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

Abstract

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.

Carpal tunnel pressure measurement during two-portal endoscopic carpal tunnel release

“…Although recent reports on endoscopic carpal tunnel release (ECTR) have shown low complication rates (Chow and Hantes, 2002;Quaglietta and Corriero, 2005;Atroshi et al, 2006;Oertel et al, 2006), there still remains concern regarding damage to the median nerve during insertion of the cannula into the high-pressure carpal tunnel (Arner et al, 1994;Dheansa and Belcher, 1998;Muller et al, 2000;Benson et al, 2006;Uchiyama et al, 2007). Actually we experienced apparent median nerve damage when great resistance was felt by the surgeon during cannula assembly insertion (Uchiyama et al, 2002).…”

An Ultrasonographic and Anatomical Study of Carpal Tunnel, with Special Emphasis on the Safe Zones in Percutaneous Release

“…Endoscopic carpal tunnel release, a popular alternative surgical treatment, is equally effective and has the theoretical advantage of being less invasive (Katz and Simmons, 2002;Thoma et al, 2004;Trumble et al, 2002). However, in addition to potential complications caused by the blind insertion of the endoscopic trocar and the restricted endoscopic view of the carpal tunnel, there are, in theory, inherent risks of incomplete release and accidental injury to neurovascular bundles and surrounding flexor tendons because of the proximity of these structures (Concannon et al, 2000;De Smet and Fabry, 1995;Forman et al, 1998;Muller et al, 2000;Shinya et al, 1995). Advances in ultrasonography have made possible higher spatial resolution and excellent visual depiction of nerves (Beekman and Visser, 2004).…”

The Canaletto®™ implant for reconstructing transverse carpal ligament in carpal tunnel surgery. Surgical technique and cohort prospective study about 400 Canaletto cases versus 400 cases with open carpal tunnel surgery

“…Nonetheless, beginnings were hard, with severe complications related to the lack of experience of the surgeons and to the limited visualization of the tunnel contents [6,[20][21][22]. Main technical disadvantage of endoscopy is that it allows only isolated section of the transverse carpal ligament, necessitating temporary hyperpressure inside the tunnel during the surgery.…”