Carpal tunnel syndrome is a common condition characterized by pain, tingling and numbness in the hand and wrist due to compression of the median nerve in the carpal tunnel. Carpal Tunnel Release, the surgical procedure to release the carpal tunnel (transverse ligament), aims to relieve these symptoms by reducing the pressure on the median nerve. There are two main surgical techniques used for carpal tunnel release: endoscopic and open surgery.
Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm to the arm through a narrow passage called the carpal tunnel, is compressed. This compression leads to symptoms such as:
- pain,
- numbness,
- tingling and
- weakness in the hand and fingers.
Several factors contribute to this compression, leading to the symptoms associated with carpal tunnel syndrome. The most important of these are:
- Anatomy and structure of the carpal tunnel. The carpal tunnel is a narrow passageway made up of bones and ligaments in the wrist. Any swelling or inflammation within this confined space can compress the median nerve.
- Repetitive movements of the hand and wrist, such as typing, using tools or working on an assembly line
- Medical conditions such as rheumatoid arthritis, diabetes, obesity, etc.
- Injuries such as wrist fractures, sprains or injuries causing swelling or deformities within the carpal tunnel.
Open carpal tunnel release
One option for carpal tunnel opening is open release. The procedure involves a simple incision, usually about 3-4 cm long, in the palm or wrist. The surgeon then cuts the transverse ligament to widen the carpal tunnel, relieving pressure on the median nerve, and closes the incision with sutures.
Usually, open surgery requires a slightly longer recovery period compared to the endoscopic approach. Postoperative light pain and swelling may persist for a few weeks while the doctor may seldom recommend physical therapy to regain strength and flexibility.
Endoscopic carpal tunnel release
The carpal tunnel can also be opened endoscopically, if conditions allow. The procedure involves one incision 1cm long, in the wrist. The surgeon then inserts an endoscope (a thin tube with a camera) to visualize the inside of the carpal tunnel. Using specialized tools, the surgeon cuts the transverse ligament, releasing pressure on the median nerve. The incision is closed with sutures or adhesive tapes. Endoscopic release requires a shorter recovery period compared to open surgery, with potentially less post-operative pain and reduced scarring due to smaller incisions. Physical therapy is also seldom recommended in this method to aid recovery and prevent stiffness.
The benefits of Carpal Tunnel Release
Both open and endoscopic carpal tunnel release offer advantages for patients and surgeons:
Open carpal tunnel release:
- Offers immediate visualization of the surgical site.
- Direct opening of the incision provides immediate access to the incision.
Endoscopic carpal tunnel release:
- Minimally invasive approach with smaller incision.
- Potentially faster recovery and less postoperative discomfort.
- Reduced scarring and aesthetic benefits.
Risks and complications.
Both open and endoscopic carpal tunnel procedures carry small risks (<1%), such as infection, nerve damage, stiffness and incomplete symptom relief. The choice of the appropriate procedure depends on the severity of symptoms, individual anatomy, surgeon experience and patient preference.
Carpal tunnel surgery, whether open or endoscopic, is intended to relieve the symptoms associated with carpal tunnel syndrome. Both techniques have their advantages and considerations, and the choice between them should be made in consultation with an orthopedic surgeon based on the patient's specific situation and needs. Both methods have shown efficacy in relieving pressure on the median nerve, ultimately restoring hand function and improving the quality of life for people with carpal tunnel syndrome.
To learn more about carpal tunnel reaming, contact us at 211 - 4057040, 6949196061 or orthopedikos-papagiannopoulos.gr and make your appointment.
