Dataset Information

Carpal tunnel release using the Paine retinaculotome inserted through a palmar incision.

ABSTRACT:

Background

Carpal tunnel syndrome (CTS) is the most commonly diagnosed and treated entrapment neuropathy. There is no consensus regarding the optimal technique for carpal tunnel release. The objective of this study is to demonstrate the surgical treatment of CTS by a small palmar incision and utilization of Paine retinaculotome to divide the transverse carpal ligament.

Methods

In this technical note, we describe the use of a retinaculotome described by Paine in 1955, through a palmar approach.

Discussion

Open, minimally invasive and endoscopic surgical techniques have all been described as treatment options for CTS, and short-term success with these methods is well established. During the last decade, less invasive techniques have been developed in order to reduce the incidence of pillar pain and tender scars. We have used a mini-palmar incision and the Paine retinaculotome for carpal tunnel release since 1994. The goals of surgery are to create a small incision that permits a patient to have early motion and return to activity.

Conclusion

After many years, no permanent nerve or vascular damage has been reported. This method has demonstrated itself to be efficient and safe in the treatment of the carpal tunnel syndrome.

SUBMITTER: Fernandes CH

PROVIDER: S-EPMC3928388 | biostudies-literature | 2014 Mar

REPOSITORIES: biostudies-literature

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Publications

Carpal tunnel release using the Paine retinaculotome inserted through a palmar incision.

Fernandes Carlos Henrique CH Nakachima Luis Renato LR Hirakawa Celso Kiyoshi CK Gomes Dos Santos João Batista JB Faloppa Flavio F

Hand (New York, N.Y.) 20140301 1

<h4>Background</h4>Carpal tunnel syndrome (CTS) is the most commonly diagnosed and treated entrapment neuropathy. There is no consensus regarding the optimal technique for carpal tunnel release. The objective of this study is to demonstrate the surgical treatment of CTS by a small palmar incision and utilization of Paine retinaculotome to divide the transverse carpal ligament.<h4>Methods</h4>In this technical note, we describe the use of a retinaculotome described by Paine in 1955, through a pal ...[more]

PMID: 24570637

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Project description:BackgroundMinimally invasive surgery for carpal tunnel syndrome has been consistently the mainstay of treatment. In this study, we developed a novel bush hook via a mini-transverse incision at proximal wrist crease to surgically treat carpal tunnel syndrome and our aim was to compare the results with those of mid-palmar small longitudinal incision in carpal tunnel release.MethodsThis is a retrospective study on patients who received a mini-transverse incision and a novel bush hook or a mid-palmar small longitudinal incision for treatment of carpal tunnel syndrome. The decision to receive either technique was made mainly based on patients' choice. The clinical results were evaluated at 1 week, 1 month, 3 and 6 months postoperatively and compared.ResultsIn total, 58 patients in mini-transverse incision group and 74 in mid-palmar longitudinal incision group were include. The follow-up period was 6.8 ± 1.6 months. The mini-transverse incision group had a significantly smaller incision (4.3 ± 0.4 mm vs. 26.2 ± 1.6 mm), shorter surgical time (7.8 ± 2.6 min vs. 19.7 ± 2.8 min), but not for hospital stay (3.2 ± 1.9 vs. 3.6 ± 2.2 days). Both groups showed significant improvement from baseline level at any time points postoperatively (all P < 0.001). At 1 month and 3 months, the mini-transverse incision group showed a significantly better improvement of VAS, SSS and FSS score (P < 0.05). At 6 months, the differences were no longer significant (P > 0.05). In addition, the mini-transverse incision group showed a significantly reduced time to return to the work and activities, tendency to higher rate of excellence and good outcomes and fewer complications.ConclusionsThis novel technique via a mini-transverse incision and bush hook showed better clinical effectiveness and safety, and can be considered as an alternative for wrist tunnel release after the results are validated by higher-level evidence studies. Evidence level: III.

Project description:Introduction:The standard open technique for carpal tunnel surgery has wound problems and complications significantly more than minimally invasive surgery using the Wongsiri technique with MiniSURE Kit® (Surgical Innovation Healthcare Co., Ltd, Bangkok, Thailand) and in particular, the open technique surgery requires a longer time for return to work. CTR surgery with endoscopic devices improves the results with fewer wound problems when compared with the commonly used open technique; however, nerve complications and injury are more prevalent with endoscopic surgery than with the open technique. The Wongsiri technique produces good results with new medical devices such as the MiniSURE View, for improved vision and line-of-sight, and the MiniSURE Cut for improved and complete cutting via the supraretinacular technique that may reduce the nerve problems associated with endoscopic tooling in the carpal tunnel. Purpose:To evaluate the results of the operation and postoperative outcomes of the Wongsiri technique with a MiniSURE Kit®. Methods:20 patients underwent carpal tunnel release using the Wongsiri technique and a MiniSURE Kit® with a five-step surgery: MIS starts when the surgeon makes a 1.5-1.8?cm incision, creates a working space, inserts the visual tube of MiniSURE View, inserts the freer, and then cuts the transverse carpal ligament by using the MiniSURE Cut. Results:All 20 successes of the Wongsiri technique and MiniSURE Kit® surgery occurred within 6.8 minutes operative time and a 12?mm wound size. A single outlier, in one case (6.7%), the patient experienced pillar pain which abated within one month. Patients can return to work in 7.3 days. Conclusions:The Wongsiri technique with the MiniSURE Kit® demonstrated good outcomes similar to the endoscope. By contrast with the endoscopic surgery, the Wongsiri technique with the MiniSURE Kit® reduced preop, operating, and postop time, many resources, and significant costs and resulted in no nerve problems or complications.

Project description:BackgroundThe symptoms in carpal tunnel syndrome (CTS) can be ameliorated by open and endoscopic release of the transverse carpal ligament. It is unknown whether a mini-incision or endoscopic carpal tunnel release more effectively reverses the pathological changes that are observed in the median nerve in patients with CTS and these morphologic changes correlates with the subjective outcomes after carpal tunnel release. We hypothesized that (1) at 24 weeks after surgery, the subjective outcomes of mini-incision release and endoscopic release would not differ in patients with CTS; and (2) the ultrasonographic (US) morphology of the median nerve reverses similarly after mini-incision and endoscopic release; (3) the subjective outcomes correlates with these morphologic changes.MethodsBetween November 2011 and January 2013, 67 patients with CTS in their dominant wrist were randomized to either mini-incision (n = 32) or endoscopic (n = 35) release. Each patient was assessed by both the Boston Carpal Tunnel Questionnaire (BCTQ) and the Disabilities of the Arm, Shoulder, and Hand (DASH) pre-operatively and 24 weeks' post-operation. An US examination was conducted at both time points to measure the cross-sectional area (CSA) at the inlet, middle, and outlet (CSA-I, CSA-M and CSA-O) and the flattening ratio (FR) at the middle and outlet (FR-M and FR-O) of the median nerve.ResultsThe post-operative mean BCTQ and DASH scores were improved significantly from the pre-operative scores in both groups (p < 0.001). The mean CSA-I decreased and CSA-M and CSA-O increased similarly in both groups (by 3.3, 3.0, and 3.8 mm2 in the mini-incision group and 2.9, 3.1. and 2.7 mm2 in the endoscopic group. The mean FR-M/FR-O decreased similarly from 3.6/4.2 to 3.2/3.0 in the mini-incision group and 3.8/4.3 to 3.2/2.9 in the endoscopic group. There were no significant differences in the subjective outcome scores or median nerve measures between the two groups. Improvement in the BCTQ-S only was significantly correlated with changes in the CSA at the inlet.ConclusionsMini-incision and endoscopic release both similarly relieved subjective symptoms and functions along with the pathological changes in the median nerve morphology along the carpal tunnel in patients with idiopathic CTS. Symptom relief after surgical decompression seems to correlate with reduced nerve swelling at carpal inlet and reversed nerve flattening inside carpal tunnel.Trial registrationThis study was retrospectively registered in "ClinicalTrials.gov" at Oct 18th, 2013, and the registration number was NCT01972165 .

Dataset Information

Carpal tunnel release using the Paine retinaculotome inserted through a palmar incision.

Background

Methods

Discussion

Conclusion

Publications

Carpal tunnel release using the Paine retinaculotome inserted through a palmar incision.

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