Median Nerve Decompression Using Mini-Skin Incision in Carpal Tunnel Syndrome: Surgical Technique and Clinical Results

Öz

Compression of the median nerve at the wrist level is the most common entrapment neuropathy and is known as Carpal Tunnel Syndrome (CTS). In this study, in patients who were operated because of CTS; In order to reduce scar sensitization and pilar pain, surgical treatment was performed with a mini palmar incision distally from the transverse carpal ligament and the results and surgical technique were evaluated. A total of 103 patients (97 females, 6 males; mean age 49.4 years) who underwent surgery with mini open skin incision in our clinic between 2014 and 2017 were evaluated retrospectively. Pain and functional evaluation of the patients after surgery were performed using visual analog scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ). Patients were also evaluated for complications. The Boston carpal tunnel questionnaire scale and visual pain scale showed statistically significant improvement (p <0.05). In one patient; pain and immobility in the joints of the fingers due to not using a hand, improved after physical therapy. No patient was reoperated. It was observed that the patients started their daily activities on the second day, and the employees returned to work in the second week. The application of distal mini open surgery in the surgical treatment of carpal tunnel syndrome; less scar tissue and tenderness on the incision, allowing patients to return to their earlier daily activities.

Anahtar Kelimeler

• Carpal tunnel syndrome
• surgery
• distal mini open
• surgical technique

Kaynakça

1. Stewart JD. Compression and entrapment neuropathies. In: Dych PJ, Thomas PK, editors. Peripheral Neuropathy. 3rd ed. WB Saunders Company, Philadelphia p. 961-979, 1993
2. Buchberger W, Schon G, Strasser K, Jungwirth W. High-resolution ultrasonography of carpal tunnel. J Ultrasound 1991; 10: 531-537
3. Paget J. Lectures on surgical pathology. Lindsay any Blakiston, Philadelphia. 1854
4. Phalen GS. The carpal tunnel syndrome: experince in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg 1966; 48(2): 211-228
5. Frank H. Netter. Atlas of Human Anatomy, Paperback 2nd ed. 1997
6. Greenberg MS. Handbook of Neurosurgery; 3rd ed. Florida: Greenberg Graphics. 1994
7. Rengachary SS. Entrapment neuropathies. In: Wilkins RH, Rengachary SS, editors. Neurosurgery. International ed. The McGraw-HillCompanies p. 3073-3098, 1996
8. MacDermid JC, Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther 2004; 17(2): 309-319

9. Szabo RM, Gelberman RH, Dimick RP. Sensibility testing in patients with carpal tunnel syndrome. J Bone Joint Surg 1984; 66(1): 60-64
10. Deryani E, Aki S, Muslumanoglu L, Rozanes I. MR imaging and electrophysiological evaluation in carpal tunnel syndrome. Yonsei Med J 2003; 44(1): 27-32
11. Kotevoglu N, Gülbahce-Saglam S. Ultrasound imaging in the diagnosis of carpal tunnel syndrome and its relevance to clinical evaluation. Joint Bone Spine 2005; 72(2): 142-145
12. Gök H, Yalçın P. The importance of clinical tests in the diagnosis of carpal tunnel syndrome. Fiziksel Tıp Rehabil Derg 1997; 21(1): 31-36
13. Gündüz OH, Borman P, Bodur H, Uçan H. Wrist size, clinical and electrodiagnostic features in patients with carpal tunnel syndrome. Fiziksel Tıp Rehabil Derg 2003; 49(1): 22-26
14. Padua L, LoMonaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand 1997; 96(5): 211-217
15. Szabo RM, Madison M. Carpal tunnel syndrome. Orthop Clin North Am 1992; 23(1): 103-109
16. Kuhlman KA, Hennessey WJ. Sensitivity and specificity of carpal tunnel syndrome signs. Am J Phys Med Rehabil 1997; 76(6): 451-457
17. Cokluk C, Senel A, Iyigun O, Celik F, Rakunt C. Open median nerve release using double mini skin incision in patients with carpal tunnel syndrome: technique and clinical results. Neurol Med Chir (Tokyo) 2003; 43: 465-468
18. Schmelzer RE, Della Rocca GJ, Caplin DA. Endoscopic carpal tunnel release: a review of 753 cases in 486 patients. Plast Reconstr Surg 2006; 117: 177-185
19. Lee DH, Masear VR, Meyer RD, Stevens DM, Colgin S. Endoscopic carpal tunnel release: a cadaveric study. J Hand Surg Am 1992; 17: 1003-1008
20. Martin CH, Seiler JG, Lesesne JS. The cutaneous innervation of the palm: an anatomic study of the ulnar and median nerve. J Hand Surg Am 1996; 21: 634-638
21. Ozcanlı H, Coskun NK, Cengiz M, Oguz N, Sindel M. Defination of a safe zone in open carpal tunnel surgery: a cadaver study. Surg Radiol Anat 2010; 32: 203-206
22. Abouzahr MK, Pastis MC, Chiu DTW. Carpal tunnel release using limited direct vision. Plast Reconstr Surg 1995; 95: 534-537
23. Klein DC, Kotsis SV, Chung KC. Open carpal tunnel release using a 1-centimeter incision: technique and outcomes for 104 patients. Plast Reconstr Surg 2003; 111: 1616-1622,
24. Lee WP, Strickland JW. Safe carpal tunnel release via a limited palmar incision. Plast Reconstr Surg 1998; 101: 418-424
25. Bagatur AE. Causes of failure and revision results in carpal tunnel syndrome surgery. Acta Orthop Traumatol Turc 2002; 36: 346-353
26. Bal E, Pişkin A, Ada S, Ademoglu Y, Toros T, Kayalar M. Comparison between two mini incision techniques utilized in carpal tunnel release. Acta Orthop Traumatol Turc 2008; 42: 234-237