Carpal Tunnel Release

About Carpal Tunnel Release

Carpal tunnel release is the surgical treatment for carpal tunnel syndrome, the most common nerve entrapment condition, in which the median nerve is compressed as it passes through the carpal tunnel at the wrist, causing numbness, tingling and weakness in the thumb and fingers. Surgery is generally considered when symptoms persist despite nonsurgical treatment such as splinting or steroid injection, or when there are signs of nerve damage such as muscle wasting. The operation divides the transverse carpal ligament, the roof of the tunnel, to relieve pressure on the nerve. In open release, the ligament is cut under direct vision through a short incision in the palm. This approach needs no special equipment, allows the surgeon to see and protect the nerve and to look for other causes of compression, and has long been regarded as the standard. Endoscopic release, using one portal at the wrist as in the Agee technique or two portals as in the Chow technique, divides the ligament from inside the tunnel with a camera and a special blade. It leaves a smaller scar and may allow a somewhat quicker early recovery with less tenderness near the incision, but requires specialized equipment and training, and conversion to an open release is possible if the anatomy is unclear. Long term results of the two approaches are broadly similar. Night time numbness often improves quickly, while grip strength recovers more gradually. Soreness at the base of the palm, called pillar pain, is a common temporary problem. Complications are uncommon and include nerve injury, infection, persistent symptoms and recurrence. Both procedures are usually performed under local anesthesia as day surgery.