Carpal tunnel release has an established history as a highly effective procedure. Despite its solid track record, conventional open carpal tunnel release (OCTR) can be plagued with surgical site pain, prolonged recovery time, and slow return to productivity. In an effort to minimize morbidity, endoscopic carpal tunnel release (ECTR) was developed.
Carpal tunnel syndrome is one of the most common hand complaints, affecting up to five percent (5%) of the US population and resulting in 500,000 carpal tunnel release surgeries per year. It tends to impact those who have repetitive use of their hands, though other medical conditions—like diabetes and hypothyroidism—can be major contributing factors. At its root, carpal tunnel syndrome is due to increased pressure on the median nerve as it crosses through a defined space at the wrist. The median nerve supplies critical sensation in the thumb, index, middle, and part of the ring finger, as well as the muscle that controls the thumb. Symptoms include numbness, pain, and weakness.
Decreased sensation can make fine motor tasks difficult and uncomfortable tingling can wake people up at night or make them take a break from their work until the symptoms pass. Left untreated, carpal tunnel results in a significantly reduced quality of life and reduced productivity. In the long term, nerve changes can become profound and irreversible.
The goal of carpal tunnel release surgery is to relieve the pressure on the median nerve as it crosses through the carpal canal by dividing the transverse carpal ligament, a ligamentous structure in the heel of the palm. While conceptually simple, the details of this procedure have evolved since it was popularized in the 1950s. Obtaining a complete release of, and avoiding injury to, the median nerve remain paramount goals, but secondary goals, like avoiding problematic scarring, palm pain, and reducing the recovery interval have received increased emphasis.
Endoscopic carpal tunnel release has become an accepted alternative to open carpal tunnel release. Here, a small incision (about 1-1.5 cm) is made in the wrist crease and a device with a camera and deployable blade is introduced into the carpal canal. It is designed to displace the nerve and tendons and provide an undersurface view of the transverse carpal ligament, which can then be divided. Advantages to ECTR include excellent visualization and ease of complete release. Further, by avoiding a 3-5 cm incision in the palm required for OCTR, the cutaneous nerves, thick fascia, and muscle in this sensitive location are spared. While it does not eliminate palm pain, it often greatly reduces it.
ECTR has a good safety profile, as well. Initial two-portal techniques and learning curves with the new procedure raised concerns about possible nerve injury. Single portal endoscopic techniques and devices have largely corrected this. In fact, review of the literature has shown OCTR release to have a higher rate of accidental structural damage to the nerve (0.49%) compared to single incision ECTR (0.19%). One downside is ECTR carries with it a learning curve that has to be overcome with additional training. This typically involves an additional year pursuing a hand surgery fellowship.
ECTR has data to support better early results. Several studies show ECTR patients have less post-operative pain, faster return to activities, improved early grip and pinch strength, and higher satisfaction overall. Based on “Quality Adjusted Life Year” modeling, which has become the standard way to compare medical intervention cost versus effect, carpal tunnel release improves quality-of-life at a modest cost. As surgeons, patients, and employers are keenly aware, recovery time after surgery carries a significant cost. Disability costs from lost productivity after carpal tunnel release are estimated to be approximately two thirds of the total costs. Therefore, reduced recovery interval greatly enhances the value of ECTR.
Carpal tunnel release is usually a very satisfying procedure and can greatly improve quality of life and productivity. While open carpal tunnel release remains an excellent and valid alternative, endoscopic carpal tunnel release provides an improved cost benefit by reducing early pain and weakness and returning patients to function sooner.
Maharsh K. Patel, M.D., is a Hand and Upper Extremity Specialist at OrthoGeorgia. A native of Macon, he earned his Bachelor of Science in Microbiology from the University of Georgia in Athens, GA, graduating summa cum laude, and his Doctor of Medicine from the Medical College of Georgia at Augusta University, graduating summa cum laude. Dr. Patel is a member of the American Academy of Orthopaedic Surgeons and the American Society for Surgery of the Hand. He enjoys exercising, traveling, cooking, reading, spending time with his beautiful family, and watching Georgia football games.
At OrthoGeorgia, we work with patients facing all manner of hand and upper extremity conditions and injuries, including carpal tunnel syndrome. As one of the first subspeciality hand surgery practices in the Southeastern United States, OrthoGeorgia is proud to remain a trusted partner for those in Central GA seeking comprehensive hand care and surgery. Our fellowship-trained hand surgeons will assess the cause of your symptoms and create a personalized treatment plan for you. If surgery is recommended, we will ensure that all of your questions are answered every step of the way. Along with hand and upper extremity care, we specialize in spine, sports medicine, foot & ankle, and total joint care at our orthopaedic care centers in Macon, Macon Spine and Orthopaedic Center, Warner Robins, Kathleen, Milledgeville, and Dublin, GA. To schedule an appointment with an orthopaedic specialist near you, please contact us at OrthoGeorgia today.
At OrthoGeorgia, we want to help you live a healthier and more comfortable life by giving those in Macon, Warner Robins, Kathleen, Milledgeville, Dublin, and the surrounding areas convenient access to the highest quality care. Whether you have been suffering from a sports injury or a common orthopaedic condition, we will determine the cause of your discomfort and craft a personalized treatment plan to bring you relief. To learn more about our services and our physicians, or to schedule an appointment at OrthoGeorgia, please contact us today.