title: Limited incision carpal tunnel release.
abstract: BACKGROUND
  Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Limited incision techniques for carpal tunnel release are gaining popularity. The main advantages of these techniques are less scar load, less pillar pain, shorter recovery, and return-to-work time. However, the completeness of release, and risk of neurovascular injury are always a concern. We devised a method of limited incision release with two mini-incisions and use of nasal speculum and a probe. We aimed to evaluate the clinical and neurological outcome of this technique.
  
  
  METHODS
  Twenty seven cases (9 male and 18 female, age 28-56 years) of isolated CTS cases were enrolled in the study. A total of 33 hands (six bilateral) underwent limited incision carpal tunnel release. In this study, two mini-incisions were used and release was done with the help of nasal speculum. Evaluation preoperatively and in 6 months and at 1-year postoperatively was done, namely, (a) clinical status examination, (b) motor testing using grip and pinch dynamometer, and (c) neurological outcome measure using nerve conduction study.
  
  
  RESULTS
  All the patients had good clinical and neurological outcome with no recurrence during followup. The first symptom to get relieved was night pains, with a mean of 4.5 days (range 2-14 days). Compared to pain, improvement of sensory symptoms was delayed; the mean duration was 42.8 days (range 30-90 days). Scar tenderness was present only for a mean duration of 9 days (range 7-21 days). The mean duration for patients to resume their daily activities was12 days (range 7-28 days) and to work was 32 days (range 21-90 days). The hand grip showed mean values of 45.12 ± 16.16 g/mm2preoperatively, 62.45 ± 18.86 g/mm2at 6 months postoperatively, and 74.87 ± 20.35 g/mm2at 1-year postoperatively. The key pinch showed mean values of 11.27 ± 3.51 g/mm2preoperatively, 20.181 ± 3.94 g/mm2at 6 months postoperatively, and 27.96 ± 94.42 g/mm2at 1-year postoperatively. The tip pinch showed mean values of 8.88 ± 2.39 g/mm2preoperatively, 15.393 ± 3.25 g/mm2at 6 months postoperatively, and 19.27 ± 4.81 g/mm2at 1-year postoperatively. The palmar pinch showed mean values of 14.42 ± 2.92 g/mm2preoperatively, 19.303 ± 3.62 g/mm2at 6 months postoperatively, and 22.97 ± 4.08 g/mm2at 1-year postoperatively.
  
  
  CONCLUSIONS
  Limited incision carpal tunnel release can be considered a feasible alternative to traditional open release and endoscopic release.
authors.affiliation: Department of Plastic Surgery, PGIMER, Chandigarh, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Gaba
authors.affiliation: Department of Plastic Surgery, PGIMER, Chandigarh, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Bhogesha
authors.affiliation: Department of Plastic Surgery, Command Hospital, Chandigarh, India.
authors.forename: Onkar
authors.initials: O
authors.lastname: Singh
keywords: Carpal tunnel syndrome; carpal tunnel release; limited incision; minimal access surgical procedures; nasal speculum; nerve compression syndrome; nerve conduction; nerve conduction study; speculum