Endoscopic carpal tunnel release using a new median nerve protector.
OBJECTIVE
We designed a reusable median nerve protector for endoscopic carpal tunnel release (ECTR) and prospectively evaluated its safety and efficacy.


METHODS
Therapeutic study--Investigating the results of treatment.


METHODS
Seventy-two patients (97 palms) with carpal tunnel syndrome were operated on endoscopically with the new median nerve protector. Patients were followed-up at 1, 3, 6, 12, and 24 weeks postoperatively. Evaluation included the symptom severity scale, functional status scale, wound pain and scar tenderness, monofilament sensory mapping, grip strength measurement, and pin strength gauge.


RESULTS
No patients sustained iatrogenic neurovascular injury or hematoma, but 3 developed superficial wound infections postoperatively. The symptom severity score decreased from 3.8 points preoperatively to 2.3 at 1 week, 1.9 at 3 weeks, and 1.3 at 6 weeks, and remained at 1 point at 12 and 24 weeks postoperatively. The functional status score dropped from 3.8 points to 2.8 at 1 week, 2 at 3 weeks, 1.5 at 6 weeks, and 1 at 12 weeks and thereafter. Semmes Weinstein monofilament mapping improved in all operated hands (59) of the 44 patients not lost to follow-up by 24 weeks. Tip pinch testing and grip strength showed gradual improvement as early as 3 weeks postoperatively. The mean value of the postoperative scar tenderness score dropped from 2.4 points at 1 week to 1.7 points at 3 weeks, 1.3 at 6 weeks, 1.2 at 12 weeks, and 1 point after 12 weeks.


CONCLUSIONS
This new median nerve protector provides clear visualization of neurovascular structures and is a safe and reliable tool for single-portal ECTR.


METHODS
Level IV.
Department of Orthopaedic Surgery, Mackay Memorial Hospital, Taipei, Taiwan. drtgkwok@hotmail.com
Tiew-Guan
TG
Kwok
Chun-Hsiung
CH
Huang
Hung-Chan
HC
Kao
D000293:Adolescent; D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000628:therapy*; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000378:metabolism; D008875:Middle Aged; D011446:Prospective Studies; D019736:Prostheses and Implants; D011482:Protective Devices; D020127:Recovery of Function; D012720:Severity of Illness Index; D013530:Surgical Wound Infection