Definition and Overview

Wrist endoscopy surgery is a minimally invasive procedure used to treat carpal tunnel syndrome. The procedure, which is also referred to as endoscopic carpal tunnel surgery, is performed with the use of an endoscope, a thin tube with a camera attached to its end. The tube’s camera takes images of the inside of the wrist and projects it to a connected monitor, providing the surgeon with a visual guide during surgery.

Carpal tunnel syndrome is a medical condition in which the major nerve (median nerve) that passes over the carpal bones at the front of the wrist becomes compressed. The median nerve gives out nerve signals to allow muscle movement around the base of the thumb and provides sensation to four of the fingers (except the little finger).

Symptoms of carpal tunnel syndrome include:

  • Wrist pain that spreads to the fingers

  • Tingling

  • Numbness

  • Burning sensation

  • Weakness

If these symptoms are so bothersome and start to interfere with the patient’s normal activities, wrist endoscopy surgery may be recommended. The procedure is currently the safest and most effective treatment for carpal tunnel syndrome.

Who Should Undergo and Expected Results

Wrist endoscopy surgery is beneficial for patients who have long been suffering from carpal tunnel syndrome. While some may suffer from the condition for a short period, such as during pregnancy when fluid builds up in the wrist and causes nerve compression, some suffer from it for several months or even years. Long-term carpal tunnel syndrome can cause other health problems such as:

  • Muscle atrophy, in which the thumb muscles weaken and waste away

  • Loss of feeling/coordination in the fingers

  • Permanent damage to the median nerve

Endoscopic surgery is not the first course of treatment for carpal tunnel syndrome. Wrist splinting and medications, including nonsteroidal anti-inflammatory drugs (NSAIDS) and corticosteroids, are used to provide symptoms relief. The procedure is only recommended if non-surgical therapies have failed to adequately address the condition and if patients are starting to how signs of nerve damage.

Patients who are most at risk of carpal tunnel syndrome are those who:

1.) Suffer from nerve-damaging or inflammatory illnesses that can cause the joints and ligaments in the arm to swell or reduce blood flow to the hands, such as:

2.) Have congenitally smaller carpal tunnels

3.) Are female between the ages of 40 and 60

4.) Are taking oestrogen or birth control pills

5.) Are prone to repetitive hand and wrist movements

6.) Smoke, which reduces the flow of blood to the median nerve

7.) Have bone spurs or bone growth due to healing bones

8.) Have dislocated bones that take up space in the carpal tunnel

9.) Have a wrist fracture or any wrist injury that narrows the carpal tunnel and irritates the median nerve

10.) Have tumours and ganglions in the wrist

While some studies link carpal tunnel syndrome with heavy computer use, there is not enough evidence to support this.

Surgical carpal tunnel treatment offers immediate carpal tunnel relief. It can be performed through traditional open surgery or a minimally invasive method. Many surgeons and patients prefer wrist endoscopy surgery because it minimises the risks of postsurgical complications. Since endoscopic carpal tunnel surgery does not require cutting the palm open, it does not disturb a large part of the hand. Also, patients generally recover faster and are able to resume normal activities within a week. On the other hand, patients who undergo open surgery may need two weeks to make a complete recovery if the procedure is performed on the less dominant hand, and up to 8 weeks if the procedure involved the dominant hand.

How is the Procedure Performed?

During wrist endoscopy surgery for carpal tunnel syndrome treatment, the surgeon uses specialised tools to make small incisions in the wrist or palm.

Once inside, the endoscope starts to send images of the transverse carpal ligament to a video monitor for the doctor to see. The doctor, guided by the images, then inserts other surgical instruments through the other incisions. Once in place, the transverse carpal ligament is cut. This releases the pressure on the median nerve and relieves carpal tunnel symptoms.

After the procedure, the doctor closes the small incisions with sutures. Patients can go home on the same day after surgery.

Possible Risks and Complications

Patients who undergo carpal tunnel syndrome treatment face a minimal risk of:

  • Nerve damage

  • Damage or injury to nearby blood vessels or tendons

  • Infection

  • Allergic reaction to anaesthesia

References:

  • Atroshi I, et al. “Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomized controlled trial.” BMJ. 2006 Jun 24; 332(7556): 1473. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1482334/

  • Malhotra R, Krishna Kiran E, et al. “Endoscopic versus open carpal tunnel release: A short-term comparative study.” Indian J Orthop. 2007 Jan-Mar; 41(1): 57-61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2981897/

  • Katz JN, Simmons BP. “Carpal tunnel syndrome.” N Engl J Med 2002; 346:1807-1812. http://www.nejm.org/doi/full/10.1056/NEJMcp013018

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