Minimal Invasive Surgical Release of the Median Nerve at the Wrist: A Study about 36 patients

Surgical treatment of carpal tunnel syndrome (CTS) has evolved those recent years. Endoscopic and minimal invasive techniques have grown considerably, to limit the incidence of cutaneous complications associated with conventional open surgery, reducing hospitalization time and allow rapid functional recovery of the hand. Purpose: The purpose of this work is to analyze in our practical conditions, the results of surgical treatment of CTS with a minimal invasive technique using a transverse palmar incision made in the wrist crease. Patients and methods: This was a prospective study of 36 patients who underwent surgical treatment by minimal invasive CTS technique. The series consisted of 24 women and 12 men, whose average age was 43 years. 47.22% of patients were hand workers. All patients had a CTS confirmed by electromyography. The intervention took place under loco regional anesthesia with axillary block. All patients have been operated by the same surgeon. For each patient, the same surgical procedure has been applied. After a transverse incision of about 1cm in the crease of the wrist, it was directed anterograde section of flexor retinaculum (RDF) using a special curved bistoury. A simple bandage was made and no immobilization has been made. Results: In the immediate post-operative follow up, local hematoma was found in 04 patients. Locally, the evolution of the scar was favorable in all patients. At 30th day, 34 patients had more functional impairment, or pain in the scar, and had recovered more than 50% grip strength. They could use all their hand for daily activities. At three months, 83% of patients had the same grip strength on both sides. Discussion and conclusion: the interest of this minimal invasive technique is based on the quality of short term postoperative follow up that are more comfortable for the patient, allowing faster functional recovery of the hand, without being more iatrogenic.