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Reducing Neurologic and Vascular Complications of Endoscopic Carpal Tunnel Release Using a Modified Chow Technique

      Purpose: To reduce the rate of median nerve injury occurring during Chow’s original 2-portal technique, we developed a modified procedure. The surgical technique was introduced, and the results were evaluated with regard to the clinical findings, nerve conduction studies, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Methods: We analyzed 119 hands of 119 patients with idiopathic carpal tunnel syndrome who underwent our procedure, wherein a cannula assembly was inserted after a partial division of both distal and proximal parts of the transverse carpal ligament through the entry and exit portals. Postoperative examinations, including evaluation of numbness, grip strength, pinch strength, tenderness over and around the wounds, and nerve conduction studies, were performed at 1 month (n = 119), 3 months (n = 119), 6 months (n = 102), and 12 months (n = 39). The DASH score was also evaluated preoperatively and at 3, 6, or 12 months postoperatively. The rate of structural damage to the median nerve, the tendon, and the artery was calculated. Results: The patients resumed their daily activities or work by 13 days postoperatively. Tenderness around the wounds was detected in 66% of patients by 3 months postoperatively. Numbness disappeared or decreased in 99% of patients by 6 months postoperatively. The DASH score was available for 82 patients, and it improved from 28.2 to 18.3 points postoperatively. Nerve conduction studies indicated a significant decrease in motor distal latency postoperatively. Temporal worsening of median nerve function was observed in 2 patients; however, no structural damage to the nerve, tendon, or artery was observed. Conclusions: We found no injury to the tendon or artery and no laceration to the nerve in all 119 patients. However, temporal worsening of median nerve function was observed in 2 patients. Level of Evidence: Level IV, therapeutic case series.

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      References

        • Chow J.C.Y.
        Carpal tunnel release.
        in: McGivney J.B. Operative arthroscopy. Lippincott-Raven, Philadelphia1996: 1041-1066
        • Nagle D.J.
        • Fischer T.J.
        • Harris G.D.
        • et al.
        A multicenter prospective review of 640 endoscopic carpal tunnel releases using the transbursal and extrabursal Chow techniques.
        Arthroscopy. 1996; 12: 139-143
        • Oertel J.
        • Schroeder H.W.S.
        • Gaab M.R.
        Dual-portal endoscopic release of the transverse ligament in carpal tunnel syndrome: Results of 411 procedures with special reference to technique, efficacy, and complications.
        Neurosurgery. 2006; 59: 333-339
        • Quaglietta P.
        • Corriero G.
        Endoscopic carpal tunnel release surgery: Retrospective study of 390 consecutive cases.
        Acta Neurochir Suppl. 2005; 92: 41-45
        • Benson L.S.
        • Bare A.A.
        • Nagle D.J.
        • Harder V.S.
        • Williams C.S.
        • Visotsky J.L.
        Complications of endoscopic and open carpal tunnel release.
        Arthroscopy. 2006; 22: 919-924
        • Arner M.
        • Hagberg L.
        • Rosen B.
        Sensory disturbances after two-portal endoscopic carpal tunnel release: A preliminary report.
        J Hand Surg [Am]. 1994; 19: 548-551
        • Seiler III, J.G.
        • Barnes K.
        • Gelberman R.H.
        • Chalidapong P.
        Endoscopic carpal tunnel release: An anatomic study of the two-incision method in human cadavers.
        J Hand Surg [Am]. 1992; 17: 996-1002
        • Lewicky R.T.
        Endoscopic carpal tunnel release: The guide tube technique.
        Arthroscopy. 1994; 10: 39-49
        • Chow J.C.
        • Hantes M.E.
        Endoscopic carpal tunnel release: Thirteen years’ experience with the Chow technique.
        J Hand Surg [Am]. 2002; 27: 1011-1018
        • Uchiyama S.
        • Yasutomi T.
        • Fukuzawa T.
        • Nakagawa H.
        • Kamimura M.
        • Miyasaka T.
        Median nerve damage during two-portal endoscopic carpal tunnel release.
        Clin Neurophysiol. 2004; 115: 59-63
        • Stancic M.F.
        • Micovic V.
        • Potocnjak M.
        The anatomy of the Berrettini branch: Implications for carpal tunnel release.
        J Neurosurg. 1999; 91: 1027-1030
        • Uchiyama S.
        • Toriumi H.
        • Nakagawa H.
        • Kamimura M.
        • Ishigaki N.
        • Miyasaka T.
        Postoperative nerve conduction changes after open and endoscopic carpal tunnel release.
        Clin Neurophysiol. 2002; 113: 64-70
        • Uchiyama S.
        • Itsubo T.
        • Yasutomi T.
        • Nakagawa H.
        • Kamimura M.
        • Kato H.
        Quantitative MRI of the wrist and nerve conduction studies in patients with idiopathic carpal tunnel syndrome.
        J Neurol Neurosurg Psychiatry. 2005; 76: 1103-1108
        • Ferrari G.P.
        • Gilbert A.
        The superficial anastomosis on the palm of the hand between the ulnar and median nerves.
        J Hand Surg [Br]. 1991; 16: 511-514
        • Kiymaz N.
        • Cirak B.
        • Tuncay I.
        • Demir O.
        Comparing open surgery with endoscopic releasing in the treatment of carpal tunnel syndrome.
        Minim Invasive Neurosurg. 2002; 45: 228-230
        • Schonauer F.
        • Belcher H.J.C.R.
        Anthropometry and endoscopic carpal tunnel release.
        J Hand Surg [Br]. 1999; 24: 6-8
        • Stutz N.
        • Gohritz A.
        • van Schoonhoven J.
        • Lanz U.
        Revision surgery after carpal tunnel release—Analysis of the pathology in 200 cases during a 2 year period.
        J Hand Surg [Br]. 2006; 31: 68-71
        • Kahraman S.
        • Kafadar A.
        • Akboru M.M.
        • Atabey C.C.
        Endoscopic carpal tunnel release using the biportal technique.
        Mil Med. 2006; 171: 150-152
        • Greenslade J.R.
        • Mehta R.L.
        • Belward P.
        • Warwick D.J.
        DASH and Boston questionnaire assessment of carpal tunnel syndrome outcome: What is the responsiveness of an outcome questionnaire?.
        J Hand Surg [Br]. 2004; 29: 159-164