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HomeSummaryReview of the conditionConsidering surgeryPreparing for surgeryAbout the procedureTechnical details Anesthetic Length of endoscopic carpal tunnel syndrome Recovering from surgeryRehabilitationConclusion

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Carpal Tunnel Syndrome: Minimally Invasive Endoscopic Carpal Tunnel Release

Edited By: Thomas Trumble, M.D.
Last updated Wednesday, October 11, 2006

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Figure 5 - A small spoon shaped device is used to clean the under surface of the ligament.

Figure 6 - Dilators help to compress the tissues in the carpal canal to make it possible to insert the endoscopic device.

Figure 7 - Once the ligament is clearly seen, the small blade in the device is used to release the ligament in stages.

About the procedure

Technical details

Endoscopic carpal tunnel release is a highly technical procedure that requires microscopic techniques and the correct endoscopic equipment with the necessary back up equipment. After the anesthetic has been administered, a small incision in marked out on the wrist just proximal to the palm (see video). The superficial tendon and small veins are carefully retracted to prevent nerve injury. An 'L' or 'U' shaped incision is made in the first layer called the flexor retinaculum. This layer is lifted up as a flap that forms a doorway into the carpal tunnel. A small spoon shaped device (synovial elevator) (Fig. 5) is used to clean the under surface of the ligament to provide a good view with the endoscope. Dilators help to compress the tissues in the carpal canal to make it possible to insert the endoscopic device with minimal pressure. (Fig. 6) The endoscopic device is inserted carefully so that the ligament can be seen along its entire length. Often the device is warmed to prevent fogging. Once the ligament is clearly seen, the small blade in the device is used to release the ligament in stages. After making sure that important nerves and arteries are protected. (Fig. 7) Once the ligament is completely released, the rest of the flexor retinaculum in the wrist is release with a special type of scissors. Local anesthetic is injected for post-operative pain relief and the incision is sutured. A soft bandage is applied for the patient to keep on for two days to reduce swelling. After two days they can remove the larger dressing and apply a Band-Aid. They can shower and change the Band-Aid but they should not soak the hand in water such as a sink, pool or bathtub until the suture has been removed in about 10 days.

Anesthetic

Most patients opt for a regional anesthetic called intravenous regional or a Bier Block. They can stay awake for the procedure with or without sedation. The Bier block is very safe and wears off quickly after surgery. They can also choose a general anesthetic. The patient may wish to discuss their preferences with the anesthesiologist before surgery.

Length of endoscopic carpal tunnel syndrome

The actual procedure takes about 30 minutes but the total time for the anesthetic, preparation, surgery and bandaging takes about one hour. To allow for time for check in and recovery the patients should plan at least a half-day for the surgery.

Surgery for carpal tunnel syndrome at the University of Washington

If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4537 to make an appointment.

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