At a Glance:
1. What is endoscopic carpal tunnel release surgery?
2. What is carpal tunnel syndrome?
3. How is carpal tunnel syndrome diagnosed?
4. What are the indications of endoscopic carpal tunnel release surgery?
5. What to expect before endoscopic carpal tunnel release surgery?
6. How is endoscopic carpal tunnel release surgery performed?
7. What are the advantages of endoscopic carpal tunnel release surgery?
8. What to expect during recovery after endoscopic carpal tunnel release surgery?
9. What are the risks of endoscopic carpal tunnel release surgery?
10. How should one choose a facility for endoscopic carpal tunnel release surgery?
Endoscopic carpal tunnel release is a minimally invasive surgery that is performed to treat a painful medical condition of the hand, known as carpal tunnel syndrome.
In endoscopic surgery, a thin tube or an endoscope fitted with a camera at its end is inserted through small ports or incisions. The endoscope allows the surgeon to visualize the structures in the surgical site without surgically opening the area with a longer incision. The surgery is performed using tiny cutting tools that are also inserted through these small incisions.
The muscles and tendons of the forearm and the hand are supplied by the median nerve which also allows movements of the fingers. The median nerve passes through a narrow passageway in the wrist called the carpal tunnel. The wrist bones form the bottom of the carpal tunnel and the transverse carpal ligament forms the top of the tunnel within the wrist. An injury or swelling from inflammation of the tissues within the tunnel can cause a compression of the median nerve. As a result, symptoms like pain, and loss of function, numbness, and tingling appear gradually and may get worse over time. The thumb side of the hand is more severely affected. This condition is called carpal tunnel syndrome.
Some factors that increase the risk of carpal tunnel syndrome include:
Carpal tunnel syndrome is unlikely to resolve on its own, hence it is recommended to take proper treatment to relieve the tingling and numbness and restore wrist and hand function.
Doctors can diagnose carpal tunnel syndrome based on a person’s medical history, physical examination, and tests.
A detailed physical examination of the hand, wrist, shoulder, and neck is done to rule out other causes of nerve pressure.
Some of the commonly performed tests include:
Carpal tunnel surgery is indicated in diagnosed cases of carpal tunnel syndrome in the following conditions:
Before undergoing any surgery, a person needs to disclose the medical history and any medicines being undertaken. These could include any over-the-counter drugs, vitamins, supplements, etc. or any prescription medicines.
Medicines such as pain relievers and blood thinners can make it harder for the blood to clot, or some may interact with the medicines prescribed by the treating surgeon, hence it becomes important that the surgeon knows the person’s medication history.
The surgeon may advise the following:
Carpal tunnel release is usually done on an outpatient basis. A person can go home the same day if the surgery is non-complicated. Carpal tunnel release surgery can be performed by the traditional method of open surgical release, in which the wrist is cut-open to do the surgery, or the other method is endoscopic carpal tunnel release. Once the necessary preparations have been done as per the protocols in the operation theatre, the endoscopic carpal tunnel release surgery is carried out as follows:
The small size of the incisions in endoscopic surgery causes less trauma to the adjacent structures like skin, muscle, and soft tissues and the procedure usually takes one hour to perform. This has many benefits like:
After the surgery is over, a person may have some amount of pain in hand and wrist that can be controlled with oral pain medicines. It may help to keep the affected hand elevated while sleeping at night to help decrease swelling.
The wrist may likely be bandaged or placed in a splint for 1 to 2 weeks and during this time, the surgeon may suggest the continuous movement of fingers to help prevent stiffness.
A physical therapy program may be advised once the splint is removed. The physical therapist will likely suggest a customized motion exercise plan to improve the movement of the wrist and hand. Adherence to such an exercise plan helps in speeding up healing and strengthen the area.
The symptoms of carpal tunnel syndrome like pain and numbness may go away at once after the surgery. However, in certain cases, it may take a few months. Heavy use of the hand should be avoided for a couple of weeks.
Depending on the hand in which surgery was done, whether the dominant hand with which a person performs work activities or not, a person may be able to return to work in a few days to a few weeks.
Adjusting to job duties, especially those involving repetitive work like continuous use of a computer mouse or assembly line jobs may be required during the healing phase. Activity restrictions if required are generally recommended by the surgeon after the surgery.
The gap where the ligament was cut gets filled with scar tissue eventually.
Endoscopic carpal tunnel release surgery is a safe and feasible option when performed by well-trained and experienced surgeons. However, though it is considered a safe procedure, it is not devoid of certain risks. These risks include general risks as well as some procedure-specific risks like:
General risks:
Procedure specific risks: Potential risks associated with the carpal tunnel release surgery include:
The risk and complication rates for endoscopic surgery are extremely low. Major problems such as nerve damage may happen in fewer than 1% of cases.
The most severe complication is the return of symptoms of pain and numbness a temporary loss of strength when pinching or gripping an object, even though these are rarely reported.
The choice of facility for availing treatment of conditions like carpal tunnel syndrome eventually depends on the person and his/her family and medical needs. However, an informed decision must be taken after considering the availability of the required expertise and infrastructure in the preferred facility.
Considering that minimally invasive procedures like endoscopic carpal tunnel release surgery are advanced and newer techniques, they are not available at every center due to the requirement of surgical expertise and state of the art equipment. Hence, such procedures are successfully performed in high-volume centers of excellence with the availability of diagnostic techniques like electromyogram and nerve conduction studies, technique trained and experienced surgeons and support staff.
Persons with carpal tunnel syndrome also special physical therapy needs. Led by plastic surgeons trained and experienced in procedures like endoscopic carpal tunnel release surgery, the Center for Plastic & Reconstructive Surgery at Yashoda Hospitals offers comprehensive services comprising of specialized teams for endoscopic plastic surgery procedures.
The carpal tunnel syndrome is a common medical condition that affects the hand and wrist of a person. Compression or injury of the median nerve is the underlying pathology that causes the syndrome. Individuals who smoke or those with medical conditions like rheumatoid arthritis, diabetes, hypothyroidism are prone to developing carpal tunnel syndrome.
The most common presenting symptoms of carpal tunnel syndrome are numbness, paraesthesia, and pain in the affected area that may also be associated with a decrease in hand function at times.
The treatment for carpal tunnel syndrome includes non-surgical options and surgical interventions if non-surgical options fail. Prompt treatment can cure carpal tunnel syndrome completely.
In the endoscopic carpal tunnel release surgery, the surgeon cuts the transverse carpal ligament using a minimally invasive technique with small incisions under local anesthesia. The procedure does not require hospitalization and is associated with minimal complications and a faster recovery.
Read more about Endoscopic Carpal Tunnel symptoms, causes and treatment
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