218/zjms.2020.043

Authors

Jagar Omar Doski Department of Surgery, College of Medicine, University of Duhok, Duhok, Iraq.
Reber Saeed Sindy Emergency Teaching Hospital, Duhok, Iraq.
Farhad Taher Hamzani Emergency Teaching Hospital, Duhok, Iraq.
Hishyar Osman Omar Emergency Teaching Hospital, Duhok, Iraq.

DOI:

https://doi.org/10.15218/zjms.2020.043

Keywords:

Carpal tunnel syndrome, Surgical treatment, Incision

Abstract

Background and objective: There are different methods and incisions to release the transverse carpal ligament in carpal tunnel syndrome. This study aimed to compare the surgical outcome of the conventional extended incision with the limited mid palmar one.

Methods: The study was a prospective comparative one. Patients with carpal tunnel syndrome were divided into two groups: Group 1 was patients operated on by the conventional extended incision, Group 2 with a limited mid palmar incision.

Results: The patients included were 79 with 89 hands. The age mean was 41 years. Group 1 included 47, and Group 2 included 42 hands. The differences between both groups were statistically significant regarding the operative data (the incision length and the operative time) and the post-operative data (the duration of analgesia needed, the date of starting to use the hand in daily life activities, and return to work). However, the date of improvement of the sensory symptoms from the fingers showed no significant differences. The sum of the overall complications that occurred for the cases of Group 2 was about a third of that occurred for Group 1. The highly significant difference was in the scar tenderness in the third month of the post-operative period.

Conclusion: The limited mid palmar incision to release the entrapment of median nerve in carpal tunnel syndrome offers a shorter operative time, less analgesia needed post-operatively, less complication rate, less scar tenderness, earlier use of the hand in daily life activities, and return to work in a shorter period.

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References

Bickel K. Carpal tunnel syndrome. J Hand Surg Am 2010; 35(1):147–52.

Thatte MR, Mansukhani KA. Compressive neuropathy in the upper limb. Indian J Plast Surg 2011; 44(2):283–97.

Karl JW, Gancarczyk SM, Strauch RJ. Complications of carpal tunnel release. Orthop Clin North Am 2016; 47(2):425–33.

Faucher GK, Daruwalla JH, Seiler JG. Complications of surgical releasebreak of carpal tunnel syndrome: A systematic review. J Surg Orthop Adv 2017; 26(1):18–24.

Sayegh ET, Strauch RJ. Open versus endoscopic carpal tunnel release: A meta-analysis of randomized controlled trials. Clin Orthop Relat Res 2015; 473(3):1120–32.

Mintalucci DJ, Leinberry CF. Open versus endoscopic carpal tunnel release. Orthop Clin North Am 2012; 43(4):431–7.

Khan AA, Ali H, Ali K, Muhammad G, Rashid B, Gul N, et al. Outcome of open carpal tunnel release surgery. J Ayub Med Coll Abbottabad 2015; 27(3):640–42.

Larsen MB, Sørensen AI, Crone KL, Weis T, Boeckstyns ME. Carpal tunnel release: a randomized comparison of three surgical methods. J Hand Surg Eur 2013; 38(6):646–50.

Bai J, Kong L, Zhao H, Yu K, Zhang B, Zhang J, et al. Carpal tunnel release with a new mini-incision approach versus a conventional approach, a retrospective cohort study. Int J Surg 2018; 52:105–9.

Tarallo M, Fino P, Sorvillo V, Parisi P, Scuderi N. Comparative analysis between minimal access versus traditional accesses in carpal tunnel syndrome: A perspective randomised study. J Plast Reconstr Aesthet Surg 2014; 67(2):237–43.

Yücetaş SC, Yildirim A. Comparative results of standard open and mini open, KnifeLight instrument-assisted carpal tunnel release. J Neurol Surg A Cent Eur Neurosurg 2013; 74(6):393–9.

Siegmeth AW, Hopkinson-Woolley JA. Standard open decompression in carpal tunnel syndrome compared with a modified open technique preserving the superficial skin nerves: A prospective randomized study. J Hand Surg Am 2006; 31(9):1483–9.

Nagle DJ. Endoscopic carpal tunnel release. Hand Clin 2002; 18(2):307–13.

Kohanzadeh S, Herrera FA, Dobke M. Outcomes of open and endoscopic carpal tunnel release: a meta-analysis. Hand (N Y) 2012; 7(3):247–51.

Michelotti B, Romanowsky D, Hauck RM. Prospective, randomized evaluation of endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome: an interim analysis. Ann Plast Surg 2014; 73(2):S157–60.

Boston Carpal Tunnel Questionnaire. (Accessed November 20, 2020, at https://journals.plos.org/plosone/article/file?id=info:doi/10.1371/journal. pone.0129918.s002&type=supplementary).

Yücel H, Seyithanoğlu H. Choosing the most efficacious scoring method for carpal tunnel syndrome. Acta Orthop Traumatol Turc 2015; 49(1):23–9.

Tzaan WC, Lui TN, Lee ST. Midpalmar accurate incision for carpal tunnel release. Chang Gung Med J 2005; 28(2):97–103.

Murthy PG, Goljan P, Mendez G, Jacoby SM, Shin EK, Osterman AL. Mini-open versus extended open release for severe carpal tunnel syndrome. Hand (N Y) 2015; 10(1):34–9.

Gülşen I, Ak H, Evcılı G, Balbaloglu O, Sösüncü E. A retrospective comparison of conventional versus transverse mini-incision technique for carpal tunnel release. ISRN Neurol 2013; 2013:721830.

Jugovac I, Burgić N, Mićović V, Radolović-Prenc L, Uravić M, Golubović V, et al. Carpal tunnel release by limited palmar incision vs traditional open technique: Randomized controlled trial. Croat Med J 2002; 43(1):33–6.

Zuo D, Zhou Z, Wang H, Liao Y, Zheng L, Hua Y, et al. Endoscopic versus open carpal tunnel release for idiopathic carpal tunnel syndrome: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2015; 10:12.

Bromley GS. Minimal-incision open carpal tunnel decompression. J Hand Surg Am 1994; 19(1):119–20.

Cellocco P, Rossi C, Bizzarri F, Patrizio L, Costanzo G. Mini-open blind procedure versus limited open technique for carpal tunnel release: a 30-month follow-up study. J Hand Surg Am 2005; 30(3):493–99.

Cho YJ, Lee JH, Shin DJ, Park KH. Comparison of short wrist transverse open and limited open techniques for carpal tunnel release: a randomized controlled trial of two incisions. J Hand Surg Eur 2016; 41(2):143–7.

Shin EK, Bachoura A, Jacoby SM, Chen NC, Osterman AL. Treatment of carpal tunnel syndrome by members of the American Association for Hand Surgery. Hand (NY) 2012; 7(4):351–6.