Name: metacarpal small incision for carpal tunnel syndrome
Uploaded: 2024-04-05T12:30:00
Description: Watch this Scientific Journal Video about Metacarpal Small Incision for Carpal Tunnel Syndrome at JoVE.com

This study was supported by a fund from the University-Industry Collaborative Education Program of the Ministry of Education in 2021 (project number: 202101312014) and a fund from the University-Industry Collaborative Education Program of the Ministry of Education in 2022 (project number: 220905634190447).

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

<ol>
	<li>Malakootian, M., Soveizi, M., Gholipour, A., Oveisee, M. Pathophysiology, diagnosis, treatment, and genetics of carpal tunnel syndrome: a review. Cellular and Molecular Neurobiology. 43 (5), 1817-1831 (2023).</li>
	<li>Sobeeh, M. G., Ghozy, S., Elshazli, R. M., Landry, M. Pain mechanisms in carpal tunnel syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes. Pain. 163 (10): E1054-E1094 (2022).</li>
	<li>Aydin, K., Cokluk, C., Cengiz, N., Bilgici, A. Microsurgical open mini uniskin incision technique in the surgical treatment of carpal tunnel syndrome. Neurology India. 54 (1), 64-67 (2006).</li>
	<li>Aydin, K., Cokluk, C., Piskin, A., Kocabicak, E. Ultrasonographically checking the sectioning of the transverse carpal ligament during carpal tunnel surgery with limited uniskin incisions. Turkish Neurosurgery. 17 (3), 219-223 (2007).</li>
	<li>Huisstede, B. M. et al. Carpal tunnel syndrome. Part 2. Effectiveness of surgical treatments. A systematic review. Archives of Physical Medicine and Rehabilitation. 91 (7), 1005-1024 (2010).</li>
	<li>Osiak, K., Elnazir, P., Walocha, J. A., Pasternak, A. Carpal tunnel syndrome: state-of-the-art review. Folia Morphologica. 81 (4), 851-862 (2022).</li>
	<li>Aroori, S., Spence, R. A. Carpal tunnel syndrome.The Ulster medical journal. 77(1),6-17 (2008).</li>
	<li>Lida, J., Hirabayashi, H., Nakase, H., Sakaki, T. Carpal tunnel syndrome: electrophysiological grading and surgical results by minimum incision open carpal tunnel release.&#160;Neurologia Medico-chirurgica.&#160;48&#160;(12), 554-559 (2008).</li>
	<li>Phalen, G. S. The carpal-tunnel syndrome: seventeen years&#39; experience in diagnosis and treatment of six hundred fifty-four hands. The Journal of Bone and Joint Surgery. American Volume.&#160;48&#160;(2), 211-228 (1966).</li>
	<li>Abdullah, A. F., Wolber, P. H., Ditto, E. W. Sequelae of carpal tunnel surgery: rationale for design of a surgical approach.&#160;Neurosurgery.&#160;37&#160;(5), 931-936 (1995).</li>
	<li>Dawson, D. M. Entrapment neuropathies of the upper extremities.&#160;The New England Journal of Medicine.&#160;329&#160;(27), 2013-2018 (1993).</li>
	<li>Hybbinette, C. H., Mannerfelt, L. The carpal tunnel syndrome: a retrospective study of 400 operated patients. Acta Orthopaedica Scandinavica. 46 (4), 610-620 (1975).</li>
	<li>Malla, M. A., Bhat, A. A., Samiullah, M., Farooq, M. Mini-open carpal tunnel release in carpal tunnel syndrome. Integrative Journal of Orthopaedics and Traumatology. 5 (2), 1-6 (2022).</li>
	<li>Harris, C. M., Tanner, E., Goldstein, M. N., Pettee, D. S. The surgical treatment of the carpal tunnel syndrome correlated with preoperative nerve conduction studies. The Journal of Bone and Joint Surgery. American Volume. 61 (1), 93-98 (1979).</li>
	<li>Hidayati, H. B., Subadi, I., Fidiana., Puspamaniar, V. A. Current diagnosis and management of carpal tunnel syndrome: A review. Anaesthesia Pain &#38; Intensive Care. 26 (3), 394-404 (2022).</li>
	<li>Carmo, J. D. &#39;INSIGHT-PRECISION&#39;: a new, mini-invasive technique for the surgical treatment of carpal tunnel syndrome. Journal of International Medical Research. 48 (1), 0300060519878082 (2020).</li>
	<li>Atthakomol, P. et al. Short incision versus minimally invasive surgery with tool-kit for carpal tunnel syndrome release: a prospective randomized control trial to evaluate the anterior wrist pain and time to return to work or activities. BMC Musculoskeletal Disorders. 23 (1), 708 (2022).</li>
	<li>Vetrano, I., Devigili, G., Nazzi, V. Minimally invasive carpal tunnel release: a technical note and a 20-year retrospective series. Cureus Journal of Medical Science. 14 (1), e21426 (2022).</li>
	<li>Lowry, W. E., Follender, A. B. Interfascicular neurolysis in the severe carpal tunnel syndrome. A prospective, randomized, double-blind, controlled study. Clinical Orthopaedics and Related Research. 227, 251-254 (1988).</li>
	<li>Franzini, A., Broggi, G., Servello, D., Dones, I., Pluchino, M. G. Transillumination in minimally invasive surgery for carpal tunnel release. Technical note. Journal of Neurosurgery. 85 (6), 1184-1186 (1996).</li>
	<li>Agee, J. M., McCarroll, H. R., North, E. R. Endoscopic carpal tunnel release using the single proximal incision technique. Hand Clinics. 10 (4), 647-659 (1994).</li>
	<li>Chow, J. C. Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome. Arthroscopy: The Journal of Arthroscopic &#38; Related Surgery. 5 (1), 19-24 (1989).</li>
	<li>Okada, M., Tsubata, O., Yasumoto, S., Toda, N., Matsumoto, T. Clinical study of surgical treatment of carpal tunnel syndrome: open versus endoscopic technique. Journal of Orthopaedic Surgery. 8 (2), 19-25 (2000).</li>
	<li>Teh, K. K., Ng, E. S., Choon, D. S. K. Mini open carpal tunnel release using knifelight: evaluation of the safety and effectiveness of using a single wrist incision (cadaveric study). The Journal of Hand Surgery, European Volume. 34 (4), 506-510 (2009).</li>
	<li>Trumble, T. E., Diao, E., Abrams, R. A., Gilbert-Anderson, M. M. Single-portal endoscopic carpal tunnel release compared with open release: a prospective randomized trial. The Journal of Bone and Joint Surgery. American Volume. 84 (7), 1107-1115 (2002).</li>
	<li>Wongsiri, S., Suwanno, P., Tangtrakulwanich, B., Yuenyongviwat, V., Wongsiri, E. A new tool for mini open carpal tunnel release-the PSU retractor. BMC Musculoskeletal Disorders. 9, 126 (2008).</li>
	<li>Nazzi, V., Franzini, A., Messina, G., Broggi, G. Carpal tunnel syndrome: matching minimally invasive surgical techniques, technical note. Journal of Neurosurgery. 108 (5), 1033-1036 (2008).</li>
	<li>Martinez-Catasus, A. et al. Comparison between single portal endoscopic and 1-cm open carpal tunnel release. Hand Surgery and Rehabilitation. 38 (3), 202-206 (2019).</li>
	<li>Lam, K. H. S. et al. Ultrasound-guided interventions for carpal tunnel syndrome: a systematic review and meta-analyses. Diagnostics. 13 (6), 1138 (2023).</li>
	<li>Kamel, S. I., Freid, B., Pomeranz, C., Halpern, E. J., Nazarian, L. N. Minimally invasive ultrasound-guided carpal tunnel release improves long-term clinical outcomes in carpal tunnel syndrome. AJR American Journal of Roentgenology. 217 (2), 460-468 (2021).</li>
	<li>Chang, K. V. Ultrasound diagnosis and guided intervention of musculoskeletal/neuromuscular pathology 2022. Diagnostics. 13 (11), 1945 (2023).</li>
	<li>Peters, S., Page, M. J., Coppieters, M. W., Ross, M., Johnston, V. Rehabilitation following carpal tunnel release. The Cochrane Database of Systematic Reviews. 17 (2), CD004158 (2016).</li>
	<li>Bai, J. et al. Carpal tunnel release with a new mini-incision approach versus a conventional approach, a retrospective cohort study. International Journal of Surgery. 52, 105-109 (2018).</li>
	<li>Eberlin, K. R. et al. Multicenter randomized trial of carpal tunnel release with ultrasound guidance versus mini-open technique. Expert Review of Medical Devices. 20 (7), 597-605 (2023).</li>
	<li>Lee, Y. S., Youn, H., Shin, S. H., Chung, Y. G. Minimally invasive carpal tunnel release using a hook knife through a small transverse carpal incision: technique and outcome. Clinics In Orthopedic Surgery. 15 (2), 318-326 (2023).</li>
</ol>

Carpal tunnel surgical decompression combined with transection of the transverse carpal ligament has been a very successful operation for the treatment of CTS11,12,13,14,15,16. Over the years, the carpal tunnel decompression procedure has been developed to reduce complications and side effects associated with the operation. A...

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 atrophy1,2, 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 testing3,4. For patients with mild symptoms, conservative treatment may be sufficient, but for those with moderate to severe symptoms, surgical intervention is often necessary5.
Many surgical techniques6,7,8,9,10,11,12,13,14,15,16,17, 
18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35 have been developed for the treatment of CTS, each with its advantages and disadvantages6,7,8. Open carpal tunnel decompression with a standard long palmar curved incision is a commonly used technique; however, it is associated with various complications such as scar tenderness, cosmetic dissatisfaction, and loss of hand grip and pinch strength3,7,9,10. Therefore, there is a need for a surgical technique that is effective in treating CTS but is also minimally invasive and associated with fewer complications.
The purpose of this study is to introduce a metacarpal small incision for carpal tunnel release (MSICTR) technique in the treatment of CTS and summarize our experience. This technique utilizes a small incision made at the base of the palm, over the carpal tunnel, allowing direct visualization of the median nerve and carpal tunnel contents (Figure 1). The advantages of MSICTR include shorter operation time, less postoperative pain, faster recovery, and improved cosmetic results when compared to traditional open carpal tunnel decompression techniques3.
Previous studies have shown that MSICTR is an effective and safe surgical technique for the treatment of CTS13,16,17,18,20,24,26,27,28. MSICTR has been associated with low rates of postoperative complications such as scar tenderness, infection, and median nerve damage17. Additionally, MSICTR can provide direct visualization of the median nerve and carpal tunnel contents, ensuring the complete release of the carpal tunnel and reducing the risk of residual compression18. The MSICTR technique is suitable for patients with CTS who have failed conservative management and are suitable for surgery. It can be used in patients with mild to severe symptoms of CTS and is particularly suitable for those who are concerned about cosmetic results and postoperative recovery time. However, MSICTR should not be used in patients with coagulation disorders or those who are not suitable for general anesthesia.
In summary, MSICTR is a safe and effective surgical technique for the treatment of CTS that has advantages over traditional open carpal tunnel decompression techniques. It is associated with shorter operation time, less postoperative pain, faster recovery, and improved cosmetic results. However, further randomized controlled trials are needed to compare MSICTR with other surgical techniques for CTS to establish its true efficacy and safety.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Absorbable suture</td>
			<td>Shandong Boda Medical supplies Co., Ltd.</td>
			<td>01-1517-8817-2</td>
			<td>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.</td>
		</tr>
		<tr>
			<td>Disposable aseptic surgical blade</td>
			<td>Huaiyin Medical equipment Co., Ltd.</td>
			<td>yuxiezhuzhun20192150063</td>
			<td>It is used to cut soft tissue during surgery.</td>
		</tr>
		<tr>
			<td>Disposable aseptic surgical membrane</td>
			<td>Zhejiang Chun&#39;an Renhe Medical products Industry and Trade Co., Ltd.</td>
			<td>zhechunxiebei20180017hao</td>
			<td>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.</td>
		</tr>
		<tr>
			<td>Disposable infusion device</td>
			<td>Shandong Weigao Group Medical Polymer products Co., Ltd.</td>
			<td>1401275143736</td>
			<td>Clinical intravenous infusion</td>
		</tr>
		<tr>
			<td>Disposable sterilized rubber surgical gloves</td>
			<td>Shanghai Huaxin Medical Materials Co., Ltd.</td>
			<td>huxiezhuzhun20172660706</td>
			<td>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.</td>
		</tr>
		<tr>
			<td>Hemostatic forceps</td>
			<td>Hunan Kefu Medical Technology Development Co., Ltd.</td>
			<td>xiangxiezhuzhun20192150038</td>
			<td>Hemostatic forceps is a kind of surgical instrument which can block blood by clamping blood vessels.</td>
		</tr>
		<tr>
			<td>LM bipolar drop hydrocoagulation forceps (hemostatic ablation electrode during surgery)</td>
			<td>Jiangsu Yibo Leiming Medical Technology Co., Ltd.</td>
			<td>20222068536P</td>
			<td>LM bipolar drop hydrocoagulation forceps (hemostatic ablation electrode during surgery) for electrocoagulation of tissue</td>
		</tr>
		<tr>
			<td>Medical forceps</td>
			<td>Yangzhou Euro Science and Technology Development Co., Ltd.</td>
			<td>6803</td>
			<td>Medical forceps are used to hold human tissue.</td>
		</tr>
		<tr>
			<td>Medical gauze piece</td>
			<td>Steady medical supplies co., Ltd.</td>
			<td>59400869174</td>
			<td>Medical gauze is a disposable item used in surgery and wound care.</td>
		</tr>
		<tr>
			<td>Medical surgical towel</td>
			<td>Xuchang Zhende Medical dressing Co., Ltd.</td>
			<td>yushiyaojianxiezhunzi2006di2640197hao</td>
			<td>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.</td>
		</tr>
		<tr>
			<td>Needle holder</td>
			<td>Shanghai Youqun Medical equipment Co., Ltd.</td>
			<td>91310113758584951A</td>
			<td>The needle holder is mainly used to hold stitches and suture various tissues.</td>
		</tr>
		<tr>
			<td>Single-use suction connecting pipe</td>
			<td>Suzhou Jingle Polymer Medical equipment Co., Ltd.</td>
			<td>huxiezhuzhun20183100062</td>
			<td>It is used to attract, aspirate blood, lavage, and rinse during the operation and play an auxiliary role in the operation.</td>
		</tr>
		<tr>
			<td>Surgical hilt</td>
			<td>Zhejiang Suichang Shuangjian Medical equipment Co., Ltd.</td>
			<td>zhexiezhuzhun2020207162234</td>
			<td>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.</td>
		</tr>
		<tr>
			<td>Surgical scissors</td>
			<td>Maichuang Medical Technology (Suzhou) Co., Ltd.</td>
			<td>91320509MA1MMLGX80</td>
			<td>For cutting dressings, human epidermis or soft tissue. Tissue scissors: used for cutting tissue.</td>
		</tr>
	</tbody>
</table>

metacarpal small incision for carpal tunnel syndrome

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.

It is important to discuss the recovery time with the patient before the operation to make the patient&#39;s expectation of the outcome of the operation realistic. The surgical marker simplifies the identification of surgical incisions (Figure 2A).
When the surgical approach is performed in accordance with the above steps, all the diseased sites of the transverse carpal ligament and adjacent metacarpal fascia can be touched without any problem (<strong class="xfig...

Watch this Scientific Journal Video about Metacarpal Small Incision for Carpal Tunnel Syndrome at JoVE.com

Metacarpal Small Incision for Carpal Tunnel Syndrome

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).

Endoscopic carpal tunnel release (ECTR) techniques have been established as a successful treatment for carpal tunnel syndrome and have proven equally ...

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