Endoscopic Carpal Tunnel Release

Capral tunnel compression of the median nerve is a common condition affecting one or both hands resulting in altered sensation of the thumb, index and middle fingers(please see the section on carpal tunnel compression/syndrome). Once non-operative measures have been exhausted, surgery is the last resort. Routinely, carpal tunnel release is performed via open method resulting in a scar over the palm(fig 1) that can be tender for 6 to 8 weeks after surgery.

Traditional carpal tunnel release surgery involves making a large incision in the palm and cutting the transverse carpal ligament to relieve pressure on the median nerve. While effective, this procedure often results in significant post-operative pain, a longer recovery period, and more noticeable scarring.

In contrast, endoscopic carpal tunnel release is performed using a smaller incision and the assistance of an endoscope. An endoscope is a thin, flexible tube with a camera and light source attached to it. This innovative technology allows the surgeon to visualize the internal structures of the wrist without the need for a large incision.

Fig 1

Endoscopic carpal tunnel release (ECTR) is a minimally invasive surgical procedure used to treat carpal tunnel syndrome (CTS). Carpal tunnel syndrome is a common condition that occurs when the median nerve, which runs from the forearm into the hand, becomes compressed or squeezed as it passes through the carpal tunnel—a narrow passage in the wrist. This compression can result in pain, numbness, tingling, and weakness in the hand and fingers (fig 2).

Fig 2

How is Endoscopic Carpal Tunnel Release performed ?

During the procedure, the patient is typically given local anesthesia to numb the area. The surgeon then makes a small incision, usually less than an inch long, near the wrist or palm. The endoscope is inserted through this incision, providing a clear view of the carpal tunnel. Other small instruments may also be inserted through additional incisions to aid in the release of the transverse carpal ligament.

The surgeon uses the endoscope(a camera) to guide the cutting or release of the transverse carpal ligament. By carefully cutting the ligament, the tunnel is opened up, providing more space for the median nerve to pass through and reducing the compression. Once the ligament is released, the endoscope and instruments are removed, and the incisions are closed with stitches (see video below).

One of the key advantages of endoscopic carpal tunnel release is the smaller incision. This results in reduced scarring and a more cosmetically appealing outcome. Additionally, the smaller incision typically lead to less post-operative pain and faster recovery compared to traditional open surgery. Many patients are able to return to normal activities sooner, including work or recreational pursuits that may have been hindered by the symptoms of carpal tunnel syndrome.

The procedure is typically performed on an outpatient basis, meaning patients can usually go home on the same day as the surgery. However, it is important to follow the surgeon's post-operative instructions for proper care and rehabilitation. This may include wearing a splint or brace, performing exercises, and attending follow-up appointments to monitor progress and ensure proper healing.

What is the advantage of Endoscopic Carpal Tunnel Release ?

The advantage of this technique is early return to work and functional activities, and less scar pain. The procedure is beneficial for patients suffering from carpal tunnel compression on both hands, as endoscopic carpal tunnel release can be performed simultaneously in a single hospital visit, with the scar away from the palm(fig 4).

As with any surgical procedure, there are potential risks and complications associated with endoscopic carpal tunnel release. These can include infection, bleeding, damage to nerves or blood vessels, incomplete release of the ligament, wrist weakness, and recurrence of symptoms. However, these risks are generally low, and most patients experience successful outcomes with significant improvement in their symptoms.

It's important to note that while endoscopic carpal tunnel release is a widely accepted and effective treatment for carpal tunnel syndrome, the suitability of the procedure may vary depending on individual patient factors and the preferences of the surgeon. Factors such as the severity of the condition, the presence of other hand or wrist conditions, and the patient's overall health may influence the decision to pursue endoscopic carpal tunnel release.

Fig 4

“ I am amazed. Within a week of the surgery I had full movement in my hand and very little discomfort. Working with my hands every day, I was worried about the impact of having surgery on my ability to work as self-employed hair dresser, and in a fortnight I am back at work.” Ms D - Endoscopic Carpal Tunnel Release Patient

If you are experiencing symptoms of carpal tunnel syndrome, it is recommended to consult with a qualified healthcare professional or hand surgeon to determine the best course of treatment for your specific condition. They can evaluate your symptoms, perform necessary diagnostic tests, and provide personalized recommendations to alleviate your discomfort and improve your hand function.