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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 1 - The median nerve is compressed at the wrist because the transverse carpal ligament has become contracted.

Figure 2 - The median nerve supplies sensation to the thumb, index, middle, and half the ring finger as well as supplying the thumb muscle.

Figure 3 - The endoscopic device being placed under the transverse carpal ligament.

Summary

Overview

Endoscopic carpal tunnel release (endo-CTR) surgery helps to relieve the pain and numbness caused by carpal tunnel syndrome. In carpal tunnel syndrome (CTS), the median nerve is compressed at the wrist because the transverse carpal ligament has become contracted as a result of activities, aging or both. (Figure 1) The median nerve supplies sensation to the thumb, index, middle, and half the ring finger as well as supplying the thumb muscle. (Figure 2) Patients with CTS often have numbness, particularly at night, and weakness.

After performing a clinical examination and obtaining a test called an EMG/NCV (Electromyogram and Nerve Conduction Velocity) the surgeon can find out the cause of the numbness and determine the severity of the carpal tunnel syndrome (CTS) if it is present. Although mild cases of CTS can be managed with bracing and nonsteriodal anti-inflammatory medication, moderate and severe cases are best managed by surgery. The goal of endoscopic carpal tunnel release (endo-CTR) is to release the tight ligament over the median nerve to relieve the patient's symptoms. The figure 3 shows the endoscopic device being placed under the transverse carpal ligament. The device uses a camera and a fiber optic cable to see the ligament with a small incision that is placed in the wrist instead of the palm where incisions can cause greater scar sensitivity.

Endoscopic carpal tunnel release (Endo-CTR) is a highly technical procedure and is best performed by a surgical team, which performs this surgery often. Such a team can maximize the benefit and minimize the risks. The 30-minute operation is usually performed under regional anesthesia although general anesthesia is safe as well. In regional anesthesia the patient's arm is made numb with a nerve block but they do not have to go to sleep with general anesthesia.

Patients are allowed to move their hand and wrist immediately after surgery. The surgery is out patient surgery so the patient goes home the same day as the surgery. Two days after the surgery, the patients can take their bandages off and shower. The patient can resume most light activities within days after the surgery but strong grip strength can take 4-6 weeks to return.

Surgery for carpal tunnel syndrome at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington

If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USA

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