Carpal Tunnel Syndrome is a medical condition that results due to the compression of the median nerve in the wrist. The subsequent paresthesia and muscle weakness is painful and depressing. Depending on the severity of the condition, corrective endoscopic surgery is suggested by a health care professional.
The human wrist comprises a number of joints and muscle groups that make complex movements possible. Tasks like picking up objects, writing, and other routine chores demand different wrist movements, consistently. The median nerve in the wrist plays a vital role in facilitating these movements and maneuvers. When this nerve is compressed as a result of some impact, the functionality of the carpal ligament is greatly affected.
This painful condition is clinically referred to as Carpal Tunnel Syndrome. The condition is usually idiopathic i.e., it arises without any definite cause, most of the time. However, genetic factors, environmental factors, and occupational triggers are not ruled out during diagnosis. The condition is characterized by:
- Waking at night, due to severe pain in the wrist.
- Nerve dysfunction, such as numbness, weakness, and atrophy.
- Paresthesia or a burning/tingling sensation in the fingers.
- Frequent dropping of objects held in the hand.
- Wasting of the thenar muscles and weakness of palmar abduction.
The onset of Carpal Tunnel Syndrome is also associated with trauma, multiple myeloma, rheumatoid arthritis, pregnancy, and hypothyroidism. Structural and biological genetic predisposition are also trigger factors. The condition is commonly observed in people, whose occupations demand the need for:
- Repetitive tasks
- Applied, deliberate wrist-force
- Deliberate wrist-concentrated posture
- Consistent grasping and wrist-manipulating activities
- Deliberate stretching of the biomechanics of the upper limb
- Psychological distress at work
Endoscopic Surgery of the Carpal Tunnel
Surgery is an important consideration when it comes to a severe case of Carpal Tunnel Syndrome. This ‘release’ surgery is conducted with the use of an endoscope. The arthroscopic device is used to release the transverse carpal ligament. Typically, the surgeon makes one or two smaller incisions and conducts the whole carpal tunnel release surgery endoscopically or via minimal invasion.
The use of a flexible plastic tube, fitted with a small camera, allows the surgeon to identify the transverse carpal ligament and ‘release’ the compression with the help of a retrograde device. Today, surgeons opt for apparatus and surgical protocol according to individual preference. While the ‘Chow’ is a two-portal device, the ‘3M Agee’ is a single portal release system. Both methods are popular, since they both guarantee small or limited incisions.
The patient is usually sedated under general anesthesia for this surgery. The numbing agent is injected into the palm and a tourniquet is placed to prevent excessive flow of blood to the region. Incisions called portals, are made, one in the palm and the other on the wrist. The carpal ligament is accessed through the half-inch incisions. The endoscope, a miniature video camera is then lowered into the wrist and surgical implements are manipulated according to the display on the video monitor. The surgical procedure does not take more than 10 minutes.
The out-patient procedure enables the patient to go home immediately after surgery. Other than pain relievers and antibiotics to speed healing, no other drugs are administered. The doctor may recommend a splint for a fortnight, to protect the wrist as it heals. Common directives suggest refraining from lifting heavy weights for at least two months after the surgery. The patient’s occupation dictates the period of absenteeism from work required. This surgery is considered only when the recorded symptoms do not improve after extensive nonsurgical treatment and if the symptoms severely restrict routine activities.
