J Korean Neurotraumatol Soc.  2008 Jun;4(1):1-7. 10.13004/jknts.2008.4.1.1.

Carpal Tunnel Syndrome: Open Carpal Tunnel Release

• Kim DH

• KMID: 1814435
• DOI: http://doi.org/10.13004/jknts.2008.4.1.1

Abstract

The carpal tunnel syndrome is the most common entrapment neuropathy. Release of the flexor retinaculum to decompress the median nerve is the most common surgical procedure in the hand, and the numbers continue to rise. Though the procedure is generally associated with low morbidity and relatively high success rates, failure of the surgeon to fully understand the anatomy, pathophysiology, and typical features of carpal tunnel syndrome, as well as the many pitfalls associated with its diagnosis and treatment, may lead to an unacceptable incidence of suboptimal results. The gold standard surgical treatment, transecting the transverse carpal ligament (TCL) with a scalpel under direct vision produces reliable symptom relief in the vast majority of cases. However, despite the clinical success of this technique, post-operative scar discomfort are known to occur in some patient. With the rising incidence of this problem, great effort has been directed to defining a less invasive surgery that would satisfactorily decompress the nerve but allow a speedier recovery and return to work. Thus, there have been evolved various offshoot types of carpal tunnel release: endoscopic and mini open. Each method generally yields very satisfactory results. However, without care, there may be more surgical complications, and we may not have effectively shortened the return to work time. With careful attention to detail during the procedure, however, mini open carpal tunnel release can provide a safe, effective, and minimally invasive method for accomplishing this frequent task.

Keyword

Carpal tunnel syndrome; Open carpal tunnel release; Mini open carpal release

MeSH Terms

Carpal Tunnel Syndrome
Cicatrix
Hand
Humans
Incidence
Ligaments
Median Nerve
Nerve Compression Syndromes
Return to Work
Vision, Ocular

Figure

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  FIGURE 1 The distal level of the carpal tunnel delimited by the hook of the hamate (H) and the tubercle of the trapezium (T). The flexor retinaculum (medium gray region) forms the roof of the carpal tunnel. The proximal level of the carpal tunnel delimited by the pisiform (P) and the scaphoid (S). The flexor retinaculum (medium gray region) forms the roof of the carpal tunnel and the floor of the Guyon tunnel. The palmar carpal ligament (dark gray region) forms the volar boundary of the Guyon tunnel. *flexor pollicis longus tendon, †flexor carpi radialis tendon.

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  FIGURE 2 Branching pattern of six of the dissected cadaveric hand.

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  FIGURE 3 Kaplan's cardinal line (1) is drawn from the apex of the first interdigital fold toward the ulnar side of the hand parallel to the proximal palmar crease. The proximal continuation of the ulnar side of the ring finger (2). The proximal continuation of the radial border of the long finger (3).

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  FIGURE 4 Frequencies and schematic presentation of different types of subcutaneous nerve distribution at the site of the incision. DWC: distal wrist crease, TH: thenar, HTH: hypothena.

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  FIGURE 5 Operation with SafeGuard® Mini-Open system.

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