TY - JOUR
T1 - 13-Year Experience of Carpal Tunnel Release Using the Indiana Tome Technique
AU - Lee, W. P.Andrew
AU - Schipper, Bret M.
AU - Goitz, Robert J.
N1 - Copyright:
Copyright 2009 Elsevier B.V., All rights reserved.
PY - 2008/9
Y1 - 2008/9
N2 - Purpose: This study evaluated the reliability and morbidity rate of carpal tunnel release with the Indiana Tome technique via a small palmar incision when used by experienced hand surgeons. Methods: A retrospective review was performed of 1332 carpal tunnel releases using the Indiana Tome performed by 2 fellowship-trained hand surgeons at university hospitals from July 1993 to August 2006. Chart review focused on complications with this technique. Results: All patients returned to preoperative activities, in employment or otherwise. Nonmanual laborers resumed regular job tasks between 2 days and 3 weeks. The 2 surgeons experienced 11 complications in 1332 cases, for an overall complication rate of 0.83%. The most common complication, in 8 cases, was numbness and hypersensitivity in the third common digital nerve distribution; 2 of these 8 patients had normal 2-point discrimination and the other 6 had persistently 2-point discrimination greater than 10 mm despite resolution of preoperative paresthesia symptoms. In the latter group, 3 patients had repeat exploration, with findings of fascicular injury and scarring in 2 patients and normal nerve in the third (who ultimately had normalized 2-point discrimination by 6 weeks after surgery). The 3 patients without re-exploration had their 2-point discrimination returned to normal by 11 months after surgery. Ultimately, only 2 patients (0.15%) had persistently increased 2-point discrimination. The remaining complications (3 cases) were transient neuropraxia of the entire median nerve (1 patient), an incomplete release (1 patient) requiring repeat surgery, and a recurrence of carpal tunnel syndrome (1 patient) with perineural scar noted at 8 months after surgery, treated successfully with a hypothenar fat pad flap. Conclusions: This is the largest retrospective review of the Indiana Tome technique to date. This technique can be used by experienced hand surgeons and offers early resumption of preoperative activities and a low complication rate. The most common complication was neurapraxia in the third common digital nerve distribution. The overall complication rate was 0.83% (11 in 1332). Type of study/level of evidence: Therapeutic IV.
AB - Purpose: This study evaluated the reliability and morbidity rate of carpal tunnel release with the Indiana Tome technique via a small palmar incision when used by experienced hand surgeons. Methods: A retrospective review was performed of 1332 carpal tunnel releases using the Indiana Tome performed by 2 fellowship-trained hand surgeons at university hospitals from July 1993 to August 2006. Chart review focused on complications with this technique. Results: All patients returned to preoperative activities, in employment or otherwise. Nonmanual laborers resumed regular job tasks between 2 days and 3 weeks. The 2 surgeons experienced 11 complications in 1332 cases, for an overall complication rate of 0.83%. The most common complication, in 8 cases, was numbness and hypersensitivity in the third common digital nerve distribution; 2 of these 8 patients had normal 2-point discrimination and the other 6 had persistently 2-point discrimination greater than 10 mm despite resolution of preoperative paresthesia symptoms. In the latter group, 3 patients had repeat exploration, with findings of fascicular injury and scarring in 2 patients and normal nerve in the third (who ultimately had normalized 2-point discrimination by 6 weeks after surgery). The 3 patients without re-exploration had their 2-point discrimination returned to normal by 11 months after surgery. Ultimately, only 2 patients (0.15%) had persistently increased 2-point discrimination. The remaining complications (3 cases) were transient neuropraxia of the entire median nerve (1 patient), an incomplete release (1 patient) requiring repeat surgery, and a recurrence of carpal tunnel syndrome (1 patient) with perineural scar noted at 8 months after surgery, treated successfully with a hypothenar fat pad flap. Conclusions: This is the largest retrospective review of the Indiana Tome technique to date. This technique can be used by experienced hand surgeons and offers early resumption of preoperative activities and a low complication rate. The most common complication was neurapraxia in the third common digital nerve distribution. The overall complication rate was 0.83% (11 in 1332). Type of study/level of evidence: Therapeutic IV.
KW - Carpal tunnel release
KW - Indiana Tome
KW - carpal tunnel syndrome
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U2 - 10.1016/j.jhsa.2008.03.013
DO - 10.1016/j.jhsa.2008.03.013
M3 - Article
C2 - 18762096
AN - SCOPUS:50549100901
SN - 0363-5023
VL - 33
SP - 1052
EP - 1056
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 7
ER -