Endoscopic Carpal Tunnel Decompression
Said G Osman, M.D., F.R.C.S.Ed. (Ortho);
F.A.A.O.S
INTRODUCTION
There are two main nerves which supply
structures in the human hand, and the one that is responsible for carpal
tunnel syndrome enters the hand in front of the wrist joint and deep to a
thick band-like structure which binds to the bones on either side of the
tunnel through which the nerve and tendons pass. Several factors acting
individually or in combinations may lead to increased pressure in the
confine of this tunnel, thereby interfering with the function of the nerve
by directly compressing the nerve and by compromising its blood circulation.
There are multiple conditions responsible for carpal tunnel syndrome, and
may be classified as anatomical (or structural abnormality) or
physiological. Structural abnormalities may include abnormalities of the
bones and the ligament which forms the walls of the carpal tunnel, or
increase in the volume of the contents of the tunnel. The latter may be due
to thickening of the nerve, benign tumors in the tunnel, abnormal muscles or
the thickening of the coverings of tendons due to some inflammatory
processes. Physiologic abnormalities may involve alterations in fluid
balance leading to swelling in the carpal tunnel. This commonly occurs in
pregnancy, chronic hemo-dialysis for kidney failure, abnormal thyroid
function and various inflammatory processes. A large number of the cases are
related to repeated use of the hand and wrist, such as repetitions of
bending forward/backwards of the wrist as in manual labor; repetitive
forceful squeezing and releasing of tools; repetitive forceful twisting
motions; repetitive finger motions such as typing; exposure to vibrations;
and resting the wrist in a flexed position for prolonged duration as in
sleep. Conditions such as pregnancy usually cause transient carpal tunnel
syndrome, as the condition resolves after pregnancy, when the fluid balance
returns to normal. Most other conditions tend to cause long term symptoms.
Whether temporary or long term, the treatment
of the carpal tunnel syndrome may be just observation; medical treatment
addressing the basic condition responsible for the carpal tunnel syndrome;
support in a brace; or interventions such as injection of cortisone in the
carpal tunnel; and surgical decompression. When the condition responsible
for the carpal tunnel syndrome is permanent the syndrome is likely to be
persistent and may even worsen over a period of time. Symptoms may start as
intermittent numbness and tingling of the hand usually involving the thumb,
the fore-finger, the middle finger and part of the ring finger. These,
symptoms, at the beginning, tend to wake the patient in the middle of night
and often resolve with shaking of the hand. Weaknesses which may manifest
with dropping cups in the morning indicate increasing severity of the
condition. With the passage of time the symptoms may become continuous
throughout the day and night.
COMPARING THE OPEN AND THE MINIMALLY INVASIVE CARPAL TUNNEL RELEASE
As is the case with many surgical conditions,
the endoscopy of the wrist and the hand are being practiced more and more
frequently. The open surgery to decompress the carpal tunnel is more
commonly practiced currently. Although the outcome of this approach is
generally satisfactory, the trend is now towards performing the minimally
invasive surgery. Overall, there is a 98% chance of improvement in symptoms
following surgery – whether conventional or minimally invasive. The outcome
tends to be less satisfactory in the older population than in the younger
patients. The most common troubling complication following surgery is pain
of the surgical scar. This steadily improves with passage of time, but up to
10% of patients will have some discomfort at a year following surgery. This
complication theoretically should be less prominent following the endoscopic
operation since the skin scar is at the level of the wrist, whereas the scar
of the open procedure is in the palm. The main advantage of the endoscopic
carpal tunnel release is the ability to return to work earlier than the
patients who undergo open surgery. The scar of endoscopic surgery is
cosmetically more acceptable although the scars of open decompression
normally heal well.
Endoscopic carpal tunnel decompression
will soon be available in Dr. Osman’s practice.
Dr. Osman is an Orthopedic Board
Certified and fellowship trained orthopedic surgeon. He performs general
orthopedic surgery such as joint replacements, sports medicine procedures,
orthopedic trauma surgery, hand and foot surgery, as well as innovative
spine surgical procedures at Russellville Hospital.
Russellville Musculoskeletal Center
15225 Highway 43 Suite 15225
Russellville Al 35653
256-332-6215 256-331-3430(fax)
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