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Carpal Tunnel Syndrome

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What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (C.T.S.) is a common condition characterized by an uncomfortable numbness/tingling, burning or stabbing pain that spreads down into the thumb, index, long, and ring fingers, often awakening the sufferer at night.

To confirm whether the symptoms are related to carpal tunnel syndrome, a nerve condition velocity (NCV) study may be performed. This study tests the ability of the median nerve to transmit impulse to the fingers from various points on the arm through the carpal tunnel in the wrist. A wrist X-ray may also be done to rule out other conditions such as fracture or arthritis.

Surgery is recommended for those patients who fail to respond to non-surgical methods such as splinting, anti-inflammatory medication, and injection. Together with the symptoms experienced by the patient, medical history, and results of prior treatments, the need for surgery can be evaluated.

Swelling in the carpal tunnel may compress the median nerve, causing CTS. Surgical treatments cut the transverse carpal ligament to make room for the nerve. Eventually new tissue will fill the gap where the ligament was cut.

Treatment Options

Non-surgical treatments may include behavioral changes such as reducing or eliminating repetitive hand motion, wearing wrist splints at night or receiving anti-inflammatory medication taken orally or injected into the carpal tunnel.

Surgical treatments vary, but the two most common are Open Surgery and Endoscopic Surgery. Both procedures share the goal of easing pressure on the median nerve by surgically cutting the transverse ligament and thereby enlarging the carpal tunnel to make more room for the nerve. Both procedures are effective, but Endoscopic Surgery results in faster recovery time, less post-operative pain and a smaller, less-noticeable scar.

Endoscopic Carpal Tunnel Ligament Release

In an effort to preserve the normal hand structure, decrease postoperative pain, scarring, loss of pinch and grip strength and to insure a rapid recovery, Dr. Joon Ahn performs an endoscopic technique as an alternative to open hand surgery; Endoscopic Carpal Tunnel Release. 

During single-portal Endoscopic Surgery, a small incision is made in the crease of the wrist, where the surgeon inserts a small camera mounted to a surgical instrument called a SmartRelease™ ECTR. This device allows the surgeon to see inside the carpal tunnel using a video monitor. The surgeon then precisely cuts the ligament using a retractable blade within the SmartRelease™ ECTR, without opening the entire palm. Once the ligament is fully released, the blade is retracted, the instrument is withdrawn and the small incision is sutured and dressed.

The guiding principle of this minimally invasive procedure is to minimize post-operative pain by avoiding an open incision extending from the wrist across to the palm. Endoscopic Surgery is highly effective and has been used for more than 20 years. There is rarely any bleeding because the two incisions are so small, and only one suture is used to close the wounds. The surgery is performed on an out-patient basis usually using a local anesthesia which further reduces recovery time and expense.

Closed Endoscopic Carpal Tunnel Release

The carpal ligament is stretched across the wrist, much like a watchband that is too tight. Surgically this ligament is divided to relieve pressure in the underlying nerve.

MICROAIRE TECHNIQUE- ENDOSCOPIC CARPAL RELEASE (SINGLE PORTAL)

DUAL PORTAL TECHNIQUE

Recovery

Reduced Pain 
Reduced Scarring 
Reduced Therapy 
Reduced Loss of Work Time

Immediate use of the hand is encouraged. Active range of motion begins just after surgery. The patient returns a week to 10 days following surgery for suture removal and a pinch and grip test. Most patients usually experience a complete recovery within a month following the surgery.

Standard Open Surgical Release

The standard open carpal tunnel surgical technique requires an incision from the midpalm, through the wrist to release all underlying structures including the carpal tunnel ligament.

When this approach is used, a recovery period of at least 6 to 8 weeks is common before therapy can be undertaken to restore the hand to normal use. Risks include scarring, infection, and possible nerve damage.

 

 

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