Endoscopic Carpal Tunnel Release

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Endoscopic Carpal Tunnel Release
Endoscopic carpal tunnel release surgery is a very technical procedure designed to release a tight carpal tunnel and decompress the median nerve.

The median nerve, which supplies sensation to the thumb, index, middle, and a portion of the ring finger, as well as supplying the thumb muscles, becomes compressed at the wrist in Carpal Tunnel Syndrome (CTS). The endoscopic carpal tunnel release technique divides the transverse carpal ligament, which is the roof of the carpal tunnel. This enlarges the volume in the carpal tunnel and decompresses the median nerve, relieving pain and discomfort.

There are numerous causes of Carpal Tunnel Syndrome, and endoscopic carpal tunnel release treats carpal tunnel syndrome associated with nearly all of these causes. Endoscopic carpal tunnel release is indicated when carpal tunnel symptoms persist despite conservative treatment, or when the severity of symptoms present with loss of hand function. Routinely, nerve conduction tests are ordered to determine the extent of damage to the median nerve as well as rule out any other neurologic conditions which may mimic carpal tunnel syndrome.

Endoscopic carpal tunnel release is performed as an outpatient procedure, generally under regional anesthesia. The procedure lasts less than 20 minutes. Once the anesthesia has taken effect, the arm is exsanguinated and a tourniquet elevated to allow for the procedure to be performed in a bloodless field. A target point is placed at the base of the ring finger and the wrist is marked proximal to the flexion crease, where the incision is to be made. A small incision is then made in the wrist crease, and the entire procedure is carried out through this small incision. The proximal portion of the carpal tunnel is exposed through this incision, and the endoscopic instrument is inserted into the carpal tunnel, viewing the undersurface of the transverse carpal ligament. While viewed on the video monitor, the transverse carpal ligament is then divided from distal to proximal. Once complete division of the ligament is confirmed, the skin is closed with a single subcuticular stitch and a soft dressing is applied to the hand.

Patients are able to move their hand and wrist immediately after surgery, although they are instructed to avoid heavy grasping, pinching, or lifting for the first two weeks. This helps to prevent the tendons from pushing up against the median nerve and promote the healing of the transverse carpal ligament. Patients are instructed to keep their dressing intact and dry (don’t change it!) for five days. On the fifth day, the dressing can be removed and a Band-aide dressing applied to the incision. The first post-operative visit is scheduled ten to twelve days after surgery, at which point the single stitch is removed from the incision and patients are instructed in a home rehabilitation program of range of motion and stretching exercises.

A rehabilitation exercise program designed specifically for carpal tunnel is demonstrated at the first post-operative visit. Examples of these exercises are given to the patient in a handout for continued work at home. These exercises are key to a rapid and successful recovery. Occasionally, some patients may require formal therapy to improve their hand function.

For more information, or to contact Dr. Hildreth, please visit http://www.davidhildrethmd.com