Single Port Endoscopic technique of Carpal Tunnel Release (ECTR)

Carpal Tunnel Syndrome is a medical condition where in people suffer from numbness, pain and discomfort in the hand accompanied by tingling, burning, numbness, weakness of hand grip or simply pain. It is caused by the gradual strangulation of the Median nerve by the surrounding structures coursing within the carpal tunnel of the wrist, leading to nerve entrapment symptoms. These are usually felt over the thumb, index and middle finger, though the pain may extend up to the shoulders.

One in every five people suffering from such symptoms can be expected to have CTS following a thorough clinical examination, imaging and electrophysiologic (Nerve Conduction) studies. If untreated, it may result in permanent nerve damage causing constant numbness, wasting of the muscles of the hand involved in thumb movements.

This condition may affect both hands, though symptoms may predominate on one side. In early stages, the symptoms are intermittent in nature and usually occur at night times, the possible explanation being the flexed position of the wrist joint during sleep. However, the numbness can be intense enough to wake one from sleep.

Non surgical treatment includes the use of night splints, steroid injection, oral anti-inflammatory and analgesic drugs. However, for acute cases, surgery is the only option. Done under local anesthesia, the procedure itself doesn’t last more than half an hour, though an added mild sedation of the patient does help in making it quicker.

With the aid of an optically linked video monitor and Smart Release device in this single port endoscopic technique of carpal tunnel release, the surgeon precisely cuts the transverse carpal ligament from underneath using a retractable blade, without cutting open the entire palmar skin. Once done the blade retracts and the endoscopic instrument is withdrawn. The less than 1 cm skin incision is closed with absorbable sutures.

The resultant cosmetically acceptable scar is small and concealed within the wrist skin crease. Patients have the advantage of returning to work after surgery within eight days or earlier.

Article by.

Apollo Speciality Hospitals, Teynampet, Chennai. Dr (Major) GB Rajan, Consultant Plastic Surgeon, Apollo Speciality Hospitals, Teynampet, Chennai.