Improving the Rate of Recovery After Carpal Tunnel SyndromeCarpal tunnel release (CTR) has become a very common surgical procedure for carpal tunnel syndrome. Symptoms of hand and wrist pain, numbness, and weakness are relieved by this operation.
In the past, CTR has been done by open incision. More recently, endoscopic release (ER) has been introduced. ER is done percutaneously. This means a long, thin instrument (endoscope) is inserted through the skin with a very small incision. A tiny camera on the end of the scope shows on a TV screen what the camera can see inside the wrist.
Many studies have been done to compare the results of open CTR and ER. It does not appear that one method is better than the other. Long-term results seem to be equal. In this study, patients with carpal tunnel syndrome were divided into two groups. In Group one the ulnar bursa was saved. In Group two the ulnar bursa was divided.
The ulnar bursa is inside the carpal tunnel. It is the lining of the finger flexor tendons and lines the carpal tunnel. The surgeons thought that preserving the lining between the carpal tunnel and the incision might prevent scar tissue from forming and speed up healing. All surgeries were done using the open method.
Results were measured and compared for the two groups using grip strength, scar pain, and hand function. Symptoms such as hand temperature, appearance, and work ability were also considered.
The authors report no difference in grip strength, scar pain, and self-reported function between the two groups. There were significantly more wound infections in Group two (ulnar bursa divided). They also found that Group two patients had better grip strength after surgery when no tourniquet around the arm had been used during the operation.
The results of this study show that preserving the ulnar bursa within the carpal tunnel is not necessary. It does not improve results and limits the surgeon's ability to see the median nerve. Although rare, tumors or other serious causes of carpal tunnel syndrome might be missed if the ulnar bursa is not divided.
D. P. Forward, MRCS, et al. Preservation of the Ulnar Bursa Within the Carpal Tunnel: Does It Improve the Outcome of Carpal Tunnel Surgery? In The Journal of Bone and Joint Surgery. November 2006. Vol. 88-A. No. 11. Pp. 2432-2438.
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