Type of Surgery
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Last updated: 11/24/2009
Individuals who perform repetitive wrist movements, either at work or play, are at risk of developing carpal tunnel syndrome. Repetitive movements include computer work, typing, computer games, sports such as tennis, scanning items at the supermarket...
checkout, playing musical instruments for extended periods of time on a daily basis, assembly-line work, especially that requiring heavy gripping or the use of vibrating machinery, and the use of power tools such as for lawn care. It is more common in women, perhaps as much as three to seven times more than in men, especially during pregnancy, and also in individuals who are obese, or have diabetes or rheumatoid arthritis. It is also more common with advancing age. Carpal tunnel release is one of the most common hand surgeries performed in the United States.
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To perform a carpal tunnel release, the surgeon makes an incision in the palm of the hand, above the area of the carpal tunnel (B). The carpal ligament going across the hand is severed (C), releasing pressure on the median nerve (D). (Illustration by GGS Inc.)
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Carpal tunnel release surgery
Release of the transverse carpal ligament ("carpal tunnel release" surgery) is recommended when there is static (everpresent, not just intermittent numbness), weakness of palmar abduction, or atrophy, and when night-splinting no longer controls intermittent symptoms. In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and are likely to result in surgical treatment.
Procedure
In carpal tunnel release surgery, the goal is to divide the transverse carpal ligament in two. This is a wide ligament that runs across the hand, from the base of the thumb to the base of the fifth finger. It also forms the top of the carpal tunnel, and when the surgeon cuts across it (i.e., in a line with the middle finger) it no longer presses down on the nerves inside, relieving the pressure.
There are several carpal tunnel release surgery variations: each surgeon has differences of preference based on their personal beliefs and experience. All techniques have several things in common, involving brief outpatient procedures; palm or wrist incision(s); and cutting of the transverse carpal ligament.
The two major types of surgery are open-hand surgery and endoscopic surgery. Most surgeons perform open surgery, widely considered to be the gold standard (test). However, many surgeons are now performing endoscopic techniques. Open surgery involves a small incision somewhere on the palm about an inch or two in length. Through this the ligament can be directly visualized and divided with relative safety. Endoscopic techniques involve one or two smaller incisions (less than half inch each) through which instrumentation is introduced including probes, knives and the scope used to visualize the operative field.
All of the surgical options typically have relatively rapid recovery profiles (days to weeks depending on the activity and technique), and all usually leave a cosmetically insignificant scar.
From http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#Carpal_tunnel_release_surgery
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New procedures like minimally invasive procedures are often subject to scrutiny, but I think that one of the biggest problems facing these innovative procedures is for people to understand exactly what we do.
-Dr. Michael Perry, Laser Spine institute
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