Minimally Invasive Surgery for Carpal Tunnel Syndrome: A New Cost-Effective Method

Carpal tunnel syndrome, also called “entrapment idiopathic median neuropathy,” is due to compression of the median nerve in the carpal tunnel, in the wrist. It is becoming more common these days and often requires surgical treatment. The increasing incidence is probably related to typing, sewing and use of vibratory tools. It causes numbness, weakness, pain and sometimes depression. Conservative treatment is often not effective, and traditionally, open surgical treatment has been the treatment of choice. Recently, minimally invasive surgery with special instruments has been described. We describe a minimally invasive surgery with the traditionally available instruments.

Methods

Regional or general anesthesia could be used. A 1.5 cm transverse incision is made along the skin crease (the wrist flexion crease between the tendons of palmaris longus and flexor carpi ulnaris) at the proximal end of the carpal tunnel in the midline. It is deepened to expose the transverse carpal ligament, or TCL . Haegar’s dilators are used to create a space under the ligament, pointing it towards the distal end of the TCL, at the junction of the third web space and distal part of the fully abducted thumb.

The optical urethrotome with insufflation with air/carbon dioxide, instead of saline, is used to visualize the ligament and cut it with the cold knife of the urethrotome. The air/carbon dioxide is pressed out after removing the instrument. Next, the incision is closed, and the hand is elevated for 24 hours.
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