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Endoscopic Carpal Tunnel Surgery

23/01/2015

ENDOSCOPIC CARPAL TUNNEL SURGERY


The carpal tunnel syndrome is extremely common (5 per 1000 in the U.S.) 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 median nerve.

The 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, 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 by opening the bottle tops or doors.

TREATMENT


The treatment is medical or surgical. It depends on the severity of clinical disease and electromyography.

Medical treatment consists of putting a wrist splint at night associated with analgesic treatment in case of pain. It is possible, to infiltrate the hydrocortisone
the carpal tunnel which has the effect of relieving symptoms or wait several weeks before surgery.

Surgical treatment cures carpal tunnel syndrome. It consists of tunnel opening by cutting the anterior annular ligament and thus decreasing the pressure inside the tunnel. The operation is performed on an outpatient basis (the patient does not sleep in the hospital), under local anaesthesia 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. Probably, the recovery of hand function is faster with the endoscopic technique.
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