Endoscopic
Carpal Tunnel Release
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This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.
The Procedure
Recently, a new procedure has become available to perform a release of the transverse carpal ligament in those patients who need surgery. This procedure utilizes the endoscope (a small fiber optic TV camera) to look into the carpal tunnel through a small incision in the wrist. The release is then accomplished using special instruments designed to cut the transverse carpal ligament - without cutting through the overlying palmar skin.
Proponents of the procedure feel that patients undergoing the procedure heal faster, are able to use the hand faster, and have less problems associated with tenderness in the palmar incision. Other physicians are not convinced that this procedure is better than the open incision technique. The endoscopic method is more technically demanding and is probably more expensive in most hospitals. There may be a higher complication rate associated with the endoscopic method, primarily due to injury of the nerves in the carpal tunnel. As more and more surgeons choose to use this method, these questions will probably be resolved.
Basic Steps in Endoscopic Carpal Tunnel Release
- The Incision
- A small incision is made in the wrist just below the crease where the palm starts. This incision allows the surgeon to place the arthroscope into the carpal tunnel.
- Entering The Carpal Tunnel
- This allows the surgeon to open the carpal tunnel just below the Transverse Carpal Ligament.
- Placing the Cannula
- Once the surgeon is sure that the instruments can be passed into the carpal tunnel a metal or plastic cannula is placed along side the Median Nerve. (The cannula is nothing more than a tube with a rounded end and a slot along one side.)
- Placing the Endoscope
- The endoscope can be placed into the tube to look at the undersurface of the Transverse Carpal Ligament, and make sure that the nerves ans arteries are safely out of the way.
- Preparing the Release the Transverse Carpal Ligament
- Through the cannula a special knife is inserted. This knife has a hook on the end (similar to a seam ripper) that cuts backwards as the knife is pulled back out of the cannula.
- Cutting the Transverse Carpal Ligament
- The slot in the cannula allows the hook to cut only in the direction the slot is facing. The nerves in the carpal tunnel are protected by the tube everywhere else.
- The Transverse Carpal Ligament Divided
- Once the knife is pulled all the way back, the Transverse Carpal Ligament is divided - without making an incision in the palmar skin. Once Transverse Carpal Ligament is divided the Median Nerve is no longer compressed and begins to return to normal.