Abstract
Median nerve release is one of the most common procedures performed in hand surgery (classical incision or endoscopic methods), with a low complication rate, but not free of morbidity conditioning work reincorporation.
We present a comparative study between the classical technique and double-incision approach of median nerve preserving the intereminencial space.
Material and methods. A review of 155 hands in 133 patients (all operated by the same surgeon), divided in two separate groups:
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– 72 hands (61 patients) operated by classical technique.
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– 83 hands (72 patients) operated by double-incision approach.
Excluding criteria: patients under 30 years-old, antecedents or symptoms of associated local pathology, trophic troubles of thenar or hypothenar eminences and recurrent carpal tunnel syndrome.
We reviewed: per-operatory neurovascular complications, difficulties in hand activity related to pillar pain at 10 and 21 days and 3 and 12 months after surgery, discomfort in the thenar-hypothenar areas (intereminencial pruritus), remaining discomfort in the area of the surgical scar at 3 and 12 months after surgery, and recurrences at 24 months.
Results: Nerve compression symptoms disappeared in all 155 hands and neither complications nor recurrences were observed at 24 months.
Pillar pain conditioning hand activity:
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21 days: A-group 32 cases (44 %) %, B-group 0%
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3 months: A-group 18 cases (25 %), B-group 0%
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12 months: A-group 5 cases (7 %), B-group 0%
Discomfort in the thenar-hypothenar areas (inter-eminencial pruritus):
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21 days: A-group 0%, B-group 15 cases (18 %)
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3 months: A-group 0%, B-group 6 cases (7 %) Remaining discomfort in surgical scars areas:
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3 months: A-group 18 cases (25%) palm area, B-group 4 cases (5 %) wrist area.
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12 months: A-group 5 cases (7 %) palm area, B-group 0%
Conclusion: Absence of pillar pain in double-incision approach and free hand activity 3-4 weeks post-operatively were obtained, only a discrete intereminencial pruritus was observed (unusual at 3 months).
We therefore consider this technique as a first choice in suitable patients as it avoids discomfort or disability. Furthermore this technique is of low risk and low cost.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
