Endoscopic carpal tunnel surgery in France

Carpal tunnel syndrome is extremely common (five in 1000 adults in the U.S.) and it corresponds to the compression of the median nerve in the carpal tunnel.

The carpal tunnel is an anatomical region located in the palm of the hand between the carpal bones and the flexor carpi. This tunnel contains nine flexor tendons and a median nerve.

Carpal tunnel syndrome occurs when the synovial tissue surrounding the tendon becomes thickened. It takes more space in the canal and the median nerve is compressed. In most cases, no cause is found for this compression.

More rarely, it can be a compression-related trauma, endocrine causes (pregnancy, thyroid disease, and diabetes) due to a rheumatic (rheumatoid arthritis, amyloidosis). In some cases, this syndrome can be recognised as an occupational disease linked to repetitive flexion-extension.

Symptoms and clinical review

The clinical picture is dominated by the presence of paresthesia (tingling, numbness, electric shock, feeling dead fingers) in the thumb, index and middle fingers predominantly at night or early morning.

Usually the patient wakes up and shakes his hand to remove the symptoms. May be associated, pain radiating into the hand of the forearm. In some case patients complain of dropping objects, or having difficulty opening the bottle tops or doors.
Treatment

The treatment is usually either medical or surgical, and will depend on the severity of the clinical disease and electromyography.

Medical treatment consists of putting on a wrist splint at night to help deal with the pain. It is possible to infiltrate the hydrocortisone the carpal tunnel which has the effect of relieving symptoms.

Surgical treatment can be used to cure carpal tunnel syndrome. It consists of opening the tunnel by cutting the anterior annular ligament and decreasing the pressure inside the tunnel.

The operation is usually performed on an outpatient basis (the patient does not sleep in the hospital) and using a local anaesthetic or locoregional (general anaesthesia is used only if the patient wishes). The procedure is done through a short incision in the palm of the hand (2 cm) or endoscopically (using a camera) with a 1 cm incision in the wrist. There is no significant difference between the two techniques, except the recovery of hand function is faster with the endoscopic technique.

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