PubMed Health⌕ Search

PubMed · 8972451

Endoscopic carpal tunnel release.

Abstract

Open carpal tunnel release has been the standard treatment of carpal tunnel syndrome for the past three decades. Since its introduction in the late 1980s, endoscopic carpal tunnel release has generated excitement and controversy. Two basic techniques have developed: the single portal and the double portal. Data from many clinical series and cadaver studies are available for review. The endoscopic carpal tunnel release offers several advantages over the standard open technique, including less scar tenderness, earlier return to work and activities of daily living, and earlier return of pinch and grip strength. Endoscopic carpal tunnel release may be safer than many of the new "mini" open techniques. The indications and threshold for surgery are the same in both techniques. The major contraindications are rheumatoid arthritis, mass lesions, and repeat surgery. Many adjunctive procedures done with open carpal tunnel release such as exploration of the motor branch, release of Guyon's canal, epineurotomy or neurolysis, and flexor tenosynovectomy are unnecessary. With proper training and equipment, endoscopic carpal tunnel release can be done safely, with complication rates comparable to those for the open technique and with high patient satisfaction.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

P C Innis. 1996. Endoscopic carpal tunnel release.. https://pubmed.ncbi.nlm.nih.gov/8972451/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

A pilot study comparing two manual therapy interventions for carpal tunnel syndrome.

OBJECTIVE: The purpose of this study was to determine the clinical efficacy of manual therapy interventions for relieving the signs and symptoms of carpal tunnel syndrome (CTS) by comparing 2 forms of manual therapy techniques: Graston Instrument-assisted soft tissue mobilization (GISTM) and STM administered with the clinician hands. METHODS: The study was a prospective comparative research design in the setting of a research laboratory. Volunteers were recruited with symptoms suggestive of CTS based upon a phone interview and confirmed by electrodiagnostic study findings, symptom characteristics, and physical examination findings during an initial screening visit. Eligible patients with CTS were randomly allocated to receive either GISTM or STM. Interventions were, on average, twice a week for 4 weeks and once a week for 2 additional weeks. Outcome measures included (1) sensory and motor nerve conduction evaluations of the median nerve; (2) subjective pain evaluations of the hand using visual analog scales and Katz hand diagrams; (3) self-reported ratings of symptom severity and functional status; and (4) clinical assessments of sensory and motor functions of the hand via physical examination procedures. Parametric and nonparametric statistics compared treated CTS hand and control hand and between the treatment interventions, across time (baseline, immediate post, and at 3 months' follow-up). RESULTS: After both manual therapy interventions, there were improvements to nerve conduction latencies, wrist strength, and wrist motion. The improvements detected by our subjective evaluations of the signs and symptoms of CTS and patient satisfaction with the treatment outcomes provided additional evidence for the clinical efficacy of these 2 manual therapies for CTS. The improvements were maintained at 3 months for both treatment interventions. Data from the control hand did not change across measurement time points. CONCLUSIONS: Although the clinical improvements were not different between the 2 manual therapy techniques, which were compared prospectively, the data substantiated the clinical efficacy of conservative treatment options for mild to moderate CTS.

Carpal Tunnel Syndrome↗

Finger flexor motor control patterns during active flexion: an in vivo tendon force study.

An in vivo tendon force measurement system was used to evaluate index finger flexor motor control patterns during active finger flexion. During open carpal tunnel release surgery (N=12) the flexor digitorum profundus (FDP) and flexor digitorum superficilias (FDS) tendons were instrumented with buckle force transducers and participants performed finger flexion at two different wrist angles (0 degrees or 30 degrees ). During finger flexion, there was concurrent change of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint angles, but the FDP and FDS tendon force changes were not concurrent. For the FDS tendon, no consistent changes in force were observed across participants at either wrist angle. For the FDP tendon, there were two force patterns. With the wrist in a neutral posture, the movement was initiated without force from the finger flexors, and further flexion (after the first 0.5s) was carried out with force from the FDP. With the wrist in a flexed posture, the motion was generally both initiated and continued using FDP force. At some wrist postures, finger flexion was initiated by passive forces which were replaced by FDP force to complete the motion.

Carpal Tunnel Syndrome↗