Metacarpal Small Incision for Carpal Tunnel Syndrome

Summary

Carpal tunnel decompression with transverse carpal ligament transection is a very successful treatment of carpal tunnel syndrome. The standard long-curved incision technique has become the best treatment for median nerve entrapment decompression. Here we introduce the metacarpal small incision carpal tunnel release (MSICTR) in the treatment of carpal tunnel syndrome (CTS).

Abstract

Endoscopic carpal tunnel release (ECTR) techniques have been established as a successful treatment for carpal tunnel syndrome and have proven equally effective as traditional open carpal tunnel release (OCTR) techniques in relieving pain and numbness. However, patients who undergo OCTR are more likely to experience scar tenderness and pillar pain and take longer to return to work.

We present here a method of metacarpal small incision for carpal tunnel release (MSICTR) as a safe, reliable, cost-effective alternative surgical decompression of the median nerve of the wrist. This technique utilizes a metacarpal small incision and direct visualization of the median nerve and carpal tunnel contents, reducing the risk of permanent injury and neurasthenia when compared to traditional OCTR. MSICTR is also suitable for the examination of the median nerve, surrounding tendon sheath, or space-occupying lesions.

MSICTR is associated with shorter operation times, less postoperative pain, faster recovery, and improved cosmetic results when compared to traditional OCTR. Therefore, MSICTR is an effective surgical decompression of the median nerve for the treatment of carpal tunnel syndrome.

Introduction

Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disorder caused by the compression of the median nerve in the wrist region, especially in the carpal canal. The clinical manifestations of CTS are diverse and may include pain, numbness, weakness, and hand muscle atrophy^1,2, which can significantly impact the quality of life of patients. The diagnosis of CTS is typically based on clinical manifestations and physical examination, supported by electrophysiological studies such as electrodiagnostic testing^3,4. For p....

Protocol

This study was approved by the ethics committee of our institution and all patients provided informed consent before participating in the study.

1. Preoperative steps

1. Exclude patients with cervical radiculitis, brachial plexus lesion, pronator syndrome, and nerve tear before the operation.
2. Define carpal tunnel syndrome based on persistent numbness, tingling, pain, and muscle weakness in the median nerve distribution area, positive physical examination (Ti.......

Discussion

Carpal tunnel surgical decompression combined with transection of the transverse carpal ligament has been a very successful operation for the treatment of CTS^{11,12,13,14,15,16}. Over the years, the carpal tunnel decompression procedure has been developed to reduce complications and side effects associated with the operation. A.......

Materials

Name	Company	Catalog Number	Comments
Absorbable suture	Shandong Boda Medical supplies Co., Ltd.	01-1517-8817-2	Absorbable suture in surgical suture, after implantation into human tissue, can be degraded and absorbed by the human body, and does not need to remove stitches, but to avoid the pain of suture removal of a new type of suture material.
Disposable aseptic surgical blade	Huaiyin Medical equipment Co., Ltd.	yuxiezhuzhun20192150063	It is used to cut soft tissue during surgery.
Disposable aseptic surgical membrane	Zhejiang Chun'an Renhe Medical products Industry and Trade Co., Ltd.	zhechunxiebei20180017hao	It can be used to cover and protect the organs of surgical patients from bacterial infection in hospital operations. at the same time, it can be used for CT, nuclear magnetic resonance, organ B-ultrasound and other inspection imaging examination.
Disposable infusion device	Shandong Weigao Group Medical Polymer products Co., Ltd.	1401275143736	Clinical intravenous infusion
Disposable sterilized rubber surgical gloves	Shanghai Huaxin Medical Materials Co., Ltd.	huxiezhuzhun20172660706	It is used in surgical procedures to protect patients and users, to avoid cross-infection, and is not suitable for examination gloves or procedural gloves.
Hemostatic forceps	Hunan Kefu Medical Technology Development Co., Ltd.	xiangxiezhuzhun20192150038	Hemostatic forceps is a kind of surgical instrument which can block blood by clamping blood vessels.
LM bipolar drop hydrocoagulation forceps (hemostatic ablation electrode during surgery)	Jiangsu Yibo Leiming Medical Technology Co., Ltd.	20222068536P	LM bipolar drop hydrocoagulation forceps (hemostatic ablation electrode during surgery) for electrocoagulation of tissue
Medical forceps	Yangzhou Euro Science and Technology Development Co., Ltd.	6803	Medical forceps are used to hold human tissue.
Medical gauze piece	Steady medical supplies co., Ltd.	59400869174	Medical gauze is a disposable item used in surgery and wound care.
Medical surgical towel	Xuchang Zhende Medical dressing Co., Ltd.	yushiyaojianxiezhunzi2006di2640197hao	It is used for hemostasis and isolation in all kinds of operations. at the same time, it can be used to observe and protect the important parts of patients in bedside photography and fluoroscopic surgery.
Needle holder	Shanghai Youqun Medical equipment Co., Ltd.	91310113758584951A	The needle holder is mainly used to hold stitches and suture various tissues.
Single-use suction connecting pipe	Suzhou Jingle Polymer Medical equipment Co., Ltd.	huxiezhuzhun20183100062	It is used to attract, aspirate blood, lavage, and rinse during the operation and play an auxiliary role in the operation.
Surgical hilt	Zhejiang Suichang Shuangjian Medical equipment Co., Ltd.	zhexiezhuzhun2020207162234	The scalpel is divided into a blade and a handle. The blade is disposable, the handle is not. Other instruments are not disposable, but they are autoclaved each time they are used.
Surgical scissors	Maichuang Medical Technology (Suzhou) Co., Ltd.	91320509MA1MMLGX80	For cutting dressings, human epidermis or soft tissue. Tissue scissors: used for cutting tissue.