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Abstract
Carpal tunnel syndrome is the most common peripheral compression neuropathy. Clinical diagnosis of CTS is usually easy and sensitive, so it is therefore the gold-standard evaluation. Electrodiagnosis must be restricted to confirm diagnosis which was proved clinically because of its false negative results.
Non-operative treatment for carpal tunnel syndrome includes the use of volar wrist splints, non-steroidal anti-inflammatory medications, activity modification, and corticosteroid injections. Those patients unresponsive to non-operative treatment are considered candidates for surgical release.
Any procedure used for nerve decompression must be evaluated on the basis of the relative risks and benefits. Open carpal tunnel release is a procedure that has withstood the test of time and is the standard to which all other procedures for treatment of carpal tunnel syndrome must be compared.
Multiple incisions have been described for an open carpal tunnel release. The etiology of postoperative “pillar pain” remains controversial. If its cause is because of alterations in the carpal arch or in the origin of the hypothenar and thenar musculature that occur after transection of the TCL, one would expect “pillar pain” in both endoscopic and open surgery, regardless of the size of the incision. An alternate theory is that violating the palmar skin, cutaneous nerves, and underlying palmar fascia is responsible for this phenomenon; a theory advocated by proponents of endoscopic and mini-open techniques
Endoscopic release of the transverse ligament was first introduced in 1987. Several endoscopic techniques were subsequently developed and refined, and now two systems are most commonly used: the two-portal Chow system and the single-portal Agee system.
The anticipated benefits of endoscopic carpal tunnel release are a small incision, less pillar pain, and a more rapid return to work and recreational activities.
Endoscopic carpal tunnel release is not a procedure to be taken lightly. Complications of ECTR include nerve injuries such as median nerve injury, either partial or complete, ulnar nerve injury, vessel laceration, tendons lacerations, incomplete section of transverse carpal ligament and recurrence of carpal tunnel syndrome
Like many surgical procedures, ECTR is a demanding exercise that requires exacting knowledge of the anatomy of the hand, attention to details, and the ability to manipulate three-dimensional objects while observing them in two dimensions on a video screen. In the hands of well-trained surgeons, ECTR provides patients with a safe, predictable solution to their CTS that will allow them a rapid return to normal activities with minimal postoperative discomfor.