Carpal Tunnel Release

Carpal Tunnel Release

1. Carpal Tunnel R elease Dr Seeyan Shah PG Resident , Deptt of Orthopaedics, GMC Srinagar.

2. Introduction:

3. Carpal tunnel is formed between carpal bones of wrist & transverse carpal ligament (flexor retinaculum ) Approx. 3cm in size in proximal to distal direction. In saggital plane : thickest in the Middle (~1.6mm)

4. Median nerve : approx 6mm wide at proximal margin 7.7mm at distal margin * lies slightly to the radial side of canal * can be more ulnar : in case of tumor , ganglion , synovitis .

5. Carpal tunnel syndrome: * Entrapment of median nerve within the carpal tunnel * Numbness , paraesthesias , pain in the median nerve distribution * weakness, & muscle wasting.

6. Signs:

7. Diagnosis of CTS to be established by: SYMPTOMS : *H/O recurrent or persistent pain / paraesthesias in the median nerve distribution. *W orsening of symptoms with hand activity *Nocturnal awakening with paraesthesias SIGNS: positive tinel / phalen /compression sign. ELECTRODIAGNOSTIC tests: NCS/EMG

8. Management: * CONSERVATIVE : NSAIDS, night splints, activity modifications, steroid injections * SURGICAL : Open (large incision) Mini open Endoscopic

9. Large incision open method: By Dr P halen in 1950 Effective but had flaws Painful and hypertrophic scars Pain in thenar and hypothenar eminences

10. Endoscopic Release:

11. Mini open: Less invasive Shorter operative time Lesser complication rate * bleeding , pain , tenderness , scar sensitivity , stiffness etc. * better appearance * Quick recovery * good patient satisfaction

12. Surgical technique: * local anasthesia * tourniquet *Wrist extended to 30° approx. *incision line(fig.) *define the distal ulnar border of flexor retinaculum .

13. Instruments used

14. * look for ulnar artery curling around hook of hamate, common sensory branch of ulnar nerve to ring/little fingers, and the ramus communicans. Once clearly identified, the distal ulnar edge of flexor retinaculum is incised for approx 1 cm

15. Surgical treatment of CTS shows satisfactory results with all 3 techniques. Endoscopic and mini open techniques have less pain and greater patient satisfaction in the first weeks . However, overall results are same and satisfactory with all 3 methods after 4 months.

16. Thank You