New approach touted for carpal tunnel syndrome
A new surgical approach for carpal tunnel syndrome promises to improve recovery time and reduce complications, according to a surgeon who has adopted the technique.
The procedure is the single portal endoscopic carpal tunnel release, an approach that involves using an endoscope to perform the surgery with minimal trauma. Endoscopic approaches to carpal tunnel release have been around for a while, but they usually have involved two incisions, one near the wrist and one in the palm. The surgeon releases the carpal tunnel under direct vision through the longitudinal incision in the palm. The new procedure, however, involves just a single incision near the wrist.
Whereas the open procedure involves the surgeon making an incision about 2 ½ inches long from the palm back to the wrist, the standard endoscopic approach involves inserting an endoscope into the wrist flexor crease through an incision that is less than a half-inch long. The endoscope is positioned so that the surgeon can view the underside of the transverse carpal ligament. A blade is then positioned beneath the ligament, elevated, and then retracted to release the ligament.
Two endoscopic techniques have been available for a while. The Agee technique uses a single incision, and the much more common Chow technique uses two incisions. With the Agee technique, some surgeons have criticized the lack of visualization, saying that the surgeon cannot see the carpal tunnel clearly enough when making the cut.
The new device in use at the Yale Hand and Comprehensive Microsurgery Center, however, is designed so that the blade does not obscure the surgeon’s vision before, during, and after the cut.
That change makes a substantial difference, says Grant Thomson, MD, associate professor of plastic surgery at the Yale University School of Medicine in New Haven, CT. Thomson has used the endoscopic approach to treat carpal tunnel syndrome for several years, but he says he recently adopted the single-portal approach.
"We get much better results for the patient," Thomson says. "They don’t have a painful scar near the palm, and that creates more patient satisfaction afterward. Any endoscopic technique is better than the open technique for carpal tunnel syndrome, but this single portal technique is better than others at alleviating palmar pain."
The surgery is performed under local anesthesia, and the patient can go home immediately without staying in the recovery room because no sedation is necessary, he says. That aspect makes the procedure less expensive than other options for both patients and employers.
With the single-portal technique, the surgeon places a small incision transversely at the wrist level, and the endoscope is inserted through this incision. The skin and soft tissues overlying the carpal tunnel are not disturbed, leading to faster recovery, Thomson says.
"The remarkable thing for me is that the patients can use their hands much more quickly than before," he says. "I have had people back to work within a week of the surgery. Most studies indicate that endoscopic carpal tunnel release gets them back to work in half the time of an open surgery. There’s not much information comparing the single-portal to the two-portal technique in terms of return to work, but I’ve seen people return very quickly."
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