Proximal carpal crease incision for carpal tunnel release: a pilot study

BackgroundLimited palmar incision (PI) is the standard approach for treatment of carpal tunnel syndrome. Proximal carpal crease incision (CI) is an investigated alternative. The aim of our study was to evaluate safety and results of PI and CI approaches.MethodsA prospective, randomised, open label pilot study was carried out in the period of November 2011-November 2017. A total of 104 patients were randomised into two groups according to the incision: group 1 (CI) had 33 patients and group 2 (PI) had 71 patients. Measured characteristics are the following: safety, severity of pain, DASH score, hand grip and pinch strength, two-point discrimination test and Semmes-Weinstein monofilament test. Data were collected 1h before surgery, in the early (2-3weeks after surgery) and late (3-4months after surgery) post-operative periods. A significance level of 0.05 was considered for testing statistical hypotheses.ResultsWe found that CI results in lower early (p=0.064) and late (p=0.033) post-operative period pain and better hand function: lower DASH score in early (p=0.005) and late (p=0.047) post-operative period and stronger hand pinch in early post-operative period (p=0.037). However, hand grip strength, two-point discrimination and Semmes-Weinstein monofilament test did not reveal any significant differences between the study groups. No major complications appeared in both study groups; thus, both incisions were considered safe.ConclusionsPilot study suggests that CI is a safe alternative treatment method of the carpal tunnel syndrome resulting in faster patient recovery after carpal tunnel release.Level of Evidence: Level I, therapeutic study.