Carpal Tunnel Release

Carpal tunnel syndrome can be corrected surgically by simply releasing the transverse carpal ligament to decompress the pinched nerve. This carpal tunnel release can usually be performed endoscopically.

This standard surgical technique for median nerve decompression—that is, carpal tunnel release—has been a very successful operation in restoring patients to their favorite activities.

One of the major drawbacks to standard, open carpal tunnel release is the extended length of recovery in the palm side surgical scar. Often, the two-inch palm scar remains sensitive to direct pressure for roughly six to eight weeks. In the working patient, this scar sensitivity could preclude return to normal work activities.

However, 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 half-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 is able to look through a scope and use 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 begins to heal, correcting the painful wrist syndrome.

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 M. Auerbach, MD.

 

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