NON-ENDOSCOPIC MINIMALLY INVASIVE RELEASE OF THE MEDIAN NERVE IN THE CARPAL TUNNEL

Abstract

Purpose of the study: We report the results of a prospective series of 104 cases of carpal tunnel decompression using a minimally invasive technique performed by one operator.

Material and methods: The 92 patients (28 men) were treated in an outpatient clinic between February 1999 and July 2002. Mean age was 50 years and 86% of the cases involved the dominant side. Twenty-one patients were manual laborers. There was a notion of repeated motion (occupational disease) in nine cases and eight patients were diabetics. Nocturnal paresthesia predominated the clinical presentation in all patients. Anesthesia of the median nerve territory was noted in five patients. There was no motor deficit. The technique consisted in decompression of the carpal tunnel under local anesthesia via an incision in the flexion fold of the wrist and introduction of a pre-moulded canulated probe into the carpal tunnel then section of the anterior retinacular ligament using a n°15 lancet guided by the probe. Patients were reviewed at 15 days, then one, three and six months.

Results: Outcome was excellent or good in 97.2%. One patient was partially relieved: this diabetic patient retained decreased sensitivity in the median nerve territory but the nocturnal paresthesia resolved completely. Two patients underwent decompression on both sides (same technique) and continued to complain about pain on one side. There were no neurological, tendinous, or infectious complications and no conversion to open surgery was required. Mean duration of sick leave was 22.3 days and daily activities were resumed without pain at the base of the hand on average 15 days after surgery.

Conclusion: The results obtained with this minimally invasive non-endoscopic technique are comparable with endoscopic techniques but at a lesser cost.