Endoscopic carpal tunnel release: An anatomic study of the two-incision method in human cadavers

Seiler, John G.; Barnes, Keith; Gelberman, Richard H.; Chalidapong, Preecha

doi:10.1016/s0363-5023(09)91045-0

Cited by 99 publications

(30 citation statements)

References 6 publications

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“…Incomplete release of the carpal tunnel occurred with both the biportal Chow technique and the uniportal Agee technique [1]. Results of various cadaver studies show incomplete retinaculum release "quotas" as 0% [46] (Agee), 5% [21] (Chow), 10% [44] (Chow), 38% [40] (Chow), 50% [20] (Chow), and 56% [47] (Agee; Table 3). The published data relating to incomplete retinaculum separation for patients with persistent pain following open carpal tunnel release range between 0.84% and 10.9% [11,16,17,33,35,37] (Table 3).…”

Section: Clinical and Electrophysiological Resultsmentioning

confidence: 99%

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Endoscopic carpal tunnel release: results with special consideration to possible complications

Müller¹,

Rudig²,

Degreif³

et al. 2000

Knee Surgery, Sports Traumatology, Arthroscopy

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Single-portal endoscopic carpal tunnel release (Agee technique) was carried out in 148 patients. Of these, 100 were examined clinically and electrophysiologically 1 day before surgery and 1 and 3 months thereafter. Ten patients experienced transient ulnar neuropraxia and two patients complained postoperatively of intense pain in the middle and ring fingers. Three patients suffered residual symptoms. In one of these an incomplete release of the distal portion of the retinaculum flexorum was suspected and later confirmed by magnetic resonance imaging. Another patient had applied for pension due to problems associated with a vertebral fracture in addition to his carpal tunnel symptoms. A third patient with residual symptoms was rheumatic, and upon reexamination 6 months later he was virtually symptom free. Five of the 148 operations were converted to an open procedure due to poor visualization. A review of literature on carpal tunnel release (biportal Chow technique and uniportal Agee technique) uncovered 31 intra- and postoperative complications, including 14 affecting nerve structures, 2 tendon structures, 2 bony structures, and 9 the surrounding tissues. We discuss the most common complications, considering in particular the anatomical characteristics in the carpal tunnel region.

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Section: Clinical and Electrophysiological Resultsmentioning

confidence: 99%

“…2). The findings of the cadaver studies, report incomplete retinaculum transection rates of 0% [46] (Agee), 5% [21] (Chow), 10% [44] (Chow), 38% [8] (Chow), 50% [20] (Chow), and 56% [47] (Agee; Table 3). While, on the one hand, these results are of only minimal value, they do underscore this potential danger.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic carpal tunnel release: results with special consideration to possible complications

Müller¹,

Rudig²,

Degreif³

et al. 2000

Knee Surgery, Sports Traumatology, Arthroscopy

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“…The conclusion of the controlled trial is strongly in favour of endoscopic release in terms of diminished scar discomfort, and more rapid return of strength and resumption of work. However, in the cadaver study (only six subjects) there were two incidences of damage to the superficial palmar arch; two previous cadaver studies have also reported a worrying incidence of incomplete division (Seiler et al, 1992;Lee et al, 1992); and in the preliminary clinical trial there was a 40% complication rate, which the author attributes in part to the use of a transbursal as opposed to an extrabursal approach which gives better visualization. However, an alternative interpretation could be that the first series reflects the steep part of the learning curve.…”

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confidence: 77%

Endoscopic Carpal Tunnel Release—The Hand Doctor’s Dilemma

Evans¹

1994

Journal of Hand Surgery

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“…In spite of the concerning nature of these reports, such complications were reported soon after the introduction of ECTR and represented the early, and oftentimes preliminary, experience with this technique. Opponents of ECTR often cite early cadaveric studies (20)(21)(22) that reported high incidences of major complications; however, these studies utilized wrists that had undergone ECTR by inexperienced surgeons who were first learning the technique. Therefore, results of these studies represent surgical experience at the bottom end of the well-recognized learning curve in performing ECTR.…”

Section: Discussionmentioning

confidence: 99%

Early major complications of endoscopic carpal tunnel release: A review of 1200 cases

Tse¹,

Hurst²

2003

J Plast Surg

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RW Tse, LN Hurst, TA Al-Yafi. Early major complications of endoscopic carpal tunnel release: A review of 1200 cases. Can J Plast Surg 2003;11(3):131-134. Although the early benefits of endoscopic carpal tunnel release have been demonstrated, there is great controversy regarding the risks and safety of the technique. The present study reports early major complications in a series of 1278 consecutive cases performed by a single surgeon over a seven-year period. All procedures were performed under local anaesthesia on an outpatient basis using the Agee single portal technique. Mean follow-up was three months. No vascular, tendon or permanent nerve injuries were documented. Recurrent or persistent symptoms occurred in 7% of patients for which 20 of 89 underwent subsequent open carpal tunnel release. No nerve injuries were found on re-exploration. Other complications were consistent with previously reported incidences. This is the largest reported case series by a single surgeon and represents an accumulation of surgical experience at the upper end of the learning curve. Endoscopic carpal tunnel release is a safe procedure in this experienced single surgeon series. Complications majeures précoces de la libéra-tion endoscopique du nerf médian au niveau du canal carpien Bien que les bénéfices précoces de la libération endoscopique du nerf médian au niveau du canal carpien soient démontrés, il existe une grande controverse au sujet des risques et de l'innocuité de la technique. La présente étude fait état de complications majeures précoces dans une série de 1 278 cas consécutifs opérés par un seul chirurgien en l'espace de sept ans. Toutes les interventions ont été exécutées sous anesthésie locale en clinique externe au moyen de la technique portale unique d'Agee. Le suivi moyen était de trois mois. Aucune lésion vasculaire, tendineuse ou nerveuse permanente n'a été documentée. Des symptômes récurrents ou persistants se sont manifestés chez 7 % des patients, et 20 de ces 89 patients ont subi une libération ouverte du nerf médian au niveau du canal carpien. Aucune lésion nerveuse n'a été découverte au moment de la deuxième exploration. D'autres complications étaient compatibles avec des incidences déclarées auparavant. C'est la plus grande série de cas à être déclarée par un seul chirurgien, et elle représente une accumulation d'expérience clinique dans le haut de la courbe d'apprentissage. La libération endoscopique du nerf médian au niveau du canal carpien est une intervention sûre dans le cadre de cette série effectuée par un seul chirurgien expérimenté.

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Endoscopic carpal tunnel release: An anatomic study of the two-incision method in human cadavers

Cited by 99 publications

References 6 publications

Endoscopic carpal tunnel release: results with special consideration to possible complications

Endoscopic carpal tunnel release: results with special consideration to possible complications

Endoscopic Carpal Tunnel Release—The Hand Doctor’s Dilemma

Early major complications of endoscopic carpal tunnel release: A review of 1200 cases

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