CARITAL TUNNEL DECOMPRESSION WITH MINIMAL-INCISION TECHNIQUE

Journal of the Korean Society for Surgery of the Hand 1997;2(1):131-140.
Published online January 1, 1997.

Duke Whan Chung,Chung Soo Han,Young Suk Song,Ki Woong Jeong

최소 절개로 시행한 수근관 감압술

정덕환,한정수,송영석,정기웅

Abstract

The carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome. The typical symptoms are pain, numbness and paresthesia in the median nerve territories of the hand and progressive thenar muscle atrophy. When the symptom is mild and its duration is short conservative treatment' such as splinting or local steroid injection is considered. But when symptoms are continued or recurrent and neurological deficit is prominent and conservative treatment is not effective, surgical decompression is indicated. Endoscopic carpal tunnel decompression has recently become popular because of a smailer incision, decreased postoperative swelling and discomfort and a shorter period of disability. However, many hand surgeons still regard endoscopic release as a "blind" procedure due to possibility of incomplete ligament division, median and ulnar nerve injury, and superficial palmar arch injury. Classic open technique with 4-5cm size incision provides complete resection of transverse carpal ligament, elimination of disease origin, and associating with synovectomy, but has disadvantages of scar problems, iatrogenic injury of palmar sensory branch and recurrent branch of median nerve, longer immobilization, and delayed return to work. Minimal-incision open carpal tunnel decompression4 can provide for direct visualization of the transverse carpal ligament and median nerve using a small palmar incision, diminishing postoperative discomfort and scarring. The minimal dressing without splinting permits rapid return to usual daily activities and time lost from work is reduced. Authors reviewed 27 patients(42 cases) of carpal tunnel syndrome treated with this minimal-incision open carpal with less than 2 cm skin incision decompression at the department of Orthopedic Surgery, Kyung Hee University Hospital from Jan. 1993 to Dec. 1995. The results are as follows : 1. The average age was 51.3 years(30-74 years). Among 27 patients, only one was male and 26 were female. Mean follow-up periods were 14.6 months(7-42 months). 2. 23 cases(85.2%) performed at the dominent site, 15 patients(55.5%) at both site. 3. Most common etiology of carpal tunnel syndrome was unknown origin in 40 cases(95.2%) of 42 cases. 4. Symptoms were paresthesia, dull sensation, pain, and muscle weakness orderly. Preoperative physical examinations showed sensory changes in 35 cases(83.8%), Tinel sign in 28 cases(66.7%), Phalen test in 27 cases(64.2%), and thenar muscle atrophy in 26 cases(61.9%) orderly. 5. EMG test was done at 35 cases of 42 cases, among them 34 cases had abnormal conduction velocity of motor and sensory. 6. Postoperative symptoms were improved at 36 cases(85.7% ), however relatively poor results came from long disease-duration cases.