Avoidance of transection of the palmar cutaneous branch of the median nerve in carpal tunnel release

Watchmaker, Greg P.; Weber, Dean; Mackinnon, Susan E.

doi:10.1016/s0363-5023(96)80019-0

Cited by 63 publications

(42 citation statements)

References 7 publications

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“…1,5,23 To avoid iatrogenic damage to the nerves, it is enough to respect certain anatomical criteria. Watchmaker 35 et al showed that the palmar cutaneous branch of the median nerve appears 2.09 ± 0.31 cm from the distal wrist crease. Samarakoon et al 28 revealed that the palmar incision must not be extended more than 8.16 mm from the proximal border of the TCL, to avoid inadvertently dividing the palmar cutaneous branch.…”

Section: Double Tunnels Techniquementioning

confidence: 99%

The double tunnels technique: an alternative minimally invasive approach for carpal tunnel syndrome

Vanni

Sirabella

Galzio

et al. 2015

JNS

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OBJECT The purpose of this study was to assess the effectiveness and safety of an alternative minimally invasive technique for the treatment of carpal tunnel syndrome (CTS). METHODS This was designed as a prospective, randomized, open-label, blinded end point evaluation (PROBE) study. The active comparison was double tunnels technique (DTT) (Group A, 110 patients) versus standard open decompression of the median nerve (control [Group B], 110 patients). Patient recruitment started in January 2011. The primary outcomes were the functional Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) scores and visual analog scale (VAS) scores for pain (pVAS) at Weeks 2 and 4, and at Months 3, 6, and 12. The secondary outcome was the aesthetics (aVAS) score at Weeks 2 and 4, and at Months 3, 6, and 12. RESULTS The Student t-test and ANOVA were used, and the results were considered statistically significant if the p value was ≤ 0.05 for continuous variables. The DTT is a tissue-sparing approach that allows the surgeon to limit the length of the incision (0.6 ± 0.05 cm) and to respect the palmar fascia and the subcutaneous tissue. Recovery from wrist pain, night pain, numbness, stiffness, and weakness was achieved more effectively and quickly compared with the standard approach. Better BCTSQ, pVAS, and aVAS scores were observed in Group A. CONCLUSIONS The DTT is a safe and effective approach for the treatment of CTS. This technique entails faster recovery times, better aesthetic outcomes, and lower risks of complications.

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Section: Double Tunnels Techniquementioning

confidence: 99%

The double tunnels technique: an alternative minimally invasive approach for carpal tunnel syndrome

Vanni

Sirabella

Galzio

et al. 2015

JNS

View full text Add to dashboard Cite

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“…To obtain the measurements, a computer-assisted graphics pad, Summa Sketch Plus (Summagraphics, USA) was used. The landmarks used were the thenar crease, the vertical axis of the third web space corresponding to 5 mm ulnar to the interthenar depression (9), the proximal palmar crease corresponding to the approximate level of the superficial palmar arch, and the distal wrist crease (Figure 1). The length of the incision and distances from the landmarks were measured.…”

Section: Methodsmentioning

confidence: 99%

“…The location of the incision in the palm has been discussed extensively for open techniques of carpal tunnel release, in particular with respect to the location of the PCB (9,11,18,19). Carroll and Green (18) noted that, with the interthenar incision described by Milford (20), the nerve is not visualized and is not likely to be injured, provided that the incision is not carried proximal to the base of the thenar eminence.…”

Section: Figure 2) Variability Of Incisions Used By the Cohort The Smentioning

confidence: 99%

Variations in incisions and postoperative management in carpal tunnel surgery

2002

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This study examines the variations in incisions and postoperative protocol of open carpal tunnel release. A questionnaire was distributed to 65 hand surgeons. Respondents were asked to draw their preferred incision on original photocopies of the same palm. The results were measured against standard anatomical landmarks (thenar crease, vertical axis of the third web space, proximal palmar crease and the distal wrist crease). The participants were also asked to answer questions concerning their postoperative protocols. Demographics of the cohort, as well as the variations in incisions and postoperative management, were analyzed. Significant variations existed in the length and location of the incision in the palm. The differences in postoperative care in this cohort of surgeons were less significant. Key Words: Carpal tunnel syndrome; Median nerve; Surgical incisionsLes variations dans le type d'incisions et la prise en charge postopératoire de l'opération du canal carpien RÉSUMÉ : La présente étude porte sur les variations dans le type d'incisions et le protocole postopératoire de la libération ouverte du canal carpien. Un questionnaire a été distribué à 65 chirurgiens de la main. Les répondants étaient invités à dessiner l'incision qu'ils préféraient sur des photocopies originales de la même paume. Les résultats ont été mesurés d'après des repères anatomiques standards (pli thénarien, axe vertical du troisième espace interdigital, pli palmaire proximal et pli distal du poignet). Les participants étaient également invités à répondre à des questions axées sur leurs protocoles postopératoires. La démographie de la cohorte ainsi que la variation du type d'incisions et de la prise en charge postopératoire ont été analysées. Il existait d'importantes variations dans la longueur et l'emplacement de l'incision de la paume, mais les différences en matière de soins postopératoires étaient moins marquées.

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“…The precise course of this nerve is a matter of significant investigation, as well as its relationship to the palmar cutaneous nerve of the ulnar nerve. The origin ranged over 3-21.5 cm proximal to the distal wrist crease (Bezerra et al 1986;Naff et al 1993;Dowdy et al 1994;Watchmaker et al 1996;Matloub et al 1998;Chaynes et al 2004). The palmar cutaneous branch of the median nerve commonly pierces through the transverse carpal ligament through a separate canal and exits above the fibers of the palmar aponeurosis (Taleisnik 1973;Naff et al 1993), although some branches may not penetrate the transverse carpal ligament or pass entirely through the carpal tunnel and recurrently innervate the skin of the thenar eminence (Fig.…”

Section: Targetsmentioning

confidence: 99%