| Introduction
The traditional incision for carpal tunnel release
is from midpalmar to a point in a line along the radio-carpal
joint. For some the incision can cause discomfort at
the site of the operation. An incision of about 3-4 cm
along the linea vitae is assumed to cause less discomfort
in the post-operative period and for a shorter period of time. The
clinic therefore used a small palmar incision surgery from
1986. To test these assumptions a questionnaire was prepared
for the purpose of analysing the results In all patients diagnosed
with Carpal Tunnel Syndrome between 1986 and 1998.
Materials and methods
A questionnalre was sent to all patients who had been operated
on. Those who had had bilateral operations received two
questionnaires. A total of 78 hands had been diagnosed witb
Carpal Tunnel Syndrome.
Of these 15 received no further treatment at other places.
One patient, who had had both hands operated on, died before
completing the questionnaire. The research covered 61
hands, 10 of which were bilaterals, on 51 patients.
The operations, using a magnifying glass, were conducted under
local anaesthetic with tourniquet control.
All questionnaires were returned completed (100% replies).
Results
| male |
|
<one week |
one-two weeks |
two-four weeks |
>one month |
| Time to disappearence
of nuisance from operationfield |
R |
1 |
3 |
1 |
3 |
| L |
1 |
2 |
3 |
3 |
Time
to start on work again
|
R |
2 |
2 |
2 |
2 |
| L |
4 |
1 |
3 |
1 |
Table
1 shows the split between sex and hand.
Not all patients experienced immediate relief from
neurological sensory discomfort.
For some it persisted for months after surgery.
| female |
|
<one week |
one-two weeks |
two-four weeks |
>one month |
| Time to disappearence
of nuisance from operationfield |
R |
8 |
4 |
3 |
5 |
| L |
3 |
1 |
2 |
4 |
Time
to start on work again
|
R |
8 |
4 |
4 |
4 |
| L |
5 |
1 |
1 |
3 |
Table 2 shows the number of patients where all neurological
discomfbrt disappeared following surgery.
Discomfort at the site of surgery however disappeared
gradually, 82% of males but only 74% of females became free
of symptoms.
| male |
|
<one week |
one-two weeks |
two-four weeks |
>one month |
| Time to disappearence
of nuisance from operationfield |
R |
|
1 |
|
1 |
| L |
|
|
|
2 |
Time
to start on work again
|
R |
|
|
1 |
1 |
| L |
|
|
|
2 |
Table 3 shows the time span in which discomfort disappeared
in patients who recovered fully.
Within two weeks 42% of men and 46% of women became
free of symptoms.
| female |
|
<one week |
one-two weeks |
two-four weeks |
>one month |
| Time to disappearence
of nuisance from operationfield |
R |
1 |
|
2 |
5 |
| L |
|
1 |
|
1 |
Time
to start on work again
|
R |
|
2 |
|
5 |
| L |
1 |
|
|
1 |
Table 4 shows the time taken by patients of working age before
they were able to take up work or for pensioners to take up
their hobbies again.
This is a good test of the absence of pain or the presence
of minor pain. After two weeks 54% of women but only 42% of men were able
to return to work.
It has not been possible to find any research on any relationship
between the absence of pain and return to work,
Discussion
Lee
(1) found, using nearly the same surgical method, a success
rate of 73% in the reduction of sensory disturbance.
Similarly Thurston (2) found 73% with a reduction in sensory
disturbance.
It appear's that the small palmar incision is nelther better
nor worse than the traditional surgical method.
No evaluation has taken place of any cosmetic improvements
there may be by using the small palmar method.
Summary
This
study shows neither advantage nor disadvantage for small incision
surgery over traditional procedures insofar as complications
are concerned.
References
Carpal
Tunnel Release by a Smail Palmar Incision.
W.P.A.Lee, K.D.Plancher, 3.W.Strickland. Hands Clinic
vol 12 ;2 May 1996, 271-84.
Results
of Open Carpal Tunnel Release: A Comprehensive Retrospective
Study. A.Thurston. N Iam Aust
NZ J Surg. 67(5): 283-8 May 1997.
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