Abstract:

Objective To explore the therapeutic effect and advantages of small incision releasing of transverse carpal ligament in the treatment of mild and moderate carpal tunnel syndrome(CTS),and to clarify its special clinical curative effect.Methods An incision 2.0 cm in length was made at the level of the middle wrist crease and the palmaris longus tendon was on the midpoint of the incision,as an anatomical landmark. After the skin and subcutaneous tissue were cut,the palmaris longus tendon and the median nerve were exposured,and the transverse carpal ligament proximal part was revealed.A mosquito haemostat was advanced forward between palmar aponeurosis and flexor retinaculum and the proximal portion of transverse carpal ligament was visualized. The palmar aponeurosis and skin were lift up and the wrist joints was extend about 15°. The wrist transverse ligament was completely cut in the direct vision along the line of the ulnar side of the median nerve ring axial extension cord by the blunt organization scissor.Results The follow-up results showed that all the clinical symptoms of all the patients were released obviously,and the latent periods of sensory nerver action potential (SNAP) of the median nerve at the wrist were shortened when the index and middle fingers were stimulated 2 weeks after the operation;3 months after the operation,the symptoms of numbess and pain disappeared in all cases and the two-point discrimation of the index finger pulp had a recovery to the level of (5.0±0.5) mm,and the muscle strength of the abductor pollicis brevis muscles was partly recovered,and the latent periods and amplitudes of the abductor pollicis brevis compound muscle action potential (CMAP) became shortned and increased,respectively.One year after the operation,all the patients had no clinical symptoms of numbess and pain.The function of thumb on the plam got normal. All the electrophysiologic parameters turned to the normal levels and no scar discomfort and other apalmar arch were seen.Conclusion Release of the transverse carpal ligament under the direct vision by a small incison is an effective surgical procedure for CTS.

Key words: carpal tunnel syndrome, electromyography, median nerve