Carpal Tunnel Syndrome – Endoscopic Release Surgery

The median nerve travels from the arm, through the wrist, and into the fingers. At the center of the wrist joint, the median nerve passes through a narrow channel known as the carpal tunnel. The bones of the wrist form the base of the carpal tunnel, while the transverse carpal ligament covers the top. Ligaments are robust tissue bands that connect bones. Alongside the median nerve, the carpal tunnel contains numerous tendons that connect to the muscles enabling finger movement.

The median nerve provides sensation to the thumb, index finger, middle finger, and half of the ring finger. It also transmits signals to the thenar muscles, which control thumb movement. These muscles are crucial for grasping and holding objects. When the median nerve is compressed within the carpal tunnel, it sends erroneous signals as it reaches the hand and fingers.

Carpal Tunnel Syndrome arises when the tissues and tendons in the carpal tunnel become swollen, narrowing the passageway. This swelling may be linked to other medical conditions, such as hypothyroidism and diabetes. The increased pressure within the tunnel compresses the median nerve, disrupting its function and leading to the symptoms associated with Carpal Tunnel Syndrome. In most cases, the precise cause of CTS remains unknown.

Conditions like rheumatoid arthritis, joint dislocation, and fractures can reduce the space within the tunnel. Some women may develop CTS due to swelling from fluid retention caused by hormonal fluctuations, which can occur during pregnancy, premenstrual syndrome, or menopause.

The primary symptoms of Carpal Tunnel Syndrome include pain, numbness, and tingling. Numbness and tingling are usually felt in the thumb, index, middle, and half of the ring finger. Some individuals describe the pain as a deep ache or burning sensation, which may radiate up into the arms. Weakness and clumsiness in the thumb are common, making it difficult to grasp objects, and leading to dropping items. Symptoms may worsen at night, during specific activities, or in cold environments.

A doctor can diagnose Carpal Tunnel Syndrome through a medical examination, review of the patient’s medical history, and inquiry into activities and symptoms. During the physical examination, the physician will assess the wrist and hand for sensation and conduct a thorough evaluation.

The doctor may conduct a few simple tests to check for pressure on the median nerve. In the Phalen’s Test, the patient flexes the wrist firmly for 60 seconds; a positive result occurs if numbness, tingling, or weakness is experienced. For the Tinel’s Sign, the doctor taps the median nerve at the wrist; a positive result is indicated by tingling or numbness in the nerve’s distribution. If a medical condition related to CTS is suspected, lab tests may be performed. An X-ray might be taken to check for arthritis or fractures.

In some instances, nerve conduction studies are used to evaluate the function of the median nerve and pinpoint the site of compression. A commonly utilized test is the Nerve Conduction Velocity (NCV) test, where a nerve is stimulated in one area, and the time taken for the impulse to travel to another area is measured. Electrodes are placed on the skin over the median nerve. While the NCV may cause some discomfort, it is brief.

An Electromyography (EMG) test is often performed alongside the NCV test to measure muscle impulses, indicating poor nerve input. Healthy muscles require impulses for movement. For this test, fine needles are inserted through the skin into the muscles controlled by the median nerve, allowing the doctor to assess the impulses generated during muscle contraction. The

The symptoms of Carpal Tunnel Syndrome can often be alleviated without surgery. Medical conditions linked to CTS may be treated, and many cases respond to non-surgical interventions that relieve pain and provide rest. A doctor may suggest wearing a splint at night to keep the wrist in a neutral position.

Splints can also be used during activities that exacerbate symptoms, ensuring proper wrist positioning and support. Over-the-counter anti-inflammatory medications may help reduce pain and swelling. In some cases, doctors may opt for corticosteroid injections to relieve symptoms.

Surgery is typically recommended when non-surgical treatments fail or if the condition worsens. There are several outpatient surgical options to alleviate pressure on the median nerve. Your doctor will guide you in selecting the most appropriate procedure.

The standard surgical method for Carpal Tunnel Syndrome is known as Open Release. The surgeon administers a local or regional anesthetic to numb the area of the hand. During this procedure, a two- to three-inch incision is made along the palm, granting access to the transverse carpal ligament, which forms the roof of the carpal tunnel. The surgeon then makes an incision in the ligament to enlarge the tunnel and relieve pressure on the median nerve. This surgery is typically quick, lasting only about fifteen minutes.

Another option is the Endoscopic Carpal Tunnel Release, which employs an endoscope through a small incision. An endoscope is a small device equipped with a light and lens, allowing the surgeon to view the carpal tunnel without disturbing adjacent tissues. This procedure may be accompanied by a camera or video system.

Endoscopic Carpal Tunnel Release often utilizes local or regional anesthesia, although sedation may be provided in certain cases. The surgeon creates a small incision below the wrist crease to insert the endoscope for visualization. Some surgeons may also make a second incision in the palm. Guided by the endoscope, a tube called a cannula is positioned alongside the median nerve, allowing a specialized surgical instrument to be inserted through the cannula to cut the transverse carpal ligament. This procedure also expands the carpal tunnel, alleviating pressure on the median nerve. Since Endoscopic Carpal Tunnel Release preserves more tissue in the palm, recovery may be quicker, and discomfort may be reduced.

After surgery, the incision will be covered with a soft dressing. Your doctor may advise wearing a splint to provide support and facilitate healing. Finger movement is possible immediately following the procedure, but heavy gripping or pinching should be avoided for about six weeks. Your doctor may recommend occupational or physical therapy to regain strength, stability, and coordination in the wrist. Full recovery of wrist and hand strength may take several months.

Recovery from Carpal Tunnel Surgery is individualized and can depend on the severity of the condition and the type of surgical procedure performed. Your doctor will provide guidance on what to expect.