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Intracarpal Tunnel Pressure in Patients with Carpal Tunnel Syndrome and the Effects of Mini-Open Carpal Tunnel Release
Justin J. Evans; Tamara L. Marquardt; Joseph N. Gabra; Zong-Ming Li, PhD; Peter J. Evans, MD, PhD
Cleveland Clinic, Cleveland, OH

Introduction: Elevated intracarpal tunnel pressure is often considered a pathomechanism of carpal tunnel syndrome (CTS). The non-uniform shape of the carpal tunnel may be responsible for varying intracarpal tunnel pressure. When non-operative treatment fails to relieve CTS symptoms, carpal tunnel release is performed. The purpose of this study was to investigate intracarpal tunnel pressure at varying anatomical locations and to examine the pressure change associated with mini-open carpal tunnel release (MOCTR). We hypothesized that (1) intracarpal tunnel pressure would be dependent on specific anatomical locations within the carpal tunnel, and (2) MOCTR would reduce this pressure in CTS patients.
Methods: Six patients (7 hands: 3L, 4R; mean age 52.0 yrs) underwent MOCTR. Patients' forearms were fully supinated with their hand/wrist resting in a neutral position. Before MOCTR, palpation was performed to identify three standardized pressure measurement locations: hook of hamate (HH), proximal pisiform (PP), and midpoint (MP) between PP and HH. After making a 1.0-1.5 cm palmar incision, a pressure catheter was introduced at the distal end of the carpal tunnel and advanced to the PP. The catheter was retracted measuring pressure at each location three times. MOCTR was performed according to standard procedures, and pressure recordings were repeated. A two-way RMANOVA (3x2) was used to analyze the effects of tunnel location (PP, MP, HH) and surgical release (pre- and post-MOCTR) on intracarpal tunnel pressure.
Results: Of the anatomical locations measured, the pressure at the HH was the highest at 35.0 (SD 18.5) mmHg, and the pressure at the PP was the lowest, 24.7 (SD 20.0) mmHg. However, statistical analyses showed that carpal tunnel location did not significantly affect the pressure values (p > 0.05). The mean intracarpal tunnel pressures were 29.5 (SD 17.8) mmHg before MOCTR, and significantly decreased to 7.7 (SD 7.6) mmHg after MOCTR (p < 0.05).

Conclusions: Our study showed that intracarpal tunnel pressure tended to be the highest at the HH for CTS patients, although more data is needed to confirm statistical significance. This finding suggests that pressure may be greatest where the carpal tunnel is narrowest, at the hook of hamate level. We confirmed that MOCTR reduced elevated intracarpal tunnel pressure to a normal physiological range (<10 mmHg), indicating that MOCTR is an effective surgical approach to treat CTS.

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