Midpalmar accurate incision for carpal tunnel release

Background: Carpal tunnel syndrome is the most common entrapment neuropathy in humans today. For patients in whom conservative treatment fails, surgical decompression is indicated. Among the various surgical techniques currently in use, endoscopic techniques are becoming increasingly popular. Due to the rapid postoperative recovery shown after endoscopic operations, midpalmar accurate incision for carpal tunnel release is a comparative alternative. Methods: From February 1998 through January 2003, 84 patients had undergone 96 midpalmar carpal tunnel releases with accurate skin incisions under regional block or general mask anesthesia. The postoperative evaluations were performed via subjective assessment with a standardized telephone interview over an average follow-up period of 22.4 months. Results: The average operation time was 16 minutes (range, 5 to 40 minutes). A total of 87 hands (91%) had excellent or good recovery in terms of symptom relief (improvement of 70% or greater). The incidence of postoperative sensory morbidity, i.e., pillar pain or scar tenderness, was 7% (7 hands). The motor functional morbidity of a persistent subjective decrease in grip strength was noted in 8% (8 hands), and the mean period for returning to work was 4.5 weeks. In addition, no operation-induced neurovascular or tendinous injury occurred in any patient. Conclusions: The outcomes were similar to those of endoscopic carpal tunnel release. Based on these results, midpalmar carpal tunnel release with accurate location of skin incision is as effective as any other surgical procedures for carpal tunnel release. Furthermore, it is also a safe and simple procedure.