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

다국어 초록 (Multilingual 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±2.59 mm and 9.50±2.13 mm, respectively.
The thickest part of the TCL was a region 25 mm distal to the distal wrist crease (average thickness, 4.00±0.57 mm). 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.

참고문헌 (Reference)

1 Learmonth JR., "The principle of decompression in the treatment of certain diseases of peripheral nerves" 13 : 905-913, 1933

2 Pfeffer GB, "The history of carpal tunnel syndrome" 13 : 28-34, 1988

3 Phalen GS., "The carpal tunnel syndrome: seventeen years’ experience in diagnosis and treatment of 654 hands" 48 : 211-228, 1966

4 Yoon-KyooKang, "Tenelectrodes: a New Stimulator for Inching Technique in the Diagnosis of Carpal Tunnel Syndrome" 연세대학교의과대학 44 (44): 479-484, 2003

5 Ikeda K, "Segmental carpal canal pressure in patients with carpal tunnel syndrome" 31 : 925-929, 2006

6 Atroshi I, "Prevalence of carpal tunnel syndrome in a general population" 282 : 153-158, 1999

7 Rotman MB, "Practical anatomy of the carpal tunnel" 18 : 219-230, 2002

8 Bezuhly M., "Plastic surgery" Elsevier Saunders 507-, 2013

9 Cellocco P, "Mini-open blind procedure versus limited open technique for carpal tunnel release: a 30-month follow-up study" 30 : 493-499, 2005

10 Paget J., "Lectures on surgical pathology" Lindsay & Blakiston 1854

11 Tinel J., "Le signe du fourmillement dans les lesions des nerfs peripheriques" 23 : 388-389, 1915

12 Sunil, "Estimation of stature from hand length" 27 : 219-221, 2005

13 Lee DH, "Endoscopic carpal tunnel release: a cadaveric study" 17 : 1003-1008, 1992

14 Graham B, "Development and validation of diagnostic criteria for carpal tunnel syndrome" 31 : 919-924, 2006

15 Okutsu I, "Complete endoscopic carpal canal decompression" 25 : 365-368, 1996

16 Kim DH., "Carpal tunnel syndrome: open carpal tunnel release" 4 : 1-7, 2008

17 Hamed SA, "Carpal tunnel release via mini-open wrist crease incision: procedure and results of four years clinical experience" 22 : 367-372, 2006

18 Watchmaker GP, "Avoidance of transection of the palmar cutaneous branch of the median nerve in carpal tunnel release" 21 : 644-650, 1996