Carpal Tunnel Syndrome: A New Surgical Approach

Abstract

Carpal tunnel syndrome (CTS) is an entrapment neuropathy of the median nerve at the wrist usually involving the dominant hand. It is particularly frequent in middle-aged women and is characterized by nocturnal pain in the distribution of the median nerve in the hand, paresthesias, sensory loss, weakness of the hand, and thenar muscle atrophy. In most cases treatment is surgical and consists of opening the carpal tunnel by dividing the volar ligament. After Marie and Foix in 1913 recommended the section of the flexor retinaculum in CTS, several surgical procedures have been performed (Learmonth 1933; Hunt and Luckey 1964; Eboh and Wilson 1978; Paine and Polyzoidis 1983). The typical curvilinear skin incision crossing the crease at the wrist requires, after surgical procedure, immobilization with a bulky hand dressing for several days, but it does not always avoid the developing of hypertrophic scars or dysesthesias following lesions of the palmar cutaneous branch of the median nerve. Nevertheless, the use of transverse incision, a blind procedure, is potentially dangerous for the patient because of the frequent occurrence of complications (Louis et al. 1985).