Abstract

DISTAL PALMAR INCISION FOR CARPAL TUNNEL RELEASE

Author(s): Biswajit Mishra

BACKGROUND Carpal tunnel syndrome is the most common entrapment neuropathy of the upper extremity. Surgical decompression is indicated in whom conservative treatment fails. Open carpal tunnel release has been replaced by endoscopic techniques and limited incision techniques, to avoid the complications of open method. Smaller incisions lead to rapid postoperative recovery. Midpalmar incision is a type of limited incision used for release of carpal tunnel. MATERIALS AND METHODS From February 2016 through January 2017, 84 patients had undergone 90 midpalmar carpal tunnel releases with accurate skin incisions under axillary block anaesthesia. Postoperative evaluations were performed via subjective assessment with a standardized telephonic interview over an average follow-up period of 12 months. RESULTS The average operation time was 20 minutes (range, 5 to 40 minutes). A total of 72 hands (80%) had excellent recovery, nine (10 %) had good relief of symptoms, four (4.44%) had fair relief of symptoms and five (5.55%) had minimal improvement. The incidence of postoperative sensory morbidity, i.e., pillar pain or scar tenderness, was 7.77% (7 hands). Motor functional morbidity in the form of a persistent subjective decrease in grip strength was noted in 8.88% (8 hands), and the mean period for returning to work was 4.5 weeks. In addition, no operation-induced neurovascular or tendinous injury occurred in any patient. CONCLUSION The outcomes were similar to those of endoscopic carpal tunnel release. Based on these results, midpalmar carpal tunnel release with accurate location of skin incision is as effective as any other surgical procedures for carpal tunnel release. It is a safe, effective and economical procedure.