The Mini-Invasive Technique for Carpal Tunnel Release: Open Approach with Converse Fiberoptic Light Retractor

Abstract

Carpal tunnel syndrome (CTS)requires a different surgical treatment depending on the clinical stage.In the first stage,which is defined as irritative or initial,a simplereleasebydivisionofthetransversecarpalligament (TCL)is indicated;in the second stage,sensory or intermediate,some cases require a flexor synovectomy in association with external neurolysis;in the third stage, paralytic or terminal,a synovectomy,an opposition transfer,and even an internal neurolysis may be necessary [1 ].In the last 30 years surgical treatment of CTS has changed because of acquired experience and availability of new technical devices.In the 1970s,when microsurgery became common in surgical practice,many surgeons suggested epineurectomy associated with internal neurolysis.This indication was then limited to fibrotic epineurium.In the 1980s,short incisions,with a simple division of the TCL became popular,with the purpose of reducing complications,followed by endoscopic division of the TCL in the 1990s.Early diagnosis wasatthebasisofthisevolution.Theendoscopictechnique (ET),has the main advantages of shortening the skin incision and obtaining an early return to work; on the other hand,it is more expensive and implies the risk of major complications [3–5].After the development of the endoscopic technique,a different solution has been researched [2–4].