title: The double tunnels technique: an alternative minimally invasive approach for carpal tunnel syndrome.
abstract: OBJECTIVE
  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.
authors.affiliation: Orthopaedic and Traumatology Department, "G. D'Annunzio" University, Chieti;
authors.forename: Daniele
authors.initials: D
authors.lastname: Vanni
authors.affiliation: Orthopaedic and Traumatology Department, "G. D'Annunzio" University, Chieti;
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Sirabella
authors.affiliation: Neurosurgery Department, "L'Aquila" University, L'Aquila; and.
authors.forename: Renato
authors.initials: R
authors.lastname: Galzio
authors.affiliation: Orthopaedic and Traumatology Department, "G. D'Annunzio" University, Chieti;
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Salini
authors.affiliation: Neurotraumatology and Vertebro-Medullary Surgery, "Renzetti" Hospital, Lanciano, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Magliani
mesh_terms: D002349:Carpal Tunnel Syndrome / Q000150:complications / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D040521:Subcutaneous Tissue / Q000601:surgery; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: BCTSQ = Boston Carpal Tunnel Syndrome Questionnaire; CTS = carpal tunnel syndrome; DTT = double tunnels technique; PF = palmar fascia; PROBE = prospective, randomized, open-label, blinded end point evaluation; TCL = transverse carpal ligament; aVAS, pVAS = aesthetic visual analog scale, pain VAS; carpal tunnel syndrome; minimally invasive technique; peripheral nerve; tissue-sparing surgery