Skip to main content

Advertisement

SpringerLink
Log in

Proximal carpal crease incision for carpal tunnel release: a pilot study

  • Original Paper
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Limited palmar incision (PI) is the standard approach for treatment of carpal tunnel syndrome. Proximal carpal crease incision (CI) is an investigated alternative. The aim of our study was to evaluate safety and results of PI and CI approaches.

Methods

A prospective, randomised, open label pilot study was carried out in the period of November 2011–November 2017. A total of 104 patients were randomised into two groups according to the incision: group 1 (CI) had 33 patients and group 2 (PI) had 71 patients. Measured characteristics are the following: safety, severity of pain, DASH score, hand grip and pinch strength, two-point discrimination test and Semmes-Weinstein monofilament test. Data were collected 1 h before surgery, in the early (2–3 weeks after surgery) and late (3–4 months after surgery) post-operative periods. A significance level of 0.05 was considered for testing statistical hypotheses.

Results

We found that CI results in lower early (p = 0.064) and late (p = 0.033) post-operative period pain and better hand function: lower DASH score in early (p = 0.005) and late (p = 0.047) post-operative period and stronger hand pinch in early post-operative period (p = 0.037). However, hand grip strength, two-point discrimination and Semmes-Weinstein monofilament test did not reveal any significant differences between the study groups. No major complications appeared in both study groups; thus, both incisions were considered safe.

Conclusions

Pilot study suggests that CI is a safe alternative treatment method of the carpal tunnel syndrome resulting in faster patient recovery after carpal tunnel release.

Level of Evidence: Level I, therapeutic study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Gelfman R, Melton LJ 3rd, Yawn BP et al (2009) Long-term trends in carpal tunnel syndrome. Neurology 72(1):33–41

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Atroshi I, Englund M, Turkiewicz A, Tägil M, Petersson IF (2011) Incidence of physician-diagnosed carpal tunnel syndrome in the general population. Arch Intern Med 171(10):943–944

    Article  PubMed  Google Scholar 

  3. Ren Y, Wang X, Wei Z et al (2016) Efficacy, safety, and cost of surgical versus nonsurgical treatment for carpal tunnel syndrome: a systematic review and meta-analysis. Medicine (Baltimore) 95(40):e4857

    Article  Google Scholar 

  4. Bland JD (2005) Carpal tunnel syndrome. Curr Opin Neurol 18(5):581–585

    Article  PubMed  Google Scholar 

  5. Martínez-Villén G, Badiola J, Alvarez-Alegret R, Mayayo E (2014) Nerve compression syndromes of the hand and forearm associated with tumours of non-neural origin and tumour-like lesions. J Plast Reconstr Aesthet Surg 67(6):828–836

    Article  PubMed  Google Scholar 

  6. Amirfeyz R, Gozzard C, Leslie IJ (2005) Hand elevation test for assessment of carpal tunnel syndrome. J Hand Surg Br 30(4):361–364

    Article  CAS  PubMed  Google Scholar 

  7. Gerritsen AA, de Vet HC, Scholten RJ et al (2002) Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA 288(10):1245–1251

    Article  PubMed  Google Scholar 

  8. Verdugo RJ, Salinas RA, Castillo JL et al (2008) Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev 4:CD001552

    Google Scholar 

  9. Radwin RG, Sesto ME, Zachary SV (2004) Functional tests to quantify recovery following carpal tunnel release. J Bone Joint Surg Am 86–A(12):2614–2620

    Article  PubMed  Google Scholar 

  10. Naidu SH, Fisher J, Heistand M, Kothari MJ (2003) Median nerve function in patients undergoing carpal tunnel release: pre- and post-op nerve conductions. Electromyogr Clin Neurophysiol 43(7):393–397

    CAS  PubMed  Google Scholar 

  11. Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, Hollingworth W, Kerrigan CL, Deyo RA (2009) Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet 374(9695):1074–1081

    Article  PubMed  Google Scholar 

  12. Capasso M, Manzoli C, Uncini A (2009) Management of extreme carpal tunnel syndrome: evidence from a long-term follow-up study. Muscle Nerve 40(1):86–93

    Article  PubMed  Google Scholar 

  13. Cellocco P, Rossi C, El Boustany S et al (2009) Minimally invasive carpal tunnel release. Orthop Clin North Am 40(4):441–448

    Article  PubMed  Google Scholar 

  14. Zhang S, Vora M, Harris AH et al (2016) Cost-minimization analysis of open and endoscopic carpal tunnel release. J Bone Joint Surg Am 98(23):1970–1977

    Article  PubMed  Google Scholar 

  15. Tarallo M, Fino P, Sorvillo V, Parisi P, Scuderi N (2014) Comparative analysis between minimal access versus traditional accesses in carpal tunnel syndrome: a perspective randomised study. J Plast Reconstr Aesthet Surg 67(2):237–243

    Article  PubMed  Google Scholar 

  16. Trumble TE, Diao E, Abrams RA et al (2002) Single-portal endoscopic carpal tunnel release compared with open release: a prospective, randomized trial. J Bone Joint Surg Am 84–A(7):1107–1115

    Article  PubMed  Google Scholar 

  17. Orak MM, Gumustas SA, Onay T et al (2016) Comparison of postoperative pain after open and endoscopic carpal tunnel release: a randomized controlled study. Indian J Orthop 50(1):65–69

    Article  PubMed  PubMed Central  Google Scholar 

  18. Brown RA, Gelberman RH, Seiler JG 3rd, Abrahamsson SO, Weiland AJ, Urbaniak JR, Schoenfeld DA, Furcolo D (1993) Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods. J Bone Joint Surg Am 75(9):1265–1275

    Article  CAS  PubMed  Google Scholar 

  19. Mackenzie DJ, Hainer R, Wheatley MJ (2000) Early recovery after endoscopic vs. short-incision open carpal tunnel release. Ann Plast Surg 44(6):601–604

    Article  CAS  PubMed  Google Scholar 

  20. Lee DH, Masear VR, Meyer RD, Stevens DM, Colgin S (1992) Endoscopic carpal tunnel release: a cadaveric study. J Hand Surg Am. 17(6):1003–1008

    Article  CAS  PubMed  Google Scholar 

  21. Rowland EB, Kleinert JM (1994) Endoscopic carpal-tunnel release in cadavera. An investigation of the results of twelve surgeons with this training model. J Bone Joint Surg Am 76(2):266–268

    Article  CAS  PubMed  Google Scholar 

  22. Yoo HM, Lee KS, Kim JS, Kim NG (2015) Surgical treatment of carpal tunnel syndrome through a minimal incision on the distal wrist crease: an anatomical and clinical study. Arch Plast Surg 42(3):327–333

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nazerani S, Motamedi MH, Nazerani T et al (2014) Endoscopic carpal tunnel release: a 5-year experience. Trauma Mon 19(4):15–19

    Article  Google Scholar 

  24. Teixeira Alves M d P (2010) Prospective comparative study between proximal transverse incision and the conventional longitudinal incisions for carpal tunnel release. Rev Bras Ortop 45(5):437–444

    Article  Google Scholar 

  25. Lanz U (1977) Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg Am 2(1):44–53

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Plastic and Reconstructive Surgery Department, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eivenių Str. 2, LT 50009, Kaunas, Lithuania

    Rytis Rimdeika, Adas Cepas & Loreta Pilipaityte

  2. Medical Faculty, Lithuanian University of Health Sciences, A. Mickevičiaus Str. 9, LT 44307, Kaunas, Lithuania

    Rytis Rimdeika, Adas Cepas, Rokas Liubauskas & Loreta Pilipaityte

  3. Department of Rehabilitation, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eivenių Str. 2, LT 50009, Kaunas, Lithuania

    Inesa Rimdeikiene

Authors
  1. Rytis Rimdeika
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adas Cepas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rokas Liubauskas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Loreta Pilipaityte
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Inesa Rimdeikiene
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adas Cepas.

Ethics declarations

Conflict of interest

Rytis Rimdeika, Adas Cepas, Rokas Liubauskas, Inesa Rimdeikiene and Loreta Pilipaityte declare that they have no conflict of interest.

Ethical approval

All procedures involving human participants were performed in accordance with the ethical standards of the Ethics Committee of Kaunas Regional Biomedical Research and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

ESM 1

(MPG 255778 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rimdeika, R., Cepas, A., Liubauskas, R. et al. Proximal carpal crease incision for carpal tunnel release: a pilot study. Eur J Plast Surg 42, 49–54 (2019). https://doi.org/10.1007/s00238-018-1450-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00238-018-1450-z

Keywords

Search

Navigation