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The standard surgical technique for median nerve decompression -- that is, carpal tunnel release -- has been a very successful operation restoring most patients to their prior activities. | ||
One of the major draw backs to standard, open carpal tunnel release was the slowness of recovery in the palm side surgical scar. Often, the 2 inch palm side scar would remain sensitive to direct pressure for approximately six to eight weeks. in the working patient, this scar sensitivity could preclude return to normal work activities. Recently, orthopedic technology has advanced to the point where a standard arthroscope has been specially modified to be of use in carpal tunnel surgery. To employ the endoscopic technique in carpal tunnel release, a small 1/2 inch horizontal incision is made at the wrist and the arthroscope is introduced underneath the transverse carpal ligament. A cannula is inserted into the hand, just under the offending ligament. The surgeon looks through a scope and uses a small knife to simply cut the ligament, thus freeing the nerve. A special blade attached to the tip of the arthroscope is then utilized to incise the transverse carpal ligament from the inside of the carpal tunnel. In effect, by cutting through the transverse carpal ligament, the compression on the median nerve is alleviated and the nerve is thus allowed to go on the heal. With nerve healing, the painful wrist syndrome is corrected. Endoscopic carpal tunnel surgery is performed on an outpatient basis utilizing a local anesthetic to numb the arm. After the procedure, a splint is applied to the wrist and the patient is discharged and allowed to go home. Within a week, the splint is removed, a temporary wrist splint is applied and hand rehabilitation is initiated. VIDEO: Endoscopic Carpal Tunnel Release by David Auerbach MD (8 mins). Click below to view the video in QuickTime, RealMedia or Windows formats.
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