The authors present a 2-year experience with a limited-incision open carpal tunnel release approach in 149 hands from 104 patients. Patients were selected based on symptoms of carpal tunnel syndrome, positive provocative tests, and positive electrodiagnostic studies. Exclusion criteria were negative studies, flexor synovitis, and previous carpal tunnel surgery. Operations were performed under local anesthesia and an upper-arm tourniquet. A 1-cm incision over the transverse carpal ligament, in line with the radial border of the ring finger, and extending proximally from Kaplan's cardinal line was used to expose the median nerve and flexor tendons. The authors then describe release of the ligament and distal flexor retinaculum under direct visualization. Soft dressings without splinting were used for 5 days. Patients were then evaluated at 3 weeks and 6 months after the procedure, using direct interviews or phone interviews, for subjective assessment of scar sensitivity and relief of symptoms. Objective outcome data were collected on 20 of the patients, using the Michigan Hand Outcomes Questionnaire (MHQ), grip strength, key pinch, and Jebsen-Taylor Hand Function testing. All but 3 patients experienced resolution of scar tenderness by 6 months. Three patients had persistent carpal tunnel symptoms at 6 months. No statistically significant difference was observed at 6 months in grip strength, pinch strength, or Jebsen-Taylor scores. The MHQ revealed significant postoperative improvement in pain relief and satisfaction. Three of the operations were converted to a larger 2.5 cm incision due to poor anatomical definition with the smaller incision. Three infections and one recurrence of median nerve compression were reported.
The authors present a very well-organized series of carpal tunnel releases using a small 1-cm "mini open" approach. The rationale for this procedure is to minimize postoperative discomfort and avoid the risks reported by many authors with endoscopic carpal tunnel release. The study results appear to support the efficacy of the technique in most patients, as their subjective and objective measurements mirror the results reported in both open and endoscopic release. The technique appears to be safe, with a low reported incidence of complications. However, the results fall short of supporting this technique over either open or endoscopic carpal tunnel release, due to the absence of any comparable control groups. The paper does serve as a sound foundation for a larger and more properly-controlled study, which would hopefully answer the remaining questions.