Evolution of Technology

Endoscopic Carpal Tunnel Release

Endoscopic carpal tunnel release uses one or two small incisions near the wrist through which instruments are inserted. A small camera is used to visualize the inner wrist, specifically the transverse carpal ligament (roof of the carpal tunnel). Often the camera is attached to an instrument that contains a small cutting tool which is used to divide the transverse carpal ligament while the surgeon visualizes it on the monitor. This releases pressure off the median nerve. The small incision is then closed with stitches.

Evolution of Procedure

Carpal Tunnel Release

Treatment for carpal tunnel syndrome include nonsurgical and surgical options. Nonsurgical treatment options usually begin with behavioral modifications such as limiting activities that aggravate your symptoms. A splint can also be worn to keep your wrist straight. Oral anti-inflammatory medications and/or steroid injections are additional options as well. This treatment can be effective especially if started early (within a few months after symptoms first start). If symptoms persist beyond this, then surgery may be recommended to relieve the pressure off the nerve in the carpal tunnel.

Carpal tunnel surgery is a very common operation. Traditionally, surgery was done via an open technique, meaning the surgeon would make an incision in the skin across your palm and wrist. This provides a view of the transverse carpal ligament and other tissues. The surgeon then cuts the ligament, which relieves the pressure and constriction in the carpal tunnel, allowing normal nerve function to return.

Open surgery leaves a bigger scar and may require a longer recovery. A newer alternative to this technique is performing the surgery endoscopically, meaning making one or two small incision near the wrist and using a small camera to visualize the inside of your wrist on a monitor. The transverse carpal ligament is then cut from underneath. Due to the small incision, endoscopic carpal tunnel release has the advantage of a smaller incision, shorter recovery time and less post-operative pain.

Evolution of Diagnosis

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common condition that most often happens in adulthood. It is caused by the compression of one nerve as it travels under the undersurface of the wrist joint. The space that it travels through is called the carpal tunnel. The carpal tunnel is surrounded by the carpal bones (the floor of the carpal tunnel) and the transverse carpal ligament (roof of the carpal tunnel). These structures create a finite space for the median nerve along with the nine flexor tendons that also travel through the carpal tunnel.

Compression of the median nerve results in pain, numbness and tingling most typically in the thumb, index, and the adjacent half of the ring finger, since all of these receive sensory and motor function from the median nerve. Symptoms may be worse at night. The pain can potentially also extend up the arm. In addition, the affected person’s grip might be weakened, and their dexterity worsened.

Risk factors for carpal tunnel syndrome include a smaller carpal tunnel from being female or from genes passed down from parents, wrist injuries, other medical conditions that cause inflammation, fluid buildup, or nerve damage such as diabetes, pregnancy, rheumatoid arthritis, obesity, and hypothyroidism, and repetitive hand or wrist motions.